Archive for the ‘Best Practices’ Category

One of the things that has become increasingly clear lately is the absolute degree of “stupidity” that is taking place within certain insurers like Unum, The Standard, MetLife and Aetna. Claims handlers, managers, field reps, HUB investigators and Customer Service Reps all seem to have been infected with NOT KNOWING the jobs they are actually performing.

As a consultant, I speak to claims handlers and managers on a regular basis and “No one seems to know anything anymore.” At one time, Unum’s claims handlers had solid training on ERISA, but as The Standard’s claim rep told me yesterday, “You can ask my manager about that”, and I did. She didn’t know anything  either.

In fact, the “stupidity gene” is so rampant among insurers these days that I’m almost tempted to conclude it’s deliberate and deceptive. We now know Unum’s management has been dumbing-down its claims personnel for a long time. All you have to do is read a Unum deposition transcript with all of the “I don’t knows” documented in it to conclude the claims process at Unum is managed by a bunch of U-numbies – and that’s a fact.

Former employees tell me Unum’s training is mostly brainwashing “A type” personalities to presume all applicants are attempting to cheat the company. Do they know about the difference between and ERISA Plan and an IDI policy? Probably not, but they sure know how to identify “cheaters.”

In order for claims handlers to manage claims appropriately, they DO have to know certain things. Why wouldn’t The Standard’s claims handlers know about ERISA time lines when it is regurgitated in its letters to claimants time and time again? I recently saw a MetLife letter sent to a claimant that was devoid of spaces….all of the words ran together. Who looked at this letter before it was sent out and decided it was OK? Makes you wonder doesn’t it?

Although I’ve had multiple conversations with at least one of Unum’s reps, and appreciated working with him, most others are devoid of valuable information and have nothing for me. As one HUB investigator told me today, Unum’s reps are robotic, and interested only  in slamming its insureds to the wall.

In a way, insurance stupidity may not be a bad thing in that it is always preferable for private disability insureds to know more than the companies who process claims. I have always claimed that “knowledge is power” and have published information for nearly 16 years to better educate those who file claims.

So, keep the faith, and realize that a dumbed-down insurance process may not be a bad thing.  It is always better to manage claims from a position of superiority rather than equal dumbness.

Insurance claims handlers are at the bottom rung of authority for a reason.



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I’ve been in the private disability claim business for over 25 years, and in that time one subject I have consistently stressed for successful claims is not communicating with insurance companies on the phone.

Despite the many articles on this blog explaining in detail why it isn’t a good idea to share verbally with claims handlers, insureds continue to call and  begin with, “…when I spoke to Unum….or, when I spoke to my claims handler.” Obviously, I’m not getting through.

If disability insurance were any other type of business, insureds would insist on having everything in writing. Would you really sell a used car without a bill of sale?  As adults, we are all well aware of the “he said, she said” impossibilities of attempting to resolve differences, and yet when it comes to managing claims insureds are more inclined to “spill the beans”, or, “give away the farm”, than recognize the importance of prudence and restraint.

Private disability insurers train their specialists to use “selective documentation” when it comes to conversations with them. This means, diary records document only what is favorable to insurers (or, that which progresses the credibility plan of denial), at the expense of all else said that favors insureds. A Unum claims specialist who is rude and says, “So why aren’t you going back to work?” clearly isn’t documenting what he/she said, only your response.

Those who are taking opioids or other depression and pain medications shouldn’t be speaking to any insurance representative on the phone. Perception and reaction can be distorted and therefore responses cannot be relied upon to be accurate or in proper balance to questions asked.

When I ask callers why they speak to their insurance reps on the phone I hear, “Because I thought I had to.”

OK. Let’s be clear. No group ERISA Plan or IDI policy contains provisions requiring insureds and claimants to communicate with insurers on the phone. Disability contract documents may contain provisions requiring you to cooperate, but certainly insureds can be very cooperative with written communications. “In writing only” is the only way insureds can accumulate complete records of all of their dealings with any insurance company.

Insurance specialists know that if they can reach you on the phone and get you talking, you may just give yourself work capacity – a great outcome for a claims specialist whose performance reviews are based on how many claims they deny.

As I said I’ve been giving the same advice about requesting all communications in writing for 25 years; and, insureds may be reading, but some are clearly not listening.

Contrary to verbal communications my advice and recommendations concerning insurance website portals is fairly new due to the advance of technologies that allow Internet interactions. It didn’t surprise me to find out that insurance website portals present the perfect façade for tracking Trojans, and documentation to allege insureds have work capacity. Accessing insurance portals could be said to be another method of covert surveillance…along with social media.

