Testimonial For Linda

October 12, 2018

After working in Corporate America for many years, I became disabled and needed  to leverage a private long term disability policy that I had purchased when I was younger.  All I knew at that point was that I had been paying monthly for this policy for a long time and as far as I was concerned it should be relatively straightforward to apply for and receive my benefits.

As I took a good look through my policy it became apparent that I was in way over my head.  I found that it was  relatively easy to get  information about how to apply for Social Security Disability (many law firms specialize in Social Security Disability)) but the opposite is true for private disability.  It was just so hard to find “real world” assistance.

I searched for hours on end (weeks)  and somehow found  Linda Nee.  Linda was immediately responsive and having previously been in that industry, was able to provide accurate and invaluable information that I was unable to find anywhere else.

Rarely have I had the chance to work with someone so knowledgeable and so giving of her knowledge than Linda.  It is in that spirit I give Linda Nee and DCS Inc. my highest recommendation.

Thanks again Linda!!!

Thank You To All Readers And Supporters

Thank you to all of Lindanee’s readers who contacted me this week to let me know how helpful the blog has been to them. I’m certainly glad that the blog is helping so many insureds and claimants with the complexities of private disability.

Interesting, I receive calls from attorney insureds looking for information, (sometimes more than one), who never act upon my recommendations. I take that as good news, although they would have a much easier time with their claims if they “just listened to those who know.”

Lindanee’s blog continues to receive approximately 800 hits per day! I’m counting on you to share the blog with others, particularly those who are members of specific impairment support groups, or chat groups.

DCS, Inc. does NOT support the “Disability Forum” because it is run by those who continue to support the insurance industry and those who do not give full answers to questions asked. They operate as a type of bait and switch forum where they tell you a little bit of information and then suggest that you “call them for more information.”

I’ve never found the information given by administrators of Disability Forum particularly accurate either. In my opinion, those who are in the business of assisting insureds should pick a side, since playing both sides of the fence for money doesn’t help  insureds very much.

DCS, Inc. works exclusively for insureds and claimants and continues with a 98% success rate.

I’m thankful for all of your support and appreciate that you took the time to give me a call and let me know how much you like the blog.

Obtaining Copies Of Plans And Policies….”Why Is It So Hard?”

Most of the people I’ve spoken to lately describe their attempts to manage “issues” with, let’s say Unum, but when I ask if they’ve read their policies or Plans they say, “No, they wouldn’t give me one!”

Those who are participants in a group employer ERISA STD/LTD Plan should be provided with a Certificate Booklet and an “SPD”, or Summary Plan Description at the time of enrollment. Since the ERISA folks are not parties to the actual Plan, but are only beneficiaries or participants, they do not receive a copy of the full Plan document.

Despite the fact that many Group STD/LTD insurers send claimants back to their employers to obtain copies of  Group Plans, insurers are actually “co-fiduciaries” to the Plans and are adjudicating the entire policy, not a summary that was provided to employees.

Requests for copies of disability Plans are major time-consuming “pain in the neck” requests for claims handlers. Unum, in particular, has difficulty finding original copies of  IDI contracts as well as disability Plans even though they frequently cite provisions from them.

I know that one of the first things Tim Arnold did when Provident took over in 1999 was to do away with the policy room. Even then, Unum had problems locating original copies of the Plans and policies it sold. IDI policies provided to insureds are often marked “DRAFT”, which makes me wonder whether Unum is adjudicating the right policy or not.

The problem is that every response or issue addressed by claimants or insureds should be backed up by a provision from a Plan or Policy. A good example is the claimant who was led by Unum to believe he/she HAD to submit to a field interview. Once the Plan was received, however, it was discovered there was no provision requiring the claimant to do so. How can one defend what they don’t know? How would anyone know whether the computation for pre-disability earnings was correct? Or, if the Plan/Policy had a COLA provision?

