4 Facts You Should Know About Your Insurance Claims Manager

4 Facts You Should Know About Your Insurance Claims Manager

If you have filed a claim for long-term disability benefits through your group or private insurance company, you will have been assigned a Claims Manager, also known as a Case Adjuster or Case Manager, who is your point-person for your claim. To help ensure that your claim is assessed fairly and in a timely manner, keep these four facts in mind during all interactions with your Claims Manager:

1. Your Claims Manager is not your friend. They may seem concerned about your well-being and ask very personal questions about your health, lifestyle and occupation, but it’s not because they care about you. Your Claims Manager works for the insurance company, and it’s their job to protect the insurance company’s bottom line by paying out on as little claims as possible. The next time your case manager asks you prying questions about your health, remember that they are looking for reasons to deny your claim. This brings us to our second point:

2. Everything you say can be used against you. Only provide the facts to your Claims Manager and never disclose more information than is absolutely necessary.

3. Your Claims Manager will avoid you when it’s time to pay up. They will claim that your documents haven’t reached their desk, that your fax was never received or that they require more information than you have already provided. They will avoid your phone calls. They may also request that you undergo medical examinations with their own doctors. These tactics are used to prolong your claim so that the insurance company saves money–the money that they should be paying you. It’s up to you to document all your conversations with your Claims Manager, request confirmation of emails, send hard copy documents by registered mail, and print and save your successful fax submissions.

4. Your Claims Manager is not the gate keeper of your benefits. If you have a dispute with your Claims Manager, you do have other resources available to help you resolve your issue. Every insurance company has an Ombuds person assigned to help resolve disputes between the insurance company and the insured. If your matter is not resolved at this stage, you may think about contacting the Ombudservice for Life and Health in Ontario. If your claim is denied or your benefits are terminated, contact a disability claims lawyer to fight for your benefits on your behalf.

Has your long-term disability claim has been denied? Contact Share Lawyers and put our experience to work for you. We offer free consultations and there are no fees unless we in.

We have recently settled cases agains Canada Life, Sun Life, Industrial Alliance, Desjardins, Manulife and many more.

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