There is a lot of talk about personal injury claims at the moment, and insurance companies are taking much of the heat for a rise in whiplash claims following road traffic accidents.
Although there are many more vehicles on the roads these days, this alone does not necessarily mean we are at greater risk of being involved or injured in an accident, suffering damage to our cars or being a witness at a scene of an accident. In fact, our roads are generally much safer places these days.
But that doesn’t mean that accidents don’t happen and that people don’t suffer a personal injury on the roads.
So, how can we account for the rise in whiplash and other personal injury claims that are being seen? And is it right that because more claims are being made by injured parties with the help of free lawyers and legal teams everyone’s insurance costs are going up?
It has been suggested that insurance companies themselves could be to blame for the rise in whiplash compensation claims, and even the government is taking action to ensure the industry is working properly with the interests of motorists at heart.
Figures from market research agency Ipsos MORI suggest that nearly two-thirds of those injured in a car accident are contacted by insurance companies about making a personal injury claim, not approached by an attorney or lawyer.
If the injured party decides to proceed with a claim their details are then ‘sold’ to the highest paying legal team, who will handle the procedures, get witness statements, collect medical reports and fight for compensation. They can work on proving the injury and the right to compensation and it is their job to see the case resolved satisfactorily according to the regulations.
Of course, if injury compensation is justified then the injured party is right to seek out a legal team to handle their claim and give them the best possible chance of being financially compensated.
But another issue arises as some whiplash claims, or even the accidents themselves, are set-up or fraudulent, which costs the insurance injury millions. It can be hard going proving that a case is fake, and in some situations claims are paid when they are not justified or the injury is not worth the amount given.
Not all insurance companies or solicitors will encourage people to make a claim when it is in their own interests and not the injured parties, but the problem is certainly having an effect on the number of claims procedures being started and the rising cost of insurance premiums.
The process of selling on the details of an injured person will be banned next year, which may bring down the number of whiplash claims; it will certainly have a positive effect on those who are encouraging people to make fake claims.
Until then motorists must continue to use common sense when considering a personal injury claim for a road traffic accident and only work with a reputable legal expert who they have selected.
This is the third article which presents the conclusion in the 3 part series written over the past several months. The sequence will provide the full scope of long term disability coverage and claim issues that need to be considered.
Article 1: “What’s Really at Stake for Professionals Filing Disability Claims?” In article 2 “What Professionals Need to Consider Before Filing a Disability Claim, we presented the scenario of Dr. Wade Sharpe, a cardiologist who had 3 LTD policies when he became disabled with carpal tunnel syndrome, and the issues and decisions he faced before filing his disability claims. In this third and final article “What Professionals Need to Do When Filing Disability Claims” we discuss how Dr. Wade Sharpe assessed the issues and the conclusions he reached on how to proceed to file claims for benefits under his 3 long term disability policies.
How Dr. Sharpe actually got his claims paid:
On the recommendation of a colleague, Dr. Sharpe engaged a disability claims consultant to assist him by clarifying the benefits in his policies, giving him a clear understanding of how each policy defined disability relative to his situation and prospective claims.
Prior to engaging the consultant, Dr. Sharpe was considering modifying his practice and limiting his practice to non-invasive procedures only. The disability claims consultant explained that were he to do that and later become disabled, his disability would be based on his then current activities and income as a non-invasive cardiologist, making it more difficult to qualify for benefits.
The consultant also confirmed that his policies defined “total disability” as the inability to perform the “material and substantial” duties of his occupation as both an invasive and non-invasive cardiologist, and further recommended how to compile documentation confirming that the invasive surgical procedures he performed accounted for almost 80 percent of his income. They took great care to provide comprehensive medical and supportive documentation, clearly delineating that performing procedures was the vast majority of his duties and income, and as such constituted the “substantial and material duties” of his occupation as a cardiologist performing both invasive and non-invasive procedures. As a result, all three (3) claims for “total disability” benefits were approved.
Once Dr. Sharpe understood the definitions and specifically what documentation was needed, he filed his claims, which happily for him, were approved.
What Dr. Sharpe learned and mistakes he avoided:
Dr. Sharpe became upset upon learning that not all three (3) policies provided lifetime benefits as his agent had advised. However, the consultant’s detailed policy analysis revealed that two included riders providing lifetime benefits for disabilities commencing prior to age 60.
At 56 when his disability began, Dr. Sharpe was eligible for lifetime benefits on these two (2) policies. The remaining policy also provided lifetime benefits for sickness, provided the disability commenced prior to age 55. So, while the agent’s advice was correct when the policies were sold, the specific policy provision, concerning his age at the onset of disability, made him ineligible for lifetime benefits on that one policy.
Contractual details like these often determine the basis for claim payments. Disability claims consultants are professionals with the expertise that can make all the difference.
Had Dr. Sharpe made the mistake of becoming of a non-invasive cardiologist because he lacked an understanding of the specifics of his benefits that the disability claims consultant provided him, he would not have learned when and how best to successfully document his disability claims:
- he would never have known his policies should provide benefits for totally disability as a cardiologist doing invasive and non-invasive procedures;
- he would not have filed claims when he did,
- nor would he have received the benefits he was entitled to.
- and once he became a non-invasive cardiologist, any future claims filed for disability would have been based on those duties, making it more difficult to be eligible for benefits.
Insureds seeking to file claims for long term disability need to have a comprehensive understanding of the contractual details that will be used to determine their eligibility for benefits. Disability claims consultants are professionals with the expertise to help you avoid those mistakes that can make all the difference in getting your disability claim(s) approved. By engaging professional help many claimants can avoid the risk, extensive time and potential legal costs of having to appeal or litigate a denied claim. And most importantly, consider how all of this will adversely impact your health.