Insurance companies are often known to interpret Plans/Policies in ways that benefit them. Therefore, if you aren’t keeping up by checking citations in your letters, you would never know if what the insurance company was telling you was accurate or not. Again, you cannot defend what you don’t know.

Claimants are entitled to copies of their ERISA Plans within 30 days of having requested them. Although insurers will provide IDI Policy copies, some companies such as Unum may charge $25 for them. Copies of IDI policies may also be obtained from agents/brokers; in most instances these copies are also “DRAFT” copies and not the final copy signed by an insurer.

If repeated requests to obtain copies of Plans/Policies fail, you can write to the U.S. Department of Labor or State Insurance Departments and request assistance in obtaining copies of Plans/Policies. I recommend that you do this if you’ve been repeatedly refused.

Although, as a consultant, I’ve never been refused when I’ve requested a copy of a Plan or Policy, I know that many claimants and insureds have been. Some employers cannot provide copies of their Plans, because they don’t have copies either!

I’ve found this to be true in several instances. Unum can’t find copies of their STD/LTD Plans and Policies because the company either misplaced them, or is so negligent it doesn’t know where the policies are. The Hartford completely lost an original policy, admitted it in a letter, and  now finds itself in a position of not being able to “enforce” anything.

Other companies don’t seem to have a problem providing copies of their policies to insureds although they  may charge a fee. What is important to remember is that it is absolutely essential to obtain copies of the Plan or Policy “in force” as of your date of disability and make sure your insurer adjudicates THAT policy.

Most of the people I spoke to literally “gave up” when their insurers refused to provide copies of policies. Don’t give up…..contact the regional EBSA (US Department of Labor), or State Insurance Departments for assistance. You’ll be surprised how quickly you receive copies of your Plans/Policies once you file a complaint and ask for help.

Please Feel Free To Call

Lindanee’s Blog receives better than 800 visitors per day resulting in as many as 50 calls per week. I’m very happy to answer quick questions, but callers need to leave their contact information with my answering service so I can return calls.

What seems to be happening is that insureds call, reach the answering service, but hang up and don’t leave any information. My answering service does not record any calls and sends me your contact information by email. I try to return as many non-client calls as I can in any given day.

If you really want to speak with me I need to ask you to please leave your contact information with my answering service so that I can return your call. Hanging up multiple times won’t put you in touch with me.

I’m happy to speak with you about your claim so please let me know how to contact you, and when you would be available to answer your phone.

One conversation could make things happen for you!

Thank you!

Mass Mutual Denies Mental Health Claim via IME

In the past, I supported Mass Mutual as a fair reviewer. In fact, it was commonly known that “Mutual” insurers tend to offer fair claims reviews since insureds are actually owners of the company and are treated fairly when they file claims.

However, over the last several years Mass Mutual descended into the abyss of egregious claim reviewers when the company showed signs of untimely review, interpretations of policy provisions unfavorable to insureds, poor customer service, and use of third-party biased medical reviewers to support terminations.

One such case in point is an elderly executive with a history of mental illness including several incidents of attempted suicide requiring brief in-patient care. Although his history is fairly complicated, he eventually was forced to sell his companies and file for disability because of his chronic pain and inability to manage his depression and anxiety.  The policy with Mass Mutual is for Lifetime and has no limitation for mental and nervous disease. The claim is also worth approximately 2.5M in financial reserve.

Mr. X. was able to manage his life, but just. With he help of his wife, he appeared to be managing his symptoms of chronic pain without the opiates that got him in trouble. After a physician prescribed medicinal marijuana, Mr. X. was able to continue counseling and was living his life with disability benefits until he got word Mass Mutual was demanding an IME.

On the day of the IME, a neuropsychological evaluation, Mr. X. was asked to complete questionnaires in a reception waiting room. The IME physician and his staff could only be described as “smart alecks” who took pot shots at the insured and moved him around from room to room for the test taking. To make a long story short, Mr. X. had to return for another session, and the IME was documented that he could return to work.