One recent Unum denial letter cited an insured’s use of its website portal as evidence of work capacity and denied the claim on that basis. Although Unum recommends using its website portal, it uses the fact that you go there to deny claims. As a result, I’ve never recommended that any insured receive emails or communicate with insurers through any website portal. Still, people keep going there to receive communications knowing full well that they are risking benefits.

So, why do you think insureds and claimants deliberately go against best advice and practices? I’m not a psychologist by any means, but it seems to me that because the claims process is stressful, worrisome, and frustrating, the only way insureds can “feel better” is to subject themselves to verbal or direct contact to obtain reassurance. Literally, insureds “take a breath” and feel calm about their claims after a “good chat” with the claims handler. Oh my……..

In other words, a phone conversation or website contact “calms the nerves.”

As a consultant I can only make the recommendations and communicate best advice; it’s up to insureds and claimants to listen and follow through.

I don’t really mind being ignored, but I do mind when I hear about claim denials that should never have been allowed to occur. I can only point you in the direction of success, but it is up to you actually implement the expert’s advice.




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This past week DCS, Inc. received several calls from avid readers of the Blog requesting assistance. Unfortunately, after talking with them I discovered their claims had recently been denied.

One of the most frequent topics I address on Lindanee’s Blog is the need for prevention of denials rather than having to deal with the risk of an appeal after the fact. DCS, Inc. is entirely about preemptive action and prevention of denials. This is not to say that I guarantee successful claims, but it does mean that having a claims expert on board to assist, particularly someone with direct claims experience does make a difference.

Once an ERISA or IDI private disability claim is denied insureds basically have two choices: 1) do the appeal yourself, which I do not recommend, or 2) attempt to find an experienced attorney who is willing to take your case – a very expensive option.

There are many things that can be done to place medical, occupational, and financial information in Administrative Records (ERISA), or claim files (IDI) that support disability. I can’t tell you all of them here because this information is proprietary to me and DCS, Inc. and represents a total strategy that consistently produces a 98% success rate.

Please give some thought to the benefit of assistance vs. claim denial. I would like to help, but you really need to contact me before your claim is denied, not after.


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One of the things I hear most often from insureds and claimants is that they spoke with insurance representatives on the phone and suddenly they either begin to receive outlandish requests for information or their claims are denied.

Although I’ve been writing and posting for years that it’s not a good idea to speak with insurance reps on the phone, many people still take the risk of doing just that. Insureds are either so scared they think they have to, or sincerely believe if they don’t their claims won’t get paid. Neither one of these are true.

In the interest of trying to explain [again] why it’s not a good idea to speak with insurance reps on the phone, please note the following:

  • Insurance reps are trained to document what you say through “filtered listening” techniques. Anything you say to reps is not documented the way it is said, but is “translated” in adverse ways.  Insurance reps can never “tell a straight story” and aren’t encouraged by management to do so either.
  • If disability insurance were any other kind of business insureds would be falling over themselves to get “it” in writing. All insureds should request to have all communications in writing so that they will have a permanent written record of all of their dealings with the insurance company.
  • Today, insurance reps like to speak to insureds to obtain additional family and social information that can be used by investigators to “hunt down” children and “friends” from Facebook. I’m seeing more and more denial letters containing information from Facebook “friends” about descriptions about outings and other activities.
  • Attitudes of, “I have nothing to hide” often encourages insureds to share more information than is necessary to investigate any disability claim. Not having anything to hide is NOT the point, and it won’t stop insurers from “interpreting information in their own favor.” This is also true of surveillance when insureds are cavalier and say, “I have nothing to hide.” Once you are observed engaging in activity with “nothing to hide” it quickly turns into “work capacity”. Please remember this.
  • Claims handlers can’t harass or abuse you in written letters that become part of the record. If you have a rude claims rep why do you spend the effort to listen to that kind of exchange? You won’t be abused verbally if you insist on everything in writing.
  • Anyone taking opiate or other pain or depression medications should not be speaking to any insurance reps on the phone. In my opinion, those taking certain medications are not able to respond accurately to questions asked simultaneously. At least responding in writing allows insureds to actually “think” about what their responses should be. Claims handlers know “you’re fuzzy” and take advantage.
  • Although my impression is that most insurers are NOT recording conversations, some still do. If you are unaware and say something detrimental to your claim, it can be discoverable in a court of law. Written communications are a matter of record and pretty much say themselves.
  • Claims handlers are given standard templates of information to ask about you, your activities and family. Much of the information is subject to interpretation and can be used against you. How many times have you said to your claims handler, “I never said that”, or, “that’s not what I meant?” What you actually said is never documented.
  • Insurance companies cannot use against you what you do not say.
  • Once something is said to an insurance company, you can’t take it back.

