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Anatomy of a DI Claim

A veteran agent learns something about human nature and discovers a service tip while filing a routine DI claim.

By Chuck Jones

In the disability income (DI) insurance business, you don’t have to be every client’s buddy, but you do have to make sure your group plan works the way it’s supposed to. And it doesn’t hurt to do a little extra.

Robert Eddy Jr., CLU, ChFC, REBC, did a little extra when he handled the DI claim of a manager for an oil field service company in the town of Lafayette, La. While Lafayette is known as the capitol of French Louisiana and for its celebration of Cajun, Creole and antebellum lifestyles, it’s also a city where oil is big business. Located 45 miles north of the Gulf of Mexico, Lafayette is home to dozens of oil-related business.

In March 2001, Eddy, a 44-year-old employee-benefits specialist with the Pinnacle Group and current chairman of NAIFA’s Member Benefits/Communications Committee, was referred to one of the city’s oil field services companies. This was a firm with 50 employees, many who had been with the company for years.

“I was referred to the company by the human resources department of a law firm that I dealt with,” Eddy says. “They wanted me to design some group benefits for their key people. The trouble was, they didn’t mind spending money on their managers, but they didn’t have as much money for the rank and file. The oil business is cyclical, and they needed to keep expenses down.”

A review of the firm’s group benefits showed a glaring need for a long-term disability (LTD) program. After performing a factfinder and doing a bit of pricing, he presented the company with a group LTD plan from UnumProvident that paid disabled employees 50 percent of their salaries after a 90-day elimination period. The company’s execs and managers got an additional 25 percent of salary in the event of disability. The company bought the plan in June 2001.

From acquaintance to client
During the installation of the plan, Eddy met the firm’s manager of wire line operations, a 45-year-old man we’ll call Brady. Brady was married and had three children—all teenagers. About three months after the plan was in place, in October 2001, Brady was diagnosed with esophageal cancer.

“He didn’t go on disability at that point,” Eddy explains. “He had treatment for the cancer and seemed to recover. He worked throughout his treatments. He didn’t actually go on disability until he had a relapse.”

Brady’s cancer reoccurred in November 2002 after being in remission for almost a year. One month later, the manager went on disability, and Eddy began the claim process, although the first payment was still three months away.

Brady’s health became worse, and Eddy found himself dealing with the manager’s wife, who was worried not only about her husband’s health, but was watchful over what was due to her husband, and when it would be paid. “Naturally, she was anxious and nervous,” Eddy says. “She was under a lot of stress. I stepped in and made sure she knew that whatever needed to be done concerning the DI claim, I would do it.”

The wife “was under a lot of stress. I stepped in and made sure she knew that whatever needed to be done concerning the DI claim, I would do it.”
—Robert Eddy Jr.,
CLU, ChFC, REBC

In March 2003, the insurance company began paying Brady $4,500 per month, which was 75 percent of his annual salary. While the payments gave the family much-needed cash flow, there was an unease in the air. “The wife was pretty uptight,” Eddy says. ”I think she was expecting more than she was getting.”

Brady’s wife did receive more money, but it came in the form of a death benefit. “The client only received three months of DI payments before he died,” Eddy says with a resigned finality. “He did have life insurance, but not through me. The family had another reputable agent for that. And this was a good thing because the wife didn’t work outside the home. They needed that money.”

A lesson learned
Eddy says he learned a lesson about human nature from this case, as well as a useful service tip. “When you’re shepherding a group DI claim, you typically have to deal with the claimant, his employer and his physician,” he explains. “You need to get statements from each of them. If you let them submit their statements to the insurance company individually, there is invariably missing information.

“What I did in this case was have the wife, the employer and the physician submit their statements to me,” he says. “Then I put them together, made sure all the information was there and wrote the carrier a cover letter that brought all those elements together. Then I sent it to the insurance company.”

The group effort paid off for Eddy and for Brady’s family. “When the DI claim process was complete, I got a letter from UnumProvident telling me that the claim was one of the easiest they had to process because of the work I did. When I showed the letter to the wife, she seemed to have a new appreciation of what I had done for her family.”

 


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