The longer Guardian Disability pays out long term disability benefits to a specific claimant, the more these benefits cost—so like all long term disability insurance carriers, Guardian has a vested interest in removing claimants from the disability rolls as soon as it can. This means that getting approved for disability benefits is just the first step; maintaining this approval is the key to receiving benefits through the end of the policy term. Learn more about what claimants should do to preserve their long term disability benefits with Guardian Disability.
GREGORY DELL: Hi, I’m Greg Dell with Attorneys Dell and Schaefer, and I’m here with attorney Stephen Jessup. And we are going to discuss Guardian disability insurance company and some tips to help you manage your claim. So Steve, in video in particular, I’m talking about the scenario where a claimant’s already been approved for benefits, and now a lot of people get into a false sense of security to think, OK, I’ve been approved, and everything’s going to be fine.
Does a Guardian Disability Approval Last Forever?
But as you know, that’s not necessarily always the case. And I want to talk about why that is, and then I want to get into some tips about how someone can protect their benefits so they don’t end up in a situation where the claim would be denied. So first thing, can you address why is it that once a claim gets approved that a person shouldn’t feel like that approval is going to continue indefinitely?
STEPHEN JESSUP: Yeah. Well, like we’ve said in videos that we’ve done before, there’s this idea that there’s no such thing as a guaranteed disability benefit. Just because you’re approved doesn’t mean they’re going continue to pay you out through the age of the policy. A lot of times people say, hey, I got this letter and they said they were going to pay me until 2035. Why was I denied?
Well, they’re a month-to-month evaluation as to whether or not you’re continuing to meet all the terms and conditions of the policy. So getting approved, like we say, is just the first step. Now it’s a matter of making sure that the information’s continuing to support that you’re unable to do your job or, if the case may be, any job. Because Guardian does do private individual policies, which is the majority what we see, and they do some group. But the vast majority are with those private disability policies.
GREGORY DELL: All right, so the most important thing is obviously going to be the medical support for a claimant. Now, the doctors for the people have been approved that are on claim already said, I think the person has these restrictions and limitations. What tips would you give for a person in order to keep up with their medical support?
STEPHEN JESSUP: Well, I think the biggest tip is going to make sure your doctor is really documenting what’s going on, everything that’s happening with you. Early on, when you’re trying to establish it, it seems someone may be a little more gung ho about getting the doctor to write reports properly, forms, the records.
But then they get that, like you said, false sense of security, and they start to lay off a little bit. Maybe they’re not treating as much. Maybe the doctor isn’t taking down the detailed notes that they used to. So it’s really important to have an open dialogue with your doctor, that your complaints that you’re having, the doctor is documenting in the records.
And also, we’ve discussed that the issues with medical recordkeeping now, electronically, sometimes wrong boxes can be checked. So just ensuring the accuracy of your records. And it doesn’t hurt to get your records, you know? We get records frequently. That way, we can make sure that there aren’t any errors or something that needs to be switched.
GREGORY DELL: So as you know, we offer a service where we help claimants to manage their claim in which all the communications come to our office. We advise them on everything with regard to their medical treatment and how to communicate with their doctors, and we review the medical records. It is still a challenge for individuals to go into their doctor and get them to properly document the medical records. How do you advise your clients to work with their doctors, and how do you work with your clients’ doctors to get the doctors to document appropriately so a claim doesn’t get denied?
Get Medical Support For Your Guardian Claim Long Term
STEPHEN JESSUP: You know, one of the first things I think you need to address is doctors aren’t under a duty to fill out forms. So that can be a problem in and of itself, and a lot of people have that issue. Unfortunately, Guardian is not going to care, you know? They’re going to want records. They’re going to want forms, attending physician statements, and stuff. So that’s first and foremost.
So if there’s issues early on with your doctor and you have concerns about that, you may want to potentially find another doctor. So that’s first and foremost. With clients, it is a sensitive thing. They don’t want to think that the doctor– they’re just going to the doctor so he can fill out these forms.
I find, especially– since we said Guardian does all the individual disability products that’s written for doctors, lawyers, professionals, dentists, things like that, where there may be more a sense of rapport with the doctor. Because a doctor understands and more than likely has this type of policy as well– that as a professional, the last thing you want is not to be able to do your work, you know? You spent all this time in school, in the practice of it, so you don’t want to be out on disability.
