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WHAT TO KNOW ABOUT CLAIMS ADMINISTRATORS/APPEALS SPECIALISTS

Beedem Law Nov. 30, 2021

Disability insurance policies are designed to provide income to policyholders (employees) who are unable to work due to a disability, injury, or illness. Unfortunately, dealing with disability insurance providers and claims administrators can involve many complexities. Even a well-supported disability claim can be denied by the LTD insurer by claiming incomplete medical evidence or biased medical reports. If you are considering filing a disability claim or if you are dealing with a disability claims administrator, consulting with an experienced Minnesota long-term disability attorney is crucial for proper guidance.

At Beedem Law, we are committed to offering knowledgeable legal guidance and reliable advocacy to clients in disability claims-related matters. Our team is available to discuss your unique situation, help you understand the disability claims process, and educate you about what to say — and what not to say — to appeals specialists. We will work aggressively to protect your rights and help you seek your rightful disability benefits. We proudly serve clients across Minneapolis, St. Paul, Duluth, Ramsey County, Anoka County, and Dakota County, Minnesota.

The Claims Administrator’s Role

A disability claims administrator or appeals specialist is responsible for coordinating and overseeing all disability claim activity. They will implement the disability claims policies and procedures. Here are some of the roles and duties of the claims administrator in the disability claim process:

  • Establish, implement, and coordinate disability claims policies and procedures

  • Address and follow-up on benefit requests filed by policyholders

  • Manage all activities related to the disability claim, including facilitating and submitting paperwork on time

  • Work with claimants and insurance providers to ensure that all claims are settled

  • Evaluate and investigate disability claims to determine a fair settlement

  • Determine whether the disability policy covers the loss claimed

  • Work with attorneys and legal counsel on claims when required

A skilled attorney can educate you about the claim administrator’s role and guide you on how to speak with them.

Tips for Speaking with Claims Administrators or Appeals Specialists

When you file for a disability claim, you must avoid anything that will inadvertently affect your benefits and do everything within your capacity to get approved. Here are some tips for speaking with a claims administration:

  • Ask the claims administrator whether you are allowed to record your conversation

  • Tell the appeals specialist about the impact and side effects of your medications

  • Only answer questions you are asked — don’t volunteer additional information

  • Explain the impact of your disability or illness on your personal life, as well as the pain and the symptoms

  • Many disability insurance policies have limited pay periods for anxiety and depression — try not to talk about depression

  • Provide all of your medical records to the claims administrator and ask if they need additional documentation for your claims

  • Never agree to see a physician recommended by the claims administrator — in most cases, they are biased

  • Do not give details about your whereabouts to the appeals specialist

  • Tell the claims administrator about other individuals who know about your condition

  • Most importantly, tell the claims administrator that they may only speak to your lawyer about your claim

An experienced attorney can advise you on what to say — and what not to say — to the appeals specialist and the information or documents you may be asked to provide.

Information You May Be Asked to Provide

The claims administrator may request the following information from you:

  • Personal details such as full name, telephone number, and address

  • The type of work you do and where you are employed

  • Medical records — including doctor’s reports, clinical notes, lab work, test results, and other supporting medical evidence

  • A written letter from your doctor

A knowledgeable attorney who is familiar with ERISA rules can help document your condition and discuss it with the claims administrator on your behalf.

Rely On Our Skilled Experience at Beedem Law

Filing for disability claims can be a time-consuming and complicated process. Even when you file, the claims administrator will contact you to investigate the disability claims and determine the amount of disability benefits to which you are entitled. No matter how nice and friendly they sound, the claims administrator is not on your side. An experienced long-term disability attorney can inform you about what to say to the appeals specialist and help you navigate key decisions in your disability claim.

At Beedem Law, our team is committed to providing outstanding legal services and helping clients file their short-term or long-term disability claims. As your legal counsel, we will work to obtain substantial evidence of your condition or disability, work together with the claims administrator on your behalf, and help complete and submit your claim application. Even if your claim is denied, we will appeal on time and continue fighting to help you recover your rightful disability payments.

Contact us at Beedem Law today to schedule a simple case assessment with knowledgeable long-term disability attorneys. Our dedicated team can offer you the experienced legal counsel and strong advocacy you need when filing your disability claims. Our firm proudly serves clients in Minneapolis, Minnesota, and the surrounding communities of St. Paul, Duluth, Hennepin County, Ramsey County, Anoka County, and Dakota County.