The disability claims services performed for each client will differ depending on the nature and complexity of the case. For example, a typical claims appeal would normally involve the following:
- A full review of the case file history or relevant facts of the case.
- A detailed telephone interview with the client.
- Additional information gathering from other pertinent sources, if required (eg. healthcare providers, case managers, employers, etc).
- Development of a case resolution plan (CRP).
- Contact with the insurer to execute case resolution.
- Follow-up with the insurer for decision.
- Once decision is rendered and if satisfactory outcome (ie. the claim is approved and re-opened), the consultant will continue to advocate on the client’s behalf to ensure that the insurer’s ongoing case management plan is fair and reasonable. If not reasonable, the consultant has the experience and expertise to negotiate an alternate case management plan with the insurer.
- If decision from insurer is not favourable (ie. the claim remains denied), consultant will discuss next steps with the client and consider other options, including alternate means of recourse. The consultant will remain the client’s advocate throughout this process.