Worst NightmareAlthough its unclear to me why so many insureds are reporting verbal abuse on the phone, apparently claims handlers are stressed out enough to really let “claimants have it” on many different levels. We are already aware that there is no such thing as customer service in an industry focused on hurting so many people for profit. In my opinion, however, there’s no excuse for rudeness.

I received a call from a young woman who described a conversation she had with her claims specialist at RMS. The specialist told her there was nothing wrong with her and that according to the medical review of their outsourced neurologist (a former Unum doctor), she could return to work.  All this after extensive proof of claim had been submitted to Disability RMS supporting total disability.

In addition, the claims handler also refused to communicate in writing and disclose the name of his manager. After later getting through to the RMS manager, the claimant reported an identical attitude directed toward her that was “rude and hateful.”

“The conversations I’ve had with RMS made me feel as though I had done something wrong and that I was in danger of going to jail. I’m just disabled and can’t work, not a  terrible criminal.  Every time I speak with them I am made to feel the same way.”

Disability RMS is an insurance reinsurer staffed in part with former Unum employees. Basically, Unum’s tendency toward “bad faith” transfers to other companies such as RMS, Sun Life and The Hartford when employees from Unum find jobs elsewhere. Still, any insurance company who denies claims unfairly should at least be polite.

The growing trend toward treating private disability insureds as criminals is due in part to pressure placed on claims specialists to deny more and more claims. Despite what most people think, the job of disability claims specialist is more like a widget factory than a mid-level administrative position.

Those who have ever worked in a factory with assembly lines can appreciate the disability claims process that places claims through internal referral resources in order to “stack the deck” with documentation supporting non-payment. Claims are placed on the internal review process assembly line and are either paid or denied at the end. Managers pressure staff at risk of employment termination if they can’t deny claims at accelerated levels particularly at month, quarter or year-end.

Claims handlers are in reality little more than glorified administrative assistants who continuously push claims through a prejudicial game of “Texas Hold’em.” As I’ve described in previous posts, the  real skill of claims managers is to juggle claim denials and approvals to meet financial reserve goals. Managers are also pressured by executive management to “roll in” more and more profits each year.

Unattainable profit targets create stressed out managers. By the time that same stress reaches the bottom rung of the ladder, claims handlers are ready to pop. The result is an entirely different approach to customer service, namely, there isn’t any.

To be clear, it is entirely inappropriate for claims handlers to express opinions directly to claimants as to whether they are disabled, or can return to work. It is equally egregious for claims handlers to communicate any opinion or judgement relative to the claim or intent of claimants. Claims handlers are NOT specialists in any particular area (medical, financial, occupational) and should refrain from “putting in their two cents worth” particularly to claimants directly.

It is important that claims handlers understand the administrative nature of their jobs and not try to place too much importance on their roles particularly when in most companies claims handlers do not have autonomy to make claims decisions on their own without some sort of validation from managers. It has taken me nearly a week to get payment on a claim at Guardian because it was sitting on a manager’s desk waiting to be approved and validated.

As a former Unum claims specialist I understand entirely what it is like to sign letters you don’t write, have responsibility without control, be an accomplice of secrets while at the same time on the front line with insureds. Still, inappropriate phone exchanges with the most vulnerable in our society is an outrage. No one should have to fight so hard to receive what is already due them.

For all of these reasons DCS, Inc. continues to recommend to insureds and claimants that they request all communications from insurers in writing.

Anytime, any entity, organization, person, group, or media resource causes a disabled person to feel bad, or less than they are because of a disability or claim, they are abusing their discretionary authority to make fiduciary decisions on behalf of those they sell policies to.

Insureds and claimants do not have to subject themselves to abusive verbal exchanges and should immediately request to receive all communications in writing in the future. It is not a crime to be disabled and anyone who takes advantage of that fact is nothing more than a bully.

Part time helpOne of the most interesting aspects of managing disability claims is the ever-present possibility of insureds and claimants returning to work. Although I am not asked to write about returning to work that often, I am of the opinion the subject should probably be addressed more often than it is.

Returning to work after a period of disability is more involved than most people think. “Working” for someone else requires a great deal more than just performing job tasks for a paycheck. Among other things, working requires employees to “be somewhere” every day and to have the physical and mental endurance to perform job tasks on a regular basis. Most people could probably work a week with poor health, but it is the permanent and regular nature of employment that can become a problem when re-entering the workforce.

To begin, insureds and claimants should have a frank and honest discussion with their physicians prior to considering a return to work. Although most physicians would be inclined to release patients for work upon their request, the question still remains whether or not a person who has not worked in years has the physical capacity to “be somewhere every day” and remain able to perform a job permanently.

