Carrots for the month of August go out to Mass Mutual and Guardian for engaging in fair and equitable file reviews and maintaining good professional relationships with outside third parties such as consultants and attorneys. DCS, Inc.’s contact with these insurers has been extremely positive. I hope the trend continues, but for the most part, both Mass Mutual and Guardian appear to “do their jobs” while at the same time respecting the fact insureds and claimants are ill. Although the Guardian continues to aggressively risk manage claims at times, there is no indication of deliberate targeting for profit. Remaining honest in a dishonest industry isn’t easy, but hats off the Mass Mutual and Guardian claim specialists for making the effort.
Another carrot is awarded to Met Life, who in recent times recognized their failed attempts at customer service, and have outsourced business to customer service representatives in India. Admitting what you don’t do well is the first step to improvement and DCS, Inc. supports insurers who attempt to “fix” mistakes. Congrats, Met Life….we hope you continue that trend.
DCS, Inc. also awards a carrot to Northwestern Mutual – a company considered the “king” of private disability insurance. DCS, Inc. appreciates the manner in which NWM conducts its business, works with third-parties, and makes fair decisions. Our hats off to NWM claims specialists who are clearly professionals and who are great to work with.
Unum Group continues to be in first place for a DCS, Inc. stick award for disagreeable claim specialists who seem to be sending out written communications containing threats of claim terminations, strong-armed attempts to obtain signed SSDI Authorizations for files, and general poor claims management. Nasty, and threatening Unum claims specialists are usually the result of increased management pressure and stress to deny more claims. There is absolutely no reason for Unum Group as a company to have letter templates of such a negative nature as to cause insureds and claimants to fear when there is no reason to do so. Unum’s letters are unreasonably threatening, contentious, and negative, no doubt deliberate to cause insureds to cooperate with its demands regardless of what they are. Consistently sending out letters that are obviously negative and adverse is a poor way of doing business and lend to Unum’s already poor public reputation.
Prudential is also given a second place stick award for engaging in claims review practices that are unfair and misrepresented by internal RN medical reviews. The company is second only to Unum Group with its egregious claims practices of misrepresenting policy provisions, relying on RN medical reviews, and unfair claim denials.
Employers should consider very carefully all of their options and engage due diligence when selecting Plan providers of group benefits.
Finally, CIGNA is given a small twig for somewhat attempting to abide by the multi-state settlement agreement, but not informing all employees of the necessity of doing so. It’s unclear whether all CIGNA employees are aware of the new claims process requirements.