Insurance Company Manipulation of Herniated and Degenerative Disc Claims

Many people have some form of degenerative back condition, ranging in severity. Certain activities and professions can aggravate these symptoms into a condition that makes working almost impossible. Several types of doctors, such as interventional cardiologists and radiologists, are susceptible to back injuries and herniated discs from wearing heavy lead aprons. While there are several types of surgeries that may help relieve symptoms, including discectomies, insertion of rods and pins, and spinal fusions, these surgeries do not always work. Before and even after such surgeries, patients can suffer from numbness, weakness, and loss of sensation in their extremities. When the conditions become unbearable, many people decide to stop working and file for their disability insurance benefits. However, getting your disability claim paid is not as simple and easy as it was promised. Here are a few ways insurance companies defend against these claims to delay or not pay benefits.Using a watered-down version of the occupationBack problems often result from degenerative conditions that many professionals will try and work through. As the pain gets worse, people may try to continue working by refocusing their job responsibilities, trying to trade more physically demanding duties for different aspects of their job until they cannot stand to work any longer. When the disability claim is filed, the insurance company looks at the occupational duties and responsibilities being performed as of the date of disability. Many insureds equate this date with when they finally stopped working rather than when they became disabled, which may be a much earlier date. Also, some insurance companies will not allow a date of disability until a doctor has deemed an individual unable to work. When the insurance company evaluates the occupation, the change in job duties and responsibilities caused by the disability are ignored, and claims are denied on the basis that the insured is able to perform the watered down occupation.To avoid this, determine and insist on an accurate date of disability and be under a doctor’s care as soon as you are no longer able to work as much or as well as you used to. Although many people have worked hard to get where they are and do not want to stop working, caution and preparation are needed to ensure that you are able to obtain your rightful disability benefits.Enforcing stringent care & treatment requirementsMany people prefer to avoid surgery or other invasive procedures when dealing with an injury or condition that is not life threatening. Insurance companies capitalize on this fear and trepidation and turn it into a reason to deny your claim. When an insured can’t work and chooses to pursue more conservative treatments rather than more risky procedures, the insurance companies may believe that the insured is choosing to not work, which can be developed to deny the disability claim and not pay benefits. Avoid this pitfall by understanding, discussing, and documenting any recommended courses of treatment with your doctor, whether the approaches are conservative or involve surgery.The “Good Day – Bad Day” ArgumentAs many with chronic back problems know, there are good days and bad days. Insurance companies like to use surveillance to follow insureds and investigate the insured’s activities. Once surveillance is obtained, they will cherry-pick through the data and potentially misconstrue the abilities of the insured. For example, if a private investigator sees an insured out grocery shopping or driving to the office, the insurance company will often stop paying disability benefits. Even if someone happens to feel good for one day or does something that will cause pain later, be aware of what’s reported on the monthly claim form. Be aware of your surroundings and anyone suspicious or just seeming to be there. Also, be very careful and thorough in describing what you can and cannot do on the claim forms and detail any activities that caused pain.Changing the disability from total to residualThis is a two-fold strategy that can help the insurance company and hurt the insured. Many disability policies provide total disability benefits only. Claims are not paid unless the insured is deemed totally disabled, which is often hard to prove and often leads to the denial of the claim due to only being partially disabled. For policies that have total and residual coverage, the issue can be much more subtle. Insureds trying to claim residual disability benefits are required to provide large amounts of paperwork every month, and the insurance company can delay or deny the claim if instructions are not followed and documents sent. Also, insureds are not guaranteed any certain amount of benefits each month, causing more stress and anxiety. The insurance companies may even try to capitalize on that stress and anxiety by offering to settle residual claims for much less than they’ve already reserved, pennies on the dollar.There are also business reasons to define claims as residual rather than total. When an individual is collecting total disability benefits, the total amount is set up as a reserve and recorded as an expense. On a residual claim, only a portion of the total amount is reserved, based on the assumption that the entire claim will probably not be paid every month. Reclassifying claims from total to residual allows an insurance company to reduce reserves and the accompanying expenses, which lowers the loss ratio, increases income, and achieves management performance goals.These four points just scratch the surface of the tactics and approaches that disability insurance companies will try and use to protect their bottom line and deny legitimate claims. Each one of these could have an entire book devoted to them to relate all of the horror stories and experiences that we have heard from our clients and others in the industry.

Posted in Insurance | Tagged , , , , , , , , , , , , , , , , , | Comments Off

Legitimate Work From Home Jobs – What to Look For to Avoid the Bad Opportunities!