Those who have been diagnosed with mental health issues serious enough to stop them from working are generally managing life on the edge. The complex process of living with a disability claim in combination with the inability to manage basic life situations often deprives insureds of basic life skills needed in order to be successful.

Clearly, trying to manage through an unfair claims process that includes meeting deadlines, preparing multi-page updates, and submitting to external reviews, can seriously impair one’s ability to think and act in a way that produces successful claims.

I’ve had several recent dealings with Mass Mutual involving contract interpretation that is largely an Aesop’s Fable concocted to support not paying benefits in accordance with policy provisions. I’ve also been in contact with claims handlers that seem a bit spaced and not well-trained in the area of disability claims.

While Mass Mutual used to be considered a good company, there are evidences that it has now fallen into the devil’s den of unfair claims review. In addition, Mass Mutual is not the only company to slip into the abyss. In fact, it now joins Guardian/Berkshire as notable has beens in the fair review category.

Those with Mass Mutual claims need to be particularly wary of policy citations that are not contractual, and the use of third-party reviewers, including IMEs that are really arms of an insurance industry lending denial support.

Mr. X.’s claim in particular showed at least a $2.5M hit to profitability when it was denied. The decision to deny Mr. X.’s claim at his expense was a really bad one, probably one of many resulting from the new Mass Mutual mantra of denying claims unfairly.

Living With A Disability Claim – Spouses Who Take Over

In the twenty-five years I’ve been involved in the management of disability claims, I’ve occasionally been involved in several claim situations where disabled insureds are entirely over run by a controlling spouse. For the most part, it doesn’t work out – not from a claims perspective, or successfully being able to work with a consultant, or an attorney.

Just last week I was contacted by a woman who was looking into hiring me to manage her husband’s claim. After a rather lengthy discussion I forwarded my written Retainer Agreement for signature. When I received it back, I was perplexed to find my Agreement,  which had been prepared by my corporate attorney, completely re-written. Approximately, three-quarters of the Agreement had been wordsmithed and changed just for change sake!

When I asked the woman why she made the changes to my legal documents she said, “I would have thought you’d like to have changes made that makes it better.” “This is NOT a good sign”, I thought, “What I have here is a controlling spouse, and an indication of potential problems on the horizon.”

To begin, disabled persons already feel a loss much greater than their career or occupation they spent so much time preparing for. Sick, and troubled by their situations, many disabled spouses feel guilty about the loss of income and personal power to the point of humiliation in front of family, friends and co-workers. Controlling spouses can be either male or female, but in my experience, are predominately female.

Disabled individuals who are in pain or extremely ill must, by necessity, depend on others, and it’s easy to just look down at the floor and allow the non-disabled spouse to “help out.” Unfortunately, controlling spouses can quickly turn “helping out” into life-long control as they communicate with insurance companies, claims reps and even doctors on behalf of the disabled spouse.

This kind of control often escalates into obsession and disabled spouses never have a chance to speak for themselves. When I asked the woman looking to retain me why her husband couldn’t speak for himself she responded that her husband, a prominent member of the medical profession by the way, didn’t pay attention to detail very well.

Another problem with a controlling spouse is they are reviewed negatively by insurance reps. Viewed as rowdy and uncooperative, frequent internal notes in the record include the following;

• “Controlling spouse frequently calls to ask questions and is uncooperative.”
• “Spouse is attempting to control the claim, and informs physicians what to say.”
• Insured’s wife is communicating for the insured and I am not allowed to speak with the insured.”
• Insured’s spouse is demanding frequent communications and calls every day.”

I think you get the picture here. Insurance companies aren’t impressed when it’s clear the non-disabled spouse is attempting to control the claim and becomes a nuisance. Simply put, a controlling spouse is considered a red flag and claims receive the lion’s share of risk management. Not a good thing.

My concern as a consultant is, of course, the insured, and how he/she feels, or what he/she wants from the claim. While I completely understand that some non-disabled spouses take over because they are scared, and feel as if the claim is not done correctly there will be no money coming in, it is also important to include the insured in all decision-making and allow the disabled spouse to feel he/she is part of the process.