It does not do insureds any good to prematurely attempt work and begin an “in and out” of disability claim process eventually leading to total disability again. Therefore, first and foremost, a decision to return to work should be made by insureds in conjunction with their treating physicians considering the possible effects of fatigue and recurrence of symptoms. DCS, Inc. recommends to insureds that they consider a “work hardening” program for a period of time before sending out resumes in search of full-time work.

A “work hardening” program can be as simple as “showing up” for volunteer work on a regular basis to determine any physical endurance limitations. Or, “work hardening” can be a more organized effort such as finding a menial part-time job working 1 or 2 hours per week and gradually increasing the number of hours worked to reach full-time in a month or so. Depending on the amount of time insureds have been on disability, former employers may agree to a formalized work hardening schedule allowing insureds to come back to work at full capacity over time.

Most claimants find that work hardening programs pinpoint physical exertion levels that rarely support full-time work. The worst thing that can happen is that insureds push themselves into full-time work prematurely and later discover they just can’t do it.

In addition, insureds and claimants may want to take pencil to paper and, in combination with the terms of their policies describing RTW and SSDI awards, actually figure out what their disability benefit would be if they returned to work part-time. Most ERISA group plans contain a Work Incentive Benefit (WIB) program whereby claimants could possibly work part-time for 12 months and keep both work earnings and full benefits for a period of 12 months. Of course, keep in mind that SSDI awards are still offsets from benefits.

Some claimants may actually attempt a part-time return to work when in fact, financially, they would be worse off. Group insurers shoot themselves in the foot by strong arming claimants into filing for SSDI. Once awarded, claimants may find it isn’t feasible financially to return to work part-time if at all.

Nevertheless, anyone hoping to re-enter a competitive workforce after more than a year on disability is already behind their peers in keeping up with technological advances and new information related to their education and skill set. Prospective employers will want to know if the individual they hire is up to date and has the physical and mental capacity to do the job well. Missing employment periods and lack of current training may prove to be a problem when constructing a new resume and employers will question whether candidates for employment can actually return to the workforce after not working for long periods of time.

Returning to work also requires money, reliable transportation, and gas. First, depending on what kind of work insureds apply for, they will need to buy appropriate attire. Insureds need to dress appropriate for the job, and have reliable transportation that doesn’t break down all the time. Some disabled persons actually rely on others to get around and a return to work may involve buying a car or looking into alternative transit systems. Also, there should be sufficient money available to buy gas until the first paycheck is received.

Although these suggestions may seem common sense, some disabled persons literally have to start over in order to return to work.

Finally, if there are dependents at home arrangements have to be made for child care and the expense of child care should be considered into the return to work financial plan. Sometimes the financial advantage of returning to work is literally “eaten up” by expensive child care costs.

DCS supports the idea that “working is healthy” and if claimants can work, they should work. Still, the system of private disability insurance is such that it forces claimants to apply for total disability SSDI benefits that are hard to give up once approved. Financially, returning to work may actually mean a loss of income and there is no incentive for claimants to perform work even when they can.

In my experience as a consultant, claimants return to work when private benefits are denied, or there is fear they will be denied.

In any event, returning to work is healthy, both physically and mentally, but after a period of disability, it should be planned and realistic. The risk of having to go out on disability again should always be considered as well as putting a work hardening program into place for a period of time to test endurance and fatigue levels.

The New NormalI am constantly amazed when insureds ask me about privacy and what kinds of information insurers are likely to obtain in hopes of discrediting claims. It’s as though, as Americans, we’ve ignored the loss of privacy rights and are still living in the rose-colored garden of the U.S. Constitution. There is little doubt but that in today’s media frenzied world of technology that Americans have joined the world’s ant farm of technology surveillance where nothing is really private anymore. The information highway collects more information about private citizens than anyone could possibly imagine.

Although living in a fool’s paradise may mean ignoring the inevitable, filing private disability claims brings the issue of the protection of privacy to the forefront because of the overly broad Authorizations insurers ask claimants to sign. The most frequent question to DCS is, “Can insurers get access to my banking and credit card information? And, do I need to start buying things with cash.”