Another way of getting your goose cooked is to have an Internet presence. Recommendations to insureds and claimants – No Facebook, no LinkedIn, no Twitter, no website leftovers – nothing. The whole purpose to Facebook is “socializing” and the worst thing you can do is communicate and share photos and give the insurance company names of your friends, children and family.

Let’s not underestimate the hackers, they can get into any Internet media and use information against you. In fact, many insurers of auto and life insurance also hack social media for underwriting information. Insureds and claimants need to be “off the Net” entirely for the period of time benefits are payable.

Stay away from emails and insurance website portals. Emails are not a good way to communicate. Some insurers do not allow communication by email, others encourage it. The problem with emails is that they may or may not be added to the official record. Insurance website portals have tracking software attached to it that tracks insureds all over the Internet.

Although I’ve been writing articles about communications with insurance companies for many years, not everyone adopts my best practice suggestions and continues to speak with insurers on the phone. I really don’t know how I can more clearly communicate the dangers of verbally communicating with reps who do not accurately report what you say other than provide you with the above information. The above are “best practices” in claims management from the perspective of insureds and claimants.

If you are looking to cook a goose today, please make sure it is not your own disability claim. There are many ways for insurers to use your own words and statements against you. I recommend all communications in writing in order to accumulate a complete written record of all dealings with any insurance company.

Please feel free to give me a call to find out how DCS, Inc. assists insureds and claimants with managing communications with insurers.


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As a consultant I’ve always held the opinion there is something inherently wrong with a disability insurer who sends a letter to an insured with inaccurate statements. In fact, some statements are so obviously inaccurate one has to wonder whether those who make them are qualified to review claims at all.

Mass Mutual recently sent an insured a letter stating, “…as a patient you are entitled to these [psychotherapy notes] records.” This statement is grossly inaccurate and I would have thought Mass Mutual would know better.

Very rarely will therapists and psychiatrists release their patient notes directly to mental health patients. It makes good sense not to do so since what is contained in the records could potentially be harmful to those who are reading them. In some cases, therapy notes have been noted to be the cause of patients attempting to hurt themselves and therefore, it is generally recognized that therapy notes should not be released to mental health patients.

In addition, therapy notes are regarded by mental health professionals as proprietary to them written for the purpose of “reminders” of what took place during therapy sessions. Therapy notes are NOT written for the purpose of verifying disability through mental health restrictions and limitations. Mental health providers now regard patient notes as private references for their eyes only.

Over the last several years those who provide mental health therapy have noted the misuse and misrepresentation of information by private disability insurers to the extent that they themselves have office policies not to release therapy notes to anyone. More often providing “actual psychotherapy notes” to companies like Prudential and Mass Mutual hurts insureds more than they help.

Here’s how:

Patient notes rarely document “affect” which is an observation of how the patient’s reactions are, (flat or normal), and therefore insurers use this omission to deny claims. Prudential, for example consistently states in denial letters that the therapist failed to comment on “affect” and denies claims just on that basis.

Most behavioral therapy does not require neuropsychological or other tests to diagnose clinical depression and many other anxiety states. Yet, insurers look for documentation of “objective testing” in the notes when most therapy does not require it, or there is a lack of psychological tests available to diagnose specific conditions. There is a non-acceptance of WHO DAS 2.0 (in lieu of the GAF Score) by insurers, and clearly isn’t considered “objective evidence.”

In other words, if the actual psychotherapy notes do not contain exactly what Prudential and Mass Mutual want to see, claims are denied. The expectation that all therapists document what is needed by insurers to evaluate claims is unreasonable and ultimately unfair.

In the past, Unum denied a depression claim because surveillance showed the insured having sex with his girlfriend in the woods. Patient notes were submitted to Unum but were not considered as compared to the surveillance. Therefore, according to Unum those with depression aren’t supposed to be having sex. What idiocy!

Recently, Mass Mutual threatened an insured with claim termination if he didn’t obtain his therapy notes and submit them. Mass Mutual’s claims manager told me personally, “Those records belong to him and he needs to obtain them and provide to us.”

