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FearI am writing this article to re-emphasize that although insureds are scared and are, in some cases, demanding that the claims process move forward as usual, everyone seems to be biting at the same pickle, including insurers.

The United States has not had to go through a national pandemic like this, (at least in my lifetime), so procedures, safety measures and functioning are all new. Insurers are struggling as much as any small business to keep things running – barely.

In the last two weeks I’ve spoken to every insurance company and they are telling me claims personnel are working at home the best they can without resources. Information is not being processed on a timely basis. Some insurers are asking insureds not to use emails, and only fax information to designated numbers. Employees are only required to check their voice mail once per day.

In the meantime, insureds are so fearful in some cases that they are actually attempting to obtain medical notes and signed update forms from physicians who have also sent employees home and closed their doors to patients. Demanding claim results just prior to the 1st Qtr. profitability end was hard enough not to mention the disorganized state currently going on.

I’m currently seeing a great deal of anxiety about deadlines, paperwork, completed forms etc., when it is unlikely the information will be reviewed in a timely way. One claims rep told me that he wouldn’t see a fax for more than four days!

Therefore, I’m recommending that insureds take a deep breath, and to the extent possible, calm down a bit. My recommendations in prior articles have focused on COMMUNICATION, (in writing of course), informing insurers about treating physicians and inability to obtain records.

My guess is that if insureds are under self-isolation, social distancing, or quarantine, they aren’t functioning very well either. Imagine what’s going on inside these big insurance companies when most employees are working at home. The claims process WILL NOT BE GOING ON AS USUAL, and  you will need to work within the current situation.

I can honestly tell you that in all of my recent communications on the phone with insurers, I have found that claims handlers have adopted a more “concerned” and “humanistic” attitude since they themselves are in the same boat. They have all wished me and my clients safety and good wishes; and, I’ve done the same.

The real problem is what to do with insureds who are so panicked about benefits that they are stressed out demaning answers and decisions that will not be forthcoming as early as expected. And yes, some checks are late. Unum seems to be the culprit, as usual. But, in all cases I’ve inquired about, the checks are LATE, not BENEFITS DENIED.

We are all dealing with situations that are unprecendented. Let’s everyone work with what we have, communicating your particular situations when required, and have a bit of calming common sense toward what is happening within the administrative processes of these big insurance companies.

Most Americans are struggling and claims decisions are just not going to go as planned for awhile.

 

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Hang onGod bless to everyone who has been hanging in there for the past couple of weeks. DCS, Inc. continues to work through may logistic problems with insurers, but please be advised that every claims handler I’ve spoken to has been very helpful and willing to work with me and my clients to provide paperwork and information. I’ve been doing a great deal of communicating on the phone, which is the quickest way to share information; and, we’re all working together.

While claims reps will tell you, “I don’t have access to a fax”, or, “I can’t scan anything in”, I’ve been finding ways to meet all of our needs. I probably have spoken to representatives of all major insurance companies in the U.S. in the last week and I have not noticed anyone deliberately attempting to deny claims during the current lockdown.

At the same time, DCS received quite a few calls regarding timelines cited in letters prior to company closings and fear that claims will be denied because of unmet deadlines. My readers should know that most medical offices have either closed their doors entirely, or have offered video conferencing/phone calls etc. in lieu of office visits. Most appointments have been cancelled until the middle of April at the soonest.

Insurance requests for medical records won’t be met, at least not for awhile, and insurers realize that. In addition, claims reps aren’t really paying attention to update paperwork deadlines, within reason of course. Please don’t expect “acknowledgements” for receipt of anything in the next coming weeks. You may get a letter, but mostly you will NOT.

The situation right now with insurers is that they are willing to work with, and around, various requests for information. I strongly encourage my readers not to take advantage of your insurer’s generosity in attempting to process requests later than usual.

Insurance companies are not behaving in ways that would lead me to believe they are taking advantage of anyone, even though this is very close to 1st Qtr. profitability results. It’s as I said earlier that insurers seem to be taking the high road here, both for their own employees as well as working with insureds.

The important thing for insureds to remember is not to push the panic button when it comes to their claims, and use common sense. If you feel you need help please call and consider coming on board as a client. However, from what I’m seeing, I’m not expecting insurers “to do bad things” in ” really bad times.”

