At Disability Insurance Law Group, our national claims attorneys know there are times when disability and long-term care insurance policyholders must work with a third-party administrator when they file a claim – instead of the insurance company behind their benefits.
This is true for those who hold policies through Davies Life & Health Company — a third-party administrator (TPA) for multiple disability insurance companies. Davies does not sell disability insurance. Disability insurance companies and self-funded disability insurance plans will use a company like Davies, so they do not have to employ an in-house claims-handling team.
According to its website, Davies “has over 400 committed life and health professionals that provide expert long-term care and disability administration and claims management services for major insurance carriers.”
When a third party is involved in any insurance claim, the challenges mount considerably for policyholders. In short, companies like Davies are contracted to administer and determine a disability insurance claimant’s eligibility for benefits. To keep their over 400 insurance-providing partners happy, chances are Davies will dispute or deny each claim almost immediately. This isn’t fair to you or your family.
That is why we are here. Our disability insurance attorneys represent Davies policyholders nationwide — no matter where they live or work in the U.S. — with their best interests and true success in mind so our clients can pursue the benefits they are entitled to from their employer-provided coverage or policies. Contact us today to learn more.
Pursuing a disability claim through a third-party administrator (TPA) can introduce several challenges for policyholders because they manage and administer insurance claims on behalf of insurance companies or employers.
Here are some challenges associated with pursuing a disability claim through a TPA:
Policyholders may have limited control over the claims process when handled by a TPA. The TPA acts as an intermediary between the policyholder and the insurance company, and the TPA may make decisions without direct involvement from the insurer.
Communication between the policyholder, the TPA, and the insurance company can sometimes be challenging. Policyholders may find it difficult to get timely and accurate information about the status of their claims.
TPAs often handle claims for multiple insurance companies or employers. As a result, the process may lack the personalization and individual attention that policyholders might receive when dealing directly with their insurer.
TPAs may not have an in-depth understanding of the specific terms and conditions of each policy they administer. This can lead to misunderstandings or misinterpretations of policy provisions, potentially impacting the outcome of the claim.
The handling of disability claims may vary among TPAs, leading to inconsistencies in the claims process. Policyholders may experience different service levels and responsiveness depending on the TPA managing their claims.
TPAs may experience delays in decision-making, which can impact the time it takes to process and approve disability claims. This delay can be particularly challenging for policyholders who need immediate financial assistance.
The TPA may manage the appeals process for denied claims, and policyholders may have limited control over the appeals process. This can be frustrating for individuals seeking to overturn a claim denial.
The process can become more complex if the TPA handles the coordination of benefits with other insurance policies or employee benefits. Coordinating benefits effectively may require additional effort and communication.
Policyholders may find holding TPAs accountable for claim processing issues or disputes challenging. Unlike dealing directly with an insurance company, policyholders may have less direct recourse when working with a TPA.
When working with a TPA, understanding the legal and regulatory landscape related to claims processing can be challenging. Policies and regulations may vary by jurisdiction, and policyholders may need to navigate these complexities.
With over 50 combined years of experience, our nationwide Davies disability insurance attorneys protect clients facing challenges in pursuing a disability claim through a TPA. We are fully dedicated to providing transparent legal services that allow us to pursue real results for real people who need our help — no matter where they live or work in the U.S.
If you are receiving resistance from Davies for your U.S. disability claim, or if your claim has already been denied, contact our dedicated disability insurance attorneys nationwide at 954-989-9000 or online to schedule a free, confidential case assessment without delay.
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