The letter clearly said, “No additional payments will be made until we receive the daily treatment records from [your doctor]. What if this patient’s therapist refuses to release his patient notes? Should Mass Mutual penalize the insured because his therapist refuses to release notes? And, even if the psychotherapy notes were released, Mass Mutual (Prudential in particular) will allege the notes do not contain sufficient detail to continue to pay the claim.

Are you getting the idea that mental health insureds and patients are “clucked” regardless of what they, or their therapists do?

In any event, Prudential and Mass Mutual continue to insist on psychotherapy notes, which by the way, is an out-of-contract request. No where is anyone’s policy or Plan is there a duty or requirement to submit actual psychotherapy notes as “proof of claim.”

When I asked the Mass Mutual claims manager to fax me the page from someone’s policy requiring submission of actual psychotherapy notes, she gave me the run around and then said, “but our Authorization allows us to request them.” That’s true, Authorizations may request submission of notes, but that doesn’t mean the therapist is willing to release them.

Unfortunately, ERISA Plans often include the phrase, “…satisfactory to us…” which  permits “discretionary authority” to the insurer to decide what is and what is not “proof of claim.”

Mental health claims remain a constant source of controversy as insurers continue to deny claims for failure to submit actual psychotherapy notes they may not be entitled to.

Therapists should be able to submit mental health restrictions and limitations in summary form (filling out forms or submitting letters) rather than giving up patient notes not intended for the validation of private disability.







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As a disability claims consultant I can certainly understand how it could happen that insureds become so angry and frustrated with the claims process that they can’t see anything else except to “make them pay” and “admit everything they’ve done to me.” Although “seeing red” when it comes to managing a disability claim is a common reaction to abuse, anger, rant and non-cooperation doesn’t move claims forward at all.

The fact is, the disability claims process IS frustrating, harassing, and comes at a time when insureds aren’t feeling well and find it difficult to put up with claims handlers who just won’t pay claims. Unfortunately, once insureds really get angry, everything insureds do or say becomes suspect and claims fall into what seems like a bottomless pit of going nowhere.

Some insureds actually act counter to provisions that specify their obligations to meet criteria of Plans or policies. Not too long ago DCS was forced to fire a client because he refused to arrange to go to an IME despite my recommendation that he should go. This particular insured also did not provide the insurance company with the “whole truth” and therefore I could not continue to assist him. The reason? According to this insured, the insurer (Northwestern Mutual) was dishonest and was trying to “trip him up.”

In addition, we’ve come across some claimants who suspect everything, demand repeated proof, and accuse insurers of “lying”, and engage in “letter wars” that also gets them no closer to claim decisions. Most of my readers know I would be the first one to tell you that disability insurers are dishonest and delay or deny payment of claims. At the same time, constantly arguing small “who done it” points is trivial and in general puts insureds on a merry-go-round they can’t easily get off of.

Although insurers should base their investigations and opinions only on the unique facts of claims, there is credibility and “appearance of honesty” suspicions that arise referred to as “red flags”. Constantly contacting claims handlers (remember we do not recommend communicating by phone), and arguing, or engaging in “letter wars” isn’t productive to the claims process and will most likely produce denial decisions.

Therefore, while I validate anger reactions of insureds and claimants to the disability claims process, I certainly do not recommend engaging in constant rants with insurers. Recently, a new client came on board with major issues concerning Guardian. By the time he made a call to DCS he mistrusted everything the company did to date, had not been paid, and was in tears during most of the call.

During our conversation he reiterated that he wanted “proof” of this, and “admission of wrongdoing”, and “statements in writing” etc. It also became apparent during the call that his impairment was due to Bipolar and cardiac issues. One thing was certain – he was so mistrustful of Guardian and had been harassed to the point of desperation by the time he contacted DCS, that his only motivation was to “make them pay for what they did to me.”

“I want every damn thing they owe me”,  he said, “and I want to put them out of business.”

The unfortunate missing part, however, is that this poor insured still had not been paid benefits due to him. Within several days, DCS was able to work with the insured to the point that together we were able to support his claim medically, and he received a $40,000 check in the mail. I could not get him to stop crying.

In this case I think Guardian brought most of the anger and suspicion upon itself by demanding a field interview with both the claims handler and a field investigator (Guardian calls them “Technical Consultants?’) showing up to ask questions of someone diagnosed with Bipolar Disorder. Of course, this interview wasn’t going to go well and it didn’t. This is an example of what I mean when I say, “disability insurers know very little about disability.”

Also, well-intentioned, but inaccurate information provided by friends and neighbors can also incite one to wrath and isn’t always helpful either. Insureds who file disability claims need accurate information about the claims process, not opinions from those who really aren’t “in the know.”