Take care, and stay safe.

 

 

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Daily BuzzInformation I have is that most insurance companies have shut their doors and have asked employees to work remotely from home. Although I have still been able to reach, and speak to, claims reps, I’ve had to be persistent with phone calls. Some handlers are only checking their voice mails intermittently and can’t get back to you in a timely way.

What this means is that insurers will have a hard time processing information and communicating with insureds in a timely way. This probably isn’t a good time to submit new claims. In my opinion, although insurers will attempt to “work with” insureds and give extensions for completed paperwork, we ARE nearing the end of the 1st Qtr. profitability reporting and those claims in the works for denials may still be denied.

It is also not a good idea to begin contacting insurers by phone when in the past you have requested “all communications in writing.” Once contacted, claims reps may take advantage of having you on the phone and begin an interview you did not intend.

Nearly all of my client treating physicians have either closed their offices to all but emergency situations, or have opted for video conferencing and/or phone conferences instead of direct office visits. DCS is recommending that all insureds keep accurate records of video or phone visits with physicians, including what was discussed and recommended.

It is very important that insureds remain in “regular and appropriate care”, therefore, I am recommending that insureds abide by the alternatives treating physicans are offering. For doctors offices that have shut down without alternatives offered, communications should be faxed to insurers informing the shut down, particularly if current appointments were pendiing.

Communication with insurance companies will be the  key. Whatever alternative your treating physicians have chosen, it is important for insurers to know why they won’t be receiving updated patient notes and other requested information. Several patient records facilities have actually shut down entirely and won’t be sending any medical notes at all. You can’t send what you can’t get access to.

Clearly, those who have disability claims will need to work through different procedures and processes in the near future. Due to the large campus facilities most insurers have, it is likely they will be dealing with their own staffing and administrative problems.

I will continue to keep insureds informed as new information is given to me about insurers, claims, and general procedures.

Please take care of you and yours and remain healthy and safe.

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Daily BuzzJust say, “No”.

Recent information has it that Unum may be asking insureds to allow the company to speak with spouses and children. While I would think such a request is an obvious “stick it in your ear” kind of question, callers to DCS are flipping out about it wondering what will happen if they don’t allow it.

Spouses and children are not parties to any disability contract and are NOT required to be brought in as witnesses against their family members. It seems obvious that the reason for the request is to find “inconsistent” stories about activities by asking minors what the disabled parent is doing. Insurance companies do not have the right to involve, or bring in any persons who are not parties to a disability contract. This is true of peers, neighbors, and co-workers. This is one time Unum needs to be told “stuff it” and sent on its way.

Contestability

This issue only involves IDI insureds and can be a major stone in one’s shoe due to misunderstandings at the time of application and underwriting. “Contestability” as you know, is a provision included in IDI policies that provides both insurers and insureds with a buffer for information that is found to be inaccurate or misrepresented within 2 years of the Effective Date of Coverage. If any misrepresentations are found after two years, there is no penalty and claims cannot be denied or policies rescinded.

However, questions asked are often deceiving and not well understood. For example, Standard’s “Application for Disability Insurance” asks questions in two different ways:

  1. “Have you had, been told you had, been treated or diagnosed by a medical practitioner as having…..” There are 13 specific questions ranging from disorders of the eye, ear, nose, throat to cysts, back or neck pain, FMS and CFS, asthma, high blood pressure etc. In fact, Standard’s questionnaire makes one wonder if any disability would be covered.
  2. A second set of questions,  namely, “Other than as stated in other answers, have you within the last 5 years…?” This is an entirely different way of asking a question. Number (1) implies “have you EVER had”, and number (2) asks specifically within the last 5 years.

Some of these questions Standard asks are outlandish. “In the last 3 years have you had any physical or mental condition or symptom that has not been treated or diagnosed?” What does this question even mean? How is the insured supposed to answer this question? Did you have a headache…cut on finger…what? I remember Unum tried to get away with rescinding a policy because the insured never revealed she took Advil for a headache.

Again, contestability issues can be easily resolved by NOT filing claims for the first two years after the Effective Date of Coverage. Insurance companies go way beyond what’s reasonable with investigations regarding “misrepresentation.”

