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Archive for the ‘Pin It!’ Category

This is just a reminder that September is the end of third-quarter profitability results for insurance companies.  After the 15th of August, most insurers, particularly Unum Group will begin to find new claim targets to manipulate and plan for terminations.

If you begin to receive increased requests for information, notice surveillance, are notified by your physicians that insurers are harassing for patient records, receive field visit requests etc., your claim is on the target list for third-quarter profitability results.

Unum’s “hungry vulture” will be looking for vulnerable claims and will be engaging in unfair practices such as alleging physical impairments are mental and nervous limited to 24 months. Other insurers such as The Hartford, Reliance Standard, Lincoln National, Liberty Mutual, CIGNA, Aetna etc. generally engage in the same practices.

Insurers will be asking for increased Independent Medical Evaluations while they still have time to get the results back by the end of September.

Please feel free to give me a call to discuss your claim if you notice increased requests that should be managed to avoid the “hungry vulture” for third quarter!

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Don’t expect your disability claim to continue to be paid if you stop going to a doctor on a regular basis. Receiving benefits is often contractually contingent on remaining in treatment with a physician who is qualified to treat you for your claimed disability.

Surgeons, for example, are infamous for not permanently supporting disability with the statement, “there’s nothing more I can do for you.” Even so, if you are receiving disability benefits you must provide “proof of claim” of “regular and appropriate” treatment. Proof of regular care is provided via medical patient notes which is why so many insurers are so anxious to request them.

Insureds are recommended to continue with consultations so that documentation can be provided as “proof” that you remain in regular care.

“Appropriate care” speaks to the credentials of physicians you are treating with. Depression and FMS should not be treated by a family physician but a Rheumatologist.

Insurance companies are aggressively ceasing benefits for insureds who have “dropped out of regular care.” Even if your specialist tells you, “there is nothing more I can do for you”, the contractual regular and appropriate care requirement must still be met.

Don’t lose your benefits because you stopped going to a doctor for regular consultations.

 

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Pin itI think we’ve all known for quite some time how “influenced” state DOIs really are. Now, we know for sure.

It’s common knowledge that state DOIs are in the pocket of the insurance industry. In Maine, the Attorney General is also in bed with Unum and basically does what Unum tells the office of the attorney general to do.

Although the Maine DOI (Department of Insurance) was one of the three regulators involved in the Unum Settlement Agreement, the department refuses to enforce it and render additional fines.

With everything else that’s going on in government these days, it makes me wonder if anything is really on the up and up anymore.

Here’s a good article submitted by a DCS client. Thanks!

https://www.publicintegrity.org/2016/10/02/20020/drinks-dinners-junkets-and-jobs-how-insurance-industry-courts-state-commissioners

 

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Pin itGuardian has been on my radar quite a bit lately from not paying previous residual periods of disability, to irate claims handlers, to over-the-top investigations that cross the line into personal privacy issues.

Another insured called DCS today to report that already Guardian’s investigators have knocked on her door and she hasn’t even filed a claim yet! Notice of claim was given by a financial advisor (a story for another post) and as a result the company took off on investigating her with an impromptu visit from a private investigator who alleged “he was in the area and thought he’d  just stop by.”

I have never really regarded Berkshire/Guardian as a fair insurer, but for a long time my dealings with the company have been relatively good. Recently though the company and its representatives seem to have made a double-turn into aggressive investigation beyond what is required for investigation of a disability claim.

Unfortunately, the insured who called me today was a victim of two sources of awful information – a financial advisor who actually called Guardian to make “notice of claim” for the insured, and an attorney who refused to help complete application paperwork, but who recommended she apply for SSDI when the insured didn’t meet the criteria for SSDI. Oh my……

It has always been my experience that when a disability insurer seems to take an arbitrary left turn in “patterns of business practices”, management is redefining internal protocols to keep the liability acceptance rate down. I suspect in the last several years Guardian’s management increased its investigatory goals and practices and is redefining the claims process in order to pay fewer claims.

Guardian is really not doing itself any favors by gaining the poor public reputation it seems dedicated to have right now. Some have said that Guardian is not the company it used to be and many prospective insureds are moving over to Northwestern Mutual. Loss of market share isn’t a good thing for any insurance company.

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A Quick Pin It!

Pin itInsureds spend far too much time trying to change what insurers do when in fact nothing can change the already firmly established protocols of internal claims management.

Nothing insureds say, do, whine, rant or dispute will change procedures directed by management; and engaging in multiple requests to restrict activities of any insurer creates “red flags” insureds may later regret.

The only control insureds have over the management of their disability claims is to change how THEY do things in working with treating physicians and providing updated paper work and information.

Requesting all communication in writing is a necessary first step in maintaining control over the flow of information. Remember, insurers cannot hold against you what you do not say.

Maintaining good communicative relationships with treating physicians is also important in making sure you have an opportunity to view completed forms and other paperwork before it is faxed to insurers