Occasionally, I do run into narcissistic behavior on the part of a controlling spouse, such as taking the liberty to completely revise one of my corporate legal documents and requiring me to appreciate that it was done in the end.

I know attorneys who have actually dismissed a controlling spouse, red-faced and steaming, to the reception room while the case was discussed alone with the disabled spouse. It might seem a bit drastic, but in some cases it needs to be done.

Controlling spouses who think they know all there is to know about the private disability industry and how business should be conducted cannot take a step back and accept better information from an expert. Releasing control of a disability claim is often very difficult for a controlling spouse, to the detriment of insureds as they look forward to receiving the benefits they are entitled to.

Disabled persons need to know they are still productive, useful human beings. Although there is nothing wrong with a spouse who is loving and supportive, the issue of “control” over one’s life and status is something entirely different. I recognize there might be a fine line sometimes between support and control, but I worry about leaving the insured behind feeling unimportant and “ditched” in the claims process.

Ultimately, there is also a difference between controlling in a family interactive sense, and attempting to control the claims process on behalf of someone else. Insurance companies do not have to deal with spouses without Powers of Attorney and often communicate just that to the non-disabled spouse who is giving the insurance company a hard time by thinking they know it all.

Those who are disabled need family support from those who can take a step backward when they need to and allow insureds the freedom to speak for themselves. It doesn’t feel good to be left behind in a process that actively involves disabled persons.

In the end, controlling spouses do more harm than good by thinking they are the only ones who know how to file and manage claims. Unfortunately for the insured, I did not accept this particular case and my legal document remains intact the way my lawyer wrote it.

The real victim here is the insured, who left alone to his own devices would probably have benefitted from my expertise.

 

Unum -“It’s Payback Time” – New POF?

Unum’s process for recapturing SSDI overpayments changed over the years from using a very straightforward “Payment Option Form”, to an unfair POF requiring voluntary liens on assets, to what is called, “Agreement Concerning Other Benefits.”

As most of you are probably aware, Unum offers claimants “an option” to receive reduced benefits or unreduced benefits while waiting for SSDI to make approval decisions. In reality, Unum “fronts” the amount of future SSDI awards as long as claimants agree to pay back the front money once SSA gets around to awarding benefits and paying the back money owed.

Although most claimants choose to receive unreduced benefits and pay back overpayments in a timely way, some claimants spend the money forcing Unum to reduce benefits to $0 until the full overpayment is recaptured.

As most of you know, I entirely support Unum’s efforts to recapture overpayments when claimants sign Payment Option Forms and agree to pay SSDI money back. Claimants who expect Unum to treat them fairly shouldn’t try to keep money that was promised to be paid back.

Unfortunately, Unum became weary of claimants who refused to turn over their SSDI overpayments and eventually came up with a Payment Option Form that forced claimants to agree to voluntary liens on assets – an action I totally disagreed with. Clearly, it was overkill, and placed claimants in situations of “no choice” either way.

Recently, I was provided with a copy of another version of a POF called “Agreement Concerning Other Benefits”. Actually, the form is very reasonable and states clearly the conditions under which Unum would agree to “front” SSDI money, and claimants’ agreements to pay back what is owed.

Basically, claimants agree to notify Unum within 48 hours of notification that benefits (or any other income paid ) have been approved, and pay back any overpayment due within 30 days. This places somewhat of a time crunch on Unum to calculate any alleged overpayment and communicate the financial outcome to claimants in time to allow overpayments to be paid back within the 30 days.

The new version of Unum’s POF is a much better form. I suspect the old POF may have been challenged legally forcing Unum to make a change to a better set of “conditions” for fronting SSDI money.

I don’t think claimants will have a problem signing the “Agreement Concerning Other Benefits” form for SSDI overpayments. The forcing of claimants to sign forms giving voluntary liens to assets was pretty nasty.