With the economy taking a dive and getting worse everyday there are many people that are unemployed or need to make extra income because they have had to take lower paying jobs. This has made many people turn to trying to find legitimate work from home jobs to work either part time or full time. The problem is how do you know what is legitimate and what is a scam? Here are some tips to help you spot the good and the bad in the work from home opportunities.1. Legitimate work from home jobs have a guaranteeWhen you are searching the online world for some type of opportunity to work from your home to make either a full time income or some extra money in your spare time you must find a program that will give you a guarantee. This may mean that you have to put some of the money up front or all of it and you will get a full refund if the program does not work. This needs to be at least a 60 day guarantee and a 90 day would be best. This gives you the time you need to work with the program to see if it will actually work for you or not.2. Those that are not legitimate work from home jobs will give you empty promisesThe programs that are not going to be legitimate will promise that you can make thousands of dollars overnight without any work. They will say things like just work 15 minutes and put it on auto pilot. It is okay if you find a program that will tell you you only have to put in an hour a day, but understand this just means it will take you longer to get a full income from the program. You just don’t want a program that promises you a ton of money without putting in much work.3. The last thing you need to know about these opportunitiesYou want a program that works with a very reputable company like eBay. There are many other programs that work with sites like Google, Yahoo, and Amazon. Anything that works with a website that is very well known is probably going to be a good program. If you put the work in you will be able to make money with these types of systems. They are there to make you money and you will learn quite a bit about how to do so.

Posted in businesses | Tagged , , , , , , , , , , , , , , , , | Comments Off

Are You A Sales Manager Or A Sales Damager?

When salespeople are not selling; – look to the sales manager.
When they are not motivated to see customers; – look to the sales manager.
When there is no enthusiasm in the team; – look to the sales manager.Sales Managers don’t look to themselves in these cases, they blame the Salespeople and the Salespeople blame the Sales manager.The other evening, after a talk, a sales manager came up to me and told me that they were having a real problem with their sales team. “They are just not performing,” “they are not motivated,” “I talk but they don’t listen,” “there is no drive, no commitment, nothing happening.”Now, all of what’s missing in this team is actually missing in the sales manager!It all starts with the sales manager.This particular person who told me this has been with their company for over 30 years and has been the sales manager for just over 20 years. They have been doing the same old thing over and over and are now wondering why it’s not working. The answer is simple. The enthusiasm has died. Not the sales people’s enthusiasm but that of the sales manager! It’s not the salespeople who are bored and have no drive, it’s the sales manager.Only when sales managers understand that the success of their team is their responsibility, will they start to make some headway to improving the situation.The sales manager first has to manage and motivate themselves before they can manage and motivate the team.When the team is motivated it’s not a new light that’s been turned on. It’s a light that was always there and will continue to be there. But it needs the switch to be flipped before it comes on.”That makes sense but how do I do that?”By sticking to the simple basics of Leadership and Motivation and using “The 6 key elements” to keeping the Sales team motivated.1. Provide inspiration.
2. Build positive attitudes.
3. Show recognition.
4. Goal setting.
5. Motivation.
6. Build team spirit and create fun.Yes, enthusiasm and excitement are what the salespeople need more than any skills training. They need to be reminded of the basics but most importantly, they need their enthusiasm ignited.Enthusiasm is everything in sales!When salespeople are enthusiastic and excited about themselves and their profession, they will start feeling motivated and look forward to getting out there and seeing their customers.Skills or no skills, this is what makes salespeople successful. When salespeople are enthusiastic, nothing will stop them. The customer can’t help getting enthusiastic as well, it rubs off on everyone.Only when sales managers accept full responsibility for their team’s performance, will they realize that the buck stops with them.They need to be the role model, the manager, the leader and the coach; all in one. They make it happen!They set the tone. That’s their job. They get results through their people. Their success depends on the success of their people. They need to manage less and LEAD more!A good sales manager spends less time in the office analyzing everything and playing with numbers and spends more time out in the field with his salespeople and their customers.”Our sales are down. If we increase the call rate by 10% and close 1 in 4 instead of the current 1 in 7 we will achieve target” This may be the answer (On paper) but how do you achieve it? What has to happen to increase the call rate and closing ratios?”The salespeople must want to achieve this. The sales manager has to sell the idea to the salespeople. They have to get buy in from the team and this is where good leadership comes in. Only a good leader can get the team to work together to achieve a common goal, budgets, the sales targets etc.It is at this point where the sales manager usually fails. They stay in the office and spend their time analyzing numbers and coming up with all sorts of solutions – only on paper.A good sales manger will get out of the office and lead by example. They will spend a full day working with a salesperson, finding out firsthand what the problems are and how to fix them. They need to speak face to face with their customers to gain information that will help them to come up with ideas for increasing sales.By doing this they will get respect from the sales team and will get support for their ideas to increase call rates and closing ratios because they are talking from the point of being there and experiencing the situation first hand.YOU CANNOT MANAGE OR LEAD A SALES TEAM FROM BEHIND A DESK.By spending time out in the field with salespeople, sales mangers will experience what the salespeople are experiencing and can then coach them on how to improve and what to do to start getting more sales.Salespeople will perform for a sales manager whom they respect. And that respect will only come from a trust and belief that the sales manager can do what they are asking the team to do.The Sales Manager MUST LEAD BY EXAMPLE!It’s all about enthusiasm and excitement. Sales people continually need motivation in order to sell well. They require Inspiration from their Manager to promote enthusiasm and drive.They need a Manager who leads by example and provides an exciting environment in which to perform. Salespeople should feel enthusiastic about making a sales call.Remind yourself that you are in the best profession in the world!Feel good about yourself and your profession and then get the sales team to feel the same way.So it’s no use complaining about the Salespeople not performing, not being enthusiastic and not listening.If this is the case, then you are not performing as an effective Sales Manager.Salespeople need a Manager who CARES!!!

Posted in Uncategorized | Comments Off