Instead of acting upon anger, overreaction and suspicion, insureds and claimants should be more focused on “solving the problem” which in most cases is “paying the claim.” Insureds who find it difficult to calm down and act accordingly could benefit from having a consultant sort through what’s needed and getting the job done.

In any event, ranting and arguing with insurers doesn’t result in timely payable claims. Again, although I validate the feelings of anger and frustration with an impossible claims review process, I do not recommend constant suspicion on the part of insureds that makes them appear uncooperative, out of control and vindictive.

Ranting and arguing with an insurance company causes those who are reviewing claims to conclude, “the insured is crazy”, and creates “red flags” that lead to the lion’s share of investigation. While Unum might just laugh and go on investigating, Guardian is more apt to investigate more intensely and be suspicious of everything that happens moving forward.

Perhaps you may not have thought of this situation in these terms, but there are only two decisions insurers can make as a result of filing a claim – pay the claim, or deny it.

A successful outcome is when an insurance company pays benefits under the terms of the policy. Arguing and ranting and trying to get the reps fired isn’t going to give you the claim result you are looking for.


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Last week I received several phone calls from insureds who said they are using Lindanee’s Blog to manage their claims. Lindanee’s Blog was originally created in order to provide accurate information concerning private disability since much of what is found on the Internet is basically misinformation.

While I’ve tried to provide readers with basic “good claims practices”, Lindanee’s Blog is not intended to be a workbook for everyone on how to manage disability claims. Each claim is a unique situation, and the truth is, my Blog represents approximately 10% of the information required in order to manage any disability claim.

I’m also concerned that it appears many insureds are actually “researching” information on the Internet and are accepting the case stories they find as gospel applications to their own claims. Most of what is found on the Internet is told from the worst possible scenarios. So, please allow me put this into perspective.

If disability insurers denied as many claims as the Internet suggests, they wouldn’t be in business. Based on my 25 years of experience and my own consulting practice it appears to me that insurers pay between 40-50% of claims. Of course, Agents won’t tell you that when they sell you your policy, but overall I believe the number is correct.

Most insureds probably aren’t aware that private insurers underwrite their policies and charge premium on a liability acceptance rate of 60%. Therefore, coming out the gate, insurers only plan to pay 60% of claims at the time they sell their policies. In my opinion, ERISA business only pays up to 50% of claims due to the targeting of vulnerable claims, and also due to the 24-month change in occupation and 24 month limitations for mental and nervous claims.

Given all factors considered one could say, that any insured or claimant has a 50/50 chance of having a disability claim paid to maximum duration. Of course, it should go without saying that transference of any information found on the Net to your own claim is not a good thing, and I include Lindanee’s Blog in that analysis.

The articles posted on Lindanee’s Blog are written to a generalized audience for the purpose of providing information about private disability insurance at least equal to that of the  insurance company having discretion to pay or not pay claims. It is not intended to be an instruction book on how to manage claims because the information is not “all there is to know” about disability claims.

In a way, there is no way I could post enough articles to give readers the benefit of my 25 years experience — it’s just not possible. In addition, I wouldn’t remain in business very long if I gave out all of my proprietary information to the public via a Blog.

It’s pretty scary to me to realize that we’ve gone from sarcastically saying, “Oh, it’s in the newspaper so it must be true” to “it’s on the Internet and it IS true.” Just go the YouTube to see that most of what’s there isn’t true at all.

Although all of the information here is accurate and is very helpful, it isn’t the whole story and insureds should make note of that. I hear a great deal of feedback from claimants who tell me, “Linda you nailed it! This is exactly what my insurer is doing to me”, and although that may be true for many people, it clearly isn’t true for everyone.

I’m proud to be of help to insureds and claimants and I’m glad the information published on Lindanee’s Blog is useful to those with private disability claims. However, every claim is different, and not every piece of information is applicable to every claim.

I also hear a great deal from insureds, “I have a friend of a friend of a friend who told me”, or “I have a close relative who is a lawyer who told me…but he doesn’t specialize in insurance law”, or “Someone I worked with who had a disability claim told me…” Albeit good intentions aside, insureds must realize that such information is coming from those who are not qualified to render opinions.

Thank you to all those who continue to support Lindanee’s Blog, I hope the information here is helpful to you, but it is not intended to be an instruction book on how to manage disability claims.

Every claim is unique, with differing sets of circumstances and requires responses and actions that relate to the claims directly. What seems appropriate for one claim, may not be for all others.

Please let me know if you have any questions in addition to what’s here on the Blog.

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