How to screw up your disability claim in three easy steps

Less than 24 hours ago, I thought filing a disability insurance claim was easy. In fact, I thought it went something like this:

  1. Get disabled.
  2. Fill out the insurance paperwork.
  3. Start collecting checks.

I was right about the first step, but way wrong about everything else. And you could be, too.

Enter Art Fries

I was fortunate enough to receive a call from Art Fries, the self-branded disability insurance claims expert.

In a formerly Brooklyn now-Californicated dialect, he explained to me - in language so colorful I dare not rephrase it on a family-oriented blog - exactly how NOT to file a claim to NOT collect benefits from the insurance industry that's NOT interested in paying you.

Here are the three easiest ways to "screw up" a claim for disability:

  1. Give the disability claim form to your doctor. Art says you want to maintain control of the claims process, and the way your case is presented to the insurers. Allowing a somewhat disinterested party to handle your claims paperwork is the fastest way to have your claim denied.
  2. Sign paperwork on the spot. Art says to read everything carefully and have a second set of eyes - his - review the paperwork BEFORE it's signed. For example? When the insurance company's field examiner prepares a tatement for you and asks you to sign it, just take the paperwork and tell him you'll sign it later and mail it back to him.
  3. Do things in your personal life that are in conflict with the symptoms of your disability. Art cites a case where a physician went on DI claim for a hand-related impairment, then went golfing. He may have made a hole-in-one, but he lost big time when the insurance company stopped sending the checks. As Art says, "You can't go skateboarding with a lower back claim."

Other Art-ful Gems

You can certainly learn a thing or two from a guy who;s been around the insurance business for 40 plus years. Ask Art about his background and he'll tell you he got his start in the 70's as a life/health agent with Washington National Insurance Company. After 3 years he was the #1 salesperson in the country with respect to individual disability/medical insurance and held that title for 6 years in a row. He later went out on his own as an independent life/health broker with earnings in the top 1% of all producers in the country. He says he was a "real driver, type A workaholic".

Art has a healthy helping of "been there, done that" too. He's filed and survived his own disability claim and ensuing lawsuit, and he's personally handled more than 600 claims totalling a half billion (yes, billion with a "B") over the past 11 years, by his own account.

A Claims Process Horror Story

He says it's common practice for the claims paperwork to ask this question, "How many people do you supervise?" Harmless enough, right?

Art says, in this particular case, the answer was "eight" because the doctor in question had eight staff members. But the insurance company interpreted the answer to mean that this doctor had the capacity to manage eight people. So he might have been disabled as a physician, but he was perfectly able to be a manager, according to the insurer, so he had only a partial disability claim at best. But in the story Art shared, the physician's disability symptoms forced him to leave his practice, so his claim for partial disability was denied. No income, no claim.

Breaking a Record "Going Backwards"

"There are some things the insurance company conveniently forgets to tell the claimant," Fries explains. For instance? The fact is that your eligibility for benefits does not begin when you file your paperwork with the insurance company; you become eligible for benefits when you experience the impact of a disability under the terms of the policy.

Art regularly pursues claims where a physician may have become disabled more than a year before she actually files her claim. Recovering benefits under this scenario is what Art calls "going backwards" with a claim.

In our interview, he said last month he broke his old record of going backwards on a disability claim when he recovered benefits for a physician who had experienced a disability more than six years ago.

So how much did he help that doc recover?

    $800,000, he said.

Can you imagine not claiming almost a million dollars to which you were rightfully entitled? It's mind-numbing.

An Interesting Business

Art says he started in this business when "a physician friend needed handholding on a disability claim." But when he went to find help for his friend, Art couldn't find anyone. He says he found a few attorneys who handle these claims but they seemed to give him the wrong answers.

According to Art, the attorneys have a conflict of interest.

If the attorney handles your paperwork, and the insurance company won't pay, guess what happens? You have to sue the insurance company.But now your attorney is in line to "earn' a contingency fee. And that fee could run as much as one-third of your benefits.

Fries' services aren't free either, but his charges seem reasonable. To handle new claims he charges $500.00 per hour with a minimum fee of $6,000 for the first policy, and $1,000 per policy thereafter. He's reasonable about his fees, making adjustments based on nuumber of insurance companies and total number of policies. He charges more to handle denied or terminated disability claims since they're tougher. While his fees may seem steep, Art handles claims that pay between $500,000 to $12,000,000 with a success rate approaching 97% on new claims, by his own estimates.

Fries says he will help his clients with the insurance exam, the field investigation, video surveillance (ew!), and of course, the paperwork. But he doesn't work with "jerks," meaning folks who are out to scam the system.

Not disabled?

If you're not disabled, you could still learn a thing or two about disability insurance from Mr. Fries. For instance, he knows which company's routinely stonewall their insured's when it's time to pay a claim. And THAT's the kind of advice it would be nice to have BEFORE you even buy insurance.

So what's the bottom line? Put Art Fries number in your Rolodex and pray that you never need to call him: (800)567-1911.