So just having a real frank conversation about what’s going on, how you’re having the problems, what the nuances of the problems are, and how it’s impacting your specific issues– and that’s another thing we do with the doctors. A lot of times, doctors will speak to us because they even want direction. They’re not quite sure how they need to document. So it’s a matter of discussing the treatment plan with the doctors, what their opinions are, and then elaborating those opinions fully and appropriately for the purposes of providing to Guardian.
GREGORY DELL: One of the common areas that I see where claimants end up running into problems that can lead to a claim denial is a client has a surgery for whatever medical condition. And usually, for the surgery, they specifically go to a surgeon. And that surgeon had initially filled out the attending physician statement for the client.
Now the claimant goes back to the surgeon, whether it’s three months, four months, six months, and the client is still feeling like, I can’t go back to work. But a surgeon does a surgery in hopes of getting someone better. And now the surgeon is kind of like, well, I don’t know that I’m going to fill out your claim form. So how do you guide the clients in that situation to get continued support if they don’t feel like as if they can continue to go back to work?
STEPHEN JESSUP: Yeah, well, the problem with surgeons, they’re there to do the surgery. They don’t like when there’s any maybe indication that it didn’t do what it was supposed to do and the person is still out. And you don’t generally go see a surgeon for regular appointments. It’s usually for the purpose of it.
So at that point, maybe it’s a matter of going back to the person who referred you, whether it was a primary care physician, or sometimes you get transferred over to pain management. So transitioning the aspect of who’s going to be supporting the claim, filling out forms, responding from questions from the insurance company, it’s maybe transitioning to that primary care or pain management doctor in a situation like that.
GREGORY DELL: Yeah, I always tell my clients, it’s great to have a family medicine, internal medicine, a general doctor that you go to who can be kind of like the quarterback–
STEPHEN JESSUP: Exactly.
GREGORY DELL: –for the medical treatment. Because the surgeon also may be like, look, I did the surgery. It may not have gotten you better, but we stopped the progression.
STEPHEN JESSUP: Exactly. Structurally, whatever needed to be repaired is repaired. Pain is just, you know, it happens kind of thing. So this surgery could’ve been a success from that standpoint, but you could still have the lingering pain, discomfort, all that.
What Treatment Schedule Should A Guardian Claimant Be On?
GREGORY DELL: Along the lines of medical treatment clients always ask, how often should I be going to the doctor, and how do you answer that question?
STEPHEN JESSUP: Well, you know, you start first with the language in the policy, this idea of appropriate care of a physician. And in a lot of ways, it’s up to the doctor to determine what appropriate care is. Now, if you claim that you’re in chronic, horrible pain day in, day out, once a year is probably not going to cut it. So you would typically see anywhere from every two to three months, you know?
And if you have multiple doctors that you see, obviously they’re all kind of a prize, unless it’s for some unrelated condition. But in a situation of family medicine or primary care, along with pain management, you may see those doctors independently, so they’re both overseeing the care.
But you would ideally– especially early on– at least at a minimum every two to three months– preferably two, even a month if it’s something more acute, just because Guardian is going to be requesting those records. They’re going to want to see. And you’re only as good as you look on paper and what those records are stating.
So if they pull your records and you haven’t really treated, there’s not much information, they send it to their doctors to do a review. And those doctors say, well, from the available records, I don’t see where the issue may be. So you really want to be on top of that.
GREGORY DELL: This question– from you handling thousands of disability claims that all different disability companies, and having litigated, and depositioned, and really seeing a behind-the-scenes look of these claims, can you explain, so that the people watching this video understand, what’s the requirement of the claim rep who’s handling the claim on an ongoing basis in order to approve that benefit every month? What kinds of things is the claim person doing so that the person who is on claim understands what they need to do to satisfy the requirements of the claim handler?
STEPHEN JESSUP: You know, the claims person, realistically, they’re, each month– it’s not on an auto renewal unless you get moved off to the long-term reporting requirements, which is usually after you’ve been on claim for many years. And some disability carriers don’t even do that, you know? They want, sometimes, forms every month, and they don’t waive that.