For those who may not know, insurers can rescind the policy, deny benefits, or engage in new underwriting recalculating what premium should have been had the misrepresentation not been made. In order to continue the policy, the insured would need to “pay up” all outstanding premium. However, it’s also likely the insurance company will exclude your current claimed disability from coverage in the future.

 

 

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Daily BuzzThe Standard just denied a ME/CFS claim using the age old argument of “subjective and self-report.” The recommendation to deny was made by a sole internal medical reviewer who stated, “there was no testing or objective evidence to prove the diagnosis.

Insurers have been denying CFS claims going all the way back to Unum UK in the 1990’s when physicians assisted the British government on how to deny ME/CFS claims and make it look legitimate. In fact, a great deal of research by Unum physicians was provided to the UK eventually leading to ATOS, the electronic system that controlled disability decisions. Although ATOS in the UK has since been discontinued, it is common practice for insurers to deny CFS claims.

Here is the United States insurers use “self-report” as cause to deny claims even when treating physicans strongly recommend disability. It’s no great surprise that insurers are still using the same unfair tactics to deny claims. The Standard, one of my defined “bottom feeders” is apparently jumping up the scale on CFS claims for 4th Qtr. profitability.


Claimants are receiving letters from CIGNA threatening benefits if claimants do not sign SSDI Authorizations to obtain files. One claimant received three letters demanding the signed release “so that we can decide your continued eligibility for benefits.”

Of course, this isn’t true. CIGNA knows quite well that it cannot force any claimant to release SSDI records. Readers should know by now that the reason why all insurers demand SSDI files is to inspect Form 831, locate aproval listings, and determine if benefits were paid on the basis of mental and nervous disease. This way insurers can limit benefits to 24  months. Although this should be “end of story”, some claimants are really intimidated by these letters.


Insurers such as Principal, and certainly others, are getting into the practice of sending out what appears to be questionnaires asking exactly the same questions that were answered on initial application or update forms. I suspect that claims handlers other than Unum’s are not reading files to determine what is in the file and what isn’t. Frivolous requests for information need not be answered multiple times.

The best example of this are the questions asked by field investigators when the same information is submitted to the file multiple times. Keep in mind that it’s not the questions field investigators ask that is important, but the rant, rant, rant some insureds get into that provides information not asked. Field investigators really don’t care about the template questions, but report only the rants.

Please be cautious of repetitive questions asking for information you’ve already submitted.


One of my clients reported to me that one of this year’s most sought after gifts is a surveillance door bell that can be easily hacked to provide information to the insurance company. Disability insureds should not have Alexa, or any other “talking” device inside their homes, or any of the versions of doorbell surveillance. Be very careful of any devices you have, including your cell phones that can be used to spy on you.

 

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Christmas GrinchThe beginning of December is hell month for Unum’s claims handlers as managers push the stress overload buttons to deny more claims. Anyone who has ever worked as a Unum claims handler will tell you it’s best to quit on October 1st and come back after the first of the year.

Unum’s claims managers are performance managed (and receive bonuses) on how well they roll in financial objectives, particularly in the 4th quarter. Therefore, you can imagine the hysteria that goes on trickling down from managers to their direct reports.

The process usually involves targeting claims at the beginning of 4th Qtr. and “risk managing” claims through the review processes to back-up denials. Increased claims are put on “Reservation of Rights” and claims handlers find themselves crying in their cubicles because of the amount of pressure put on them to locate and deny more and more claims.

Likewise, this is really not a good time for claimants/insureds who read posts like this and get an uneasy feeling all through the holidays. I wish I could spread the happier message of “sugar plums” and Santa’s reindeer, but the truth is disability claims have a 50-50 chance of staying paid through the holidays.

On a positive note, insureds can counter the claim targeting by making sure all requests from Unum have been met, medical information is specific, and complete, and that there are no outstanding issues going on at this time of the year. While its always a good idea to make sure Unum’s requests have been met (if reasonable), 4th Qtr. should be a priority.

Let’s just say: Don't grinch on my Christmas

 

 

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newslettersThis is just a reminder that DCS, Inc.’s subscriber July newsletter was sent out by email today. If you paid your subscription fee and did not receive it, please let me know so I can determine why you didn’t.

Readers can subscribe to the newsletter at any time and I will email all back issues as well as the most current. Information communicated in the newsletter is generally not placed on the Blog.

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