We are always trying to save money more likely if we have children, but the one thing we shouldn’t think about getting the cheapest is the insurance. People usually don’t understand all the benefits they can have with great insurance, so they make some mistakes that can affect them in certain situations. From picking the right agent to picking the right insurance, we make mistakes all the time.

Because there are many ways you can get insured it is harder to understand every concept. Independent agents or online agency, everyone has their own way of explaining the benefits and getting to users. You can address these mistakes to your agents, if you have an agency, by using some insurance software or just explaining personally.

Get more information here: schemeserve.com

Fraudulent misstatement and pre-existing condition

Can the insurance company take away your policy based on a fraudulent mistake? Did you materially misrepresent anything on the application? That is where the carrier can come back and contest what you said on the application. Oftentimes, the agent or the broker will have misheard, misunderstood, miss recorded, and that information is easily correctable.

To see whether anything that you had before is similar to the claim that you are filing, most of the time, the language is clear as mud, and it is a Swiss cheese full of holes policy, so take a look at the pre-existing condition.

Misunderstood policy and carrier calls

Policyholders don’t understand the features advantages and benefits of their insurance. They know they bought a policy, they know they got a promise from the agent that is supposed to work this way or that way, but most people haven’t walked through the policy to look at the definitions. You have to understand how to use your policy before you can actually sit down and make the claim. Read more on this link.

Carriers are asking important claim ending questions. You need to keep your conversations brief. Tell the carrier to put important questions in writing, so you can reflect on the question, and you can give a fully complete and honest answer.

Documents and field visit

Once users start asking for documents it is a never enough situation. They want medical records, they want an authorization, and they want prescription medical. Some things you don’t have to provide. So, when it comes to documents, be careful, only give what you need to.

They are not out there trying to get a better understanding of your claim. You have given them an authorization that allows them to go back to the time that you were born to get everything about you occupationally, vocationally, medically, and now six months a year into the claim the carrier says “we need to better understand your claim” with a field visit from one of their company representatives. They are there to talk about your neighborhood, your lifestyle, and what kind of car you are driving.

Surveillance and functional capacity

A field visit is always accompanied by surveillance. The carrier is also trying to measure your activities that are inconsistent with your restrictions and limitations. So, if you say I can’t bend, stoop, push, carry, or lift. They are going to hire video-tapers to come out there and stake out your place. Don’t use words like always and never. If you say you never drive and they get your driving, that is an activity inconsistent with your own restriction and limitation.

A functional capacity evaluation done by a physical therapist, they are going to see how much you can lift, stoop, how much you could walk, and they are going to translate that, two and a half hours, on a functional capacity evaluation into a 40 hour work week.

Appeal or not appeal

The carrier wants to do a doc to doc, get your doctor on the phone with their on-site physician to talk about care and treatment. That is a recipe for disaster. How often does your treating doctor have your file with them 24/7? There is nothing in anybody’s policy that says they get to talk to your doctor on the telephone.

In the denial letter, the carrier says “would you like to appeal” you can appeal within a hundred and eighty days. They are not supposed to look at the claim with their eyes closed or point all their discoveries and all the things they have gathered to use against us a policyholder. Appeal or not appeal, it can mean the difference between a bad faith claimed or be prevented from later getting to file your lawsuit against the carrier. You need top insurance help to answer that question.

You always need to have these in mind so you can make the right decision at the right moment. We all make mistakes, but that is because our lack of knowledge.

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