While most Americans do need to take notice of changes in our rights to legal privacy, insurance investigation is almost unlimited. Let’s use Unum’s Authorization as an example. The first paragraph states:

“I authorize the following persons: health care professionals, hospitals, clinics, laboratories, pharmacies and all other medical or medically related providers, facilities or services, rehabilitation professionals, vocation evaluators, health plans, insurance companies, third-party administrators, insurance producers, insurance service providers, consumer reporting agencies including credit bureaus, GENEX Services, Inc., The Advocator Group, and other Social Security advocacy vendors, professional licensing bodies, employers, attorneys, financial institutions and/or bank, and governmental agencies;”

Looking at the first paragraph literally it lists all of the persons or institutions you are allowing to disclose information about you. While most insureds wouldn’t have a problem with the first list of medical sources of information, the paragraph then authorizes other agencies to release information as well. “Insurance companies” means that Unum can obtain information form all insurers and share information among them. “Insurance producers” means the agent who sold the policies; “insurance service providers” are call centers and insurance customer service reps; “consumer reporting agencies including credit bureaus” includes the Better Business Bureau and local Departments of Commerce; “Social Security Advocacy vendors” includes others who assist in obtaining SSDI awards; the inclusion of attorneys into this mix may be futile since attorneys are held to attorney/client privilege; “financial institutions and or/banks”, means your bank, credit bureau, and other lending institutions; “governmental agencies” means, social security, departments of justice and treasury and human services.

Insureds and claimants should read this authorization with trepidation since all agencies named do NOT provide information about you without direct permission from you separate from Unum’s Authorization. For example, SSA requires a separate Authorization signed by you in order to disclose copies of SSDI files; banking institutions have their own paperwork and will only give up information after you have been contacted or it receives a warrant or subpoena for the information. Therefore, banks, as a general rule do NOT provide checking and savings information unless of course you sign Unum’s new POF form giving the company a voluntary lien to all of your assets.

GENEX, Allsup and even The Advocator Group may have Authorizations of their own allowing them to remove SSDI overpayments directly from checking accounts. Credit information is so easy to obtain, although most individuals probably have no idea how or why. Let’s use DCS, Inc. for an example. The top three credit agencies are “membership” organizations and businesses may join for an annual fee. The fee allows businesses to obtain credit information about any individual as long as they promise to report credit history back into the system.

Therefore, if I were so inclined, I could join Trans Union and Equifax as a business, pay the fee, and obtain credit information for all of my clients as long as I reported credit histories back. As a service advocacy corporation I choose not to “join” the credit bureaus and never obtain credit information on my clients. But, insurers can.

If you go to Credit Karma, for example, you will see your credit score and a list of creditors and current balances. Individual transactions are not part of credit bureau reporting unless a particular transaction is in dispute. Therefore, individual transaction information is not disclosed to insurers.

If I were an insured, I’d be more concerned about information available on the Internet through list serve data exchanges, Facebook, and other social media. Non-working disabled persons probably spend more time on the Internet which is exactly where they shouldn’t be. Insurance “snoop dogs” roam the internet looking for mentions of insureds who continue to maintain business websites, and who communicate activities on Facebook. GPS software included on the iPhone and other devices may allow investigation teams to find you regardless of where you are. If you are communicating with your insurer through an online website, cookies and other tracking software is identifying exactly where you go on the Net.

In my opinion the loss of privacy is a much bigger issue than signing insurer Authorizations. There is probably enough information about you already accessible that even without the Auth insurers could follow investigative trails and arrive at the same information.

Finally, Unum’s Authorization does contain an important contradiction insureds and claimants should be aware of.

The Authorization contains both of the following statements:

“Unum will not condition the payment of insurance benefits on whether I authorize the disclosure described in this paragraph.”

“If I do not sign this authorization or if I alter or revoke it, except as specified above, Unum may not be able to evaluate or administer my claim(s) which may lead to my claim(s) being denied. I may revoke this authorization at any time by sending written notice to the address above.”

Well…..which one is it? “If I don’t sign the Authorization Unum won’t stop paying me?”, or, “If I don’t sign or alter it, my claim could be denied?” Is Unum just covering all of its options?

In today’s world citizens should never presume to have privacy rights; insurance Internet investigators are turning up volumes of information insureds forgot ever existed and they’ve been doing it for the last decade.

Like the New World Order, we are also living with The New Normal. Insurance investigators probably already know more about you than a signed Authorization would ever give them permission to obtain.

QuestionsLindanee’s Blog is a very popular website with more than 1,000 posts containing information of concern to those with private disability insurance. The blog receives over 800 reads per day and recently readers have been placing calls me to with questions concerning their claims.

As most of you know, DCS, Inc. is a consulting corporation owed by Linda Nee to provide insureds and claimants with case management services. The blog has 178 subscribed members, 1,000 articles, and over 900 comments.