So every month, that claims manager is looking at your file, making a determination if they believe benefits should be approved for it. So they could be requesting updated medicals, vocational stuff. If you were in the medical profession and you’re still working in some capacity, your CPT codes, financials, all kinds of stuff too to be able to coordinate what your benefit’s going to be– especially if you’re on a residual disability and you’re still working.
So each month, they have hands on the file. And they’re determining, OK, the benefit will be released on that date. So you need to understand that every month is a whole new process. It’s Groundhog’s Day. It’s repeating the same thing over and over again to make sure that you’re going to be entitled.
And sometimes it seems like maybe all is quiet, you don’t hear from them, and then you get bombarded with a bunch of stuff that can take you by surprise. So knowing that even if you don’t hear from them every month, the claim just to prove you can get your benefit, they’re still doing work on every file.
And Guardian is very meticulous and detail-oriented. So they will have all the information they need. And they’ll run it through the proper channels to make sure that it’s processed well and articulates whatever position they’re going to have, especially if it comes to a denial of benefits.
GREGORY DELL: Yeah, that’s what I wanted people to understand, is that the guardian rep isn’t just sitting there saying, oh, here’s another check, hit Pay in the computer– that they’re working behind the scenes, they’re reporting to managers, they’re reporting to medical consultants whenever they get medical records or nurses to review them, that they’re very aggressive behind the scenes, but often kind on the front side.
So it can lull people into a false sense of security. Can you talk about the other tools that guardian has available to them to use to investigate a claim that a claim person should expect is going to happen to them throughout the duration of their claim?
Be Very Cautious of Social Media Profiles & Posts as Guardian Will View Them
STEPHEN JESSUP: Well, I think more so in this day and age– and you see it now with most insurance companies– first and foremost, simple internet searches. You know, when we do see denials or there’s information from the claim file that we’re able to garner, there’s a lot of times they’re looking up your activity on social media, if you have blogs, LinkedIn, all these various different things. There’s a plethora of information they’ll pull from there.
Sometimes you’ll even see they’ll do full Investigative reports, where they’ll show know cars your own, places you’ve lived, all this– put you under video surveillance. They can have you meet with one of their field interviewers. You know, sometimes these are benign meet-and-greets, where they’re trying to gather initial information. And sometimes they’ve already got something that’s raised a level of suspicion, especially if you’ve been on claim for a while, and they really want to get to the heart of it and hash out those.
So they’re always going to find a way, whether it be putting physical eyes on you or seeing what type of footprint and what information you’re sharing on the internet. That all goes back, and that formulates an opinion. We’ve seen claim denials where you know the impetus of it was based on stuff they found online, and then the reviews of the medical reports from their professionals are saying, well, you know, in context of reviewing this surveillance and social media activity, what the insured is reporting in their medical records isn’t gelling with what they’re actually doing. So you have to be very cognizant that you are putting something out there that could be used against you.
GREGORY DELL: Right, and you also have to be very careful. Guardian likes to have phone calls often with the claimants to discuss what they’re doing or possibly they got some investigation. And any little thing they get, they want to further dive into it. Because they don’t handle as big a case load as the other companies, so they have time to dig into that stuff, and they will turn over every stone.
I know when we’re representing a claimant, we always attend every phone call with them, any in-person meeting, or whether it’s telephonically. But we protect them and prep them, and we don’t let a guardian get more than what they’re entitled to. So that gives the clients a good sense of security.
So overall, we’re available to provide you with a free consultation to review the status of your claim. We simply ask that you send us a copy of your long-term disability policy, possibly your approval letter if you have that already. Whether you speak with Stephen or myself, we’re always going to give you that free initial consultation. Our clients are located all over the country, so we can help you anywhere. And we appreciate you considering our law firm.
As you’ve learned, Guardian Disability has a number of tools in its tool chest when it comes to the early termination of long term disability benefits, and fighting to preserve your right to continue receiving these benefits can be a full-time battle. But you don’t have to do this alone. At Dell & Schaefer, our nationwide team of disability insurance attorneys has helped thousands of claimants recover long term disability benefits from Guardian Disability, and we can help you too. Give us a call or visit our website to set up your with a member of our legal team today.