Over the last year or so DCS, Inc. has been contacted by both clients and non-clients concerning the 45-day allowable review periods for claims on appeal and otherwise. The typical scenario is that claimants really pay attention to letters from insurers indicating decisions will be made within 45 days. Although claimants depend on, and look forward to, [...]
Archive for February, 2012
Insurance Deadlines – ERISA – An Important Read
Posted in Claims Process, ERISA on February 29, 2012 | 8 Comments »
Mental Health Claims by Linda Nee
Posted in M&N Claims on February 28, 2012 | 5 Comments »
Most employer-sponsored group disability claims contain a policy provision limiting the payment of benefits for mental and nervous conditions to 24 months. Very few disability income (DI) policies contain such provisions, but occasionally we’ll find an old policy that has it. Unum, for example, closed most of the common loopholes over time in its ERISA policy language. Common [...]
Unum’s Claim Process – A Targeting Warehouse
Posted in Unfair Practices on February 27, 2012 | 5 Comments »
Nearly all generally accepted claims practices established by the National Association of Insurance Commissioners (NAIC Model Acts) and the Employment Retirement Income Security Act of 1974 (ERISA) require insurers to review claims in “good faith and fair dealing.” In addition, ERISA establishes “fiduciary” relationships which require both the employer and the Plan Administrator to “decide [...]
What Is “Risk Management” Anyway?
Posted in Claims Process, Uncategorized on February 26, 2012 | 10 Comments »
Over the last eight years I’ve written many articles and Lindanee Blog posts using the term “risk management” when describing the various internal strategies used by insurers to process claims. As most of you know the sale of insurance is profitable because of the concept of risk and the “law of large numbers”. “Risk” as [...]
Unum – Are You Asking For That Again? It’s In The File!
Posted in Appeals, Claims Process on February 26, 2012 | 11 Comments »
One of the most frustrating issues when managing Unum disability claims is receiving frequent requests for information already provided. Recently, a claimant with a claim on appeal received a letter asking for his help in obtaining records from one of his physicians. Upon further inspection of the claim file provided as part of the appeal, [...]
Claimant Bill of Rights 2012 by Linda Nee
Posted in NCDI News on February 23, 2012 | 4 Comments »
As a direct or indirect party to a legal contract involving insurance coverage for group disability or income replacement, you are entitled to legal and contractual rights of expectation that the provisions agreed to are adjudicated in a fair, unbiased and equitable manner by the disability insurer. You have the right of full disclosure. As the insured [...]
What Happens When…..Insureds Speak Directly to Insurers
Posted in Claims Process on February 23, 2012 | 15 Comments »
As you know DCS, Inc. consistently recommends insureds and claimants not speak directly on the phone to any insurance company including disability insurers. Here’s why: –Claims handlers are given management approved templates of questions specifically designed to encourage insureds to share conflicting information. These “TPC” (telephone personal conversation) templates are distributed to all claims handlers [...]
Unum – A Reminder About Actual Psychotherapy Notes
Posted in M&N Claims on February 22, 2012 | 12 Comments »
Recently, it came to our attention Unum claims handlers are once again attempting to obtain actual psychotherapy notes from mental health providers using Unum’s general authorization which specifically excludes patient notes from the form. It’s unclear to me what part of, “(except this authorization does not authorize release of psychotherapy notes)” does Unum’s claims staff not understand. The [...]
It’s Not Personal – It’s Strictly Business by Linda Nee
Posted in Claims Process on February 17, 2012 | 2 Comments »
One of the hardest realities in managing disability claims is helping insureds understand there is nothing personal in the claims process–it’s all strictly business. No one who has any contact internally with your claim cares about you as a person, nor is anyone looking to “do the right thing.” The insurance company is not concerned [...]