One of my closest attorney friends, now deceased, once told me that if I were a lawyer I’d be a rather poor one. I wish I could help everyone resolve their disability claim issues, but of course I can’t. Therefore, my time and expertise must be dedicated to those who retain my services and expect me to work on their behalf.

As a result, I may not be able to return the hundreds of calls and emails I receive each week from those looking to just ask questions. If there is a topic you would like to see addressed on “Friday Q&A”, please send me a private email and  I’ll be happy to answer your question anonymously at the end of the week. Although I am flattered that insureds and claimants consider me a valuable source of information, it is impossible for me to return all of the calls I receive each week.

For those who are looking to retain me as a consultant and wish to discuss their claims, please feel free to contact me. I will try very hard to continue to write articles of interest, therefore, your first inclination should be to search the blog to see if your question has already been addressed.

Thank you to all of you who support DCS, Inc. and the work we do to try to educate the general public as to the private disability claims process. I will continue to write and post articles to help you as best I can.

Please email me your questions so that I can post them on Friday’s Q&A and help all others who may have the same question.

Thank you.




Carrot & Stick Awards

Carrot and StickA well deserved carrot is awarded to Mass Mutual for its continuous professional claims management for policyholders who are also owners. The company appears to be managing ERISA group claims in good faith for the time being. DCS has not observed any deliberate targeting of claims, or aggressive risk management deliberately adverse to claimants. We applaud any disability insurer who is able to manage claims in an appropriate manner when the industry as a whole remains corrupt. Thanks, MM!

A hats-off carrot is also given to employers who become involved on behalf of employees when Unum’s internal practices are financially harmful. One employer this week actually extended their internal transitional leave so that its employee would not have to pay back money for benefits or health services received. It is hoped that employers who continuously find themselves in positions of having to defend employees against an unfair third-party administrator or insurer will replace the company at the next annual enrollment period. Employers rarely get involved, but this one did, and saved its employee a great deal of harm caused by Unum.

A definite stick goes to Lincoln Financial who rarely overturns prior denial decisions on appeal. The company also deprives claimants of the benefit of a full 180-day appeal period allowing only one shot to submit additional information in support of claim. Lincoln is a tough cookie to crack these days and the best chance insureds and claimants have is in avoiding denials in the first place. In order to overturn a Lincoln denial one would need to submit a preponderance of objective evidence in support of claim, and even then it would be questionable as to whether the denial would be overturned and claims paid.

Due to Lincoln’s failure to consider payment of claims on appeal it is also in third place for the worst insurer in America. Unum and Prudential are numbers 1 and 2.

Finally, a stick is awarded to The Hartford’s claims handler who sent threatening letters concerning SSDI estimates and reductions from benefits to claimants and won’t return phone calls. In our opinion anyone who works for an insurance company who threatens to reduce benefits unfairly should at least pick up the phone and accept responsibility for his actions.

In this particular case, The Hartford’s claims specialist hit the roof when our client fired The Advocator Group and retained her own SSDI attorney. Apparently, The Advocator Group made quite a few errors in managing her application, and fed up, the claimant terminated the relationship. The Hartford immediately stepped in and assumed the claimant refused to continue her application for SSDI and informed her the next benefit would be reduced by an estimate for SSDI.

The claims handler’s reaction is overkill since what he should have done was find out if the claimant hired an attorney to continue the appeal to an Administrative Law Judge before threatening an offset from benefits. Insurance companies really know how to push claimant’s buttons, particularly when benefits are challenged. Hartford’s claims handler well deserves a stick.

Pop Goes the weasel

This is just a reminder that we are heading toward the end of the 3rd Qtr. profitability reporting period and most insurers are diligently searching for deniable claims to bolster profitability.  Although not all insurers behave in the same ways, most increase “risk management” activities such as  IME, field visit and patient note requests, including attempts for phone interviews.

It’s hard to imagine sometimes how disability insurers can deny claims unfairly to increase their profitability. Just the other day, a caller said to me, “How can they get away with this?” And, of course, that’s the real question isn’t it?

When questioned about claim targeting insurers respond, “We don’t do that” even though, for example, former Unum employees insist the company attempts to bolster profits at month or quarter end. Insurers “get away with it” because they are entitled to fully investigate claims and have (in about half of the states) full discretion to determine who will and won’t get paid. “Discretionary authority” is not entirely a thing of the past, and insurers “get away with” denying claims unfairly just because they can.

Insureds and claimants should make sure that all requested paperwork is verified received by their insurers and continue to request all communications in writing.


Get every new post delivered to your Inbox.

Join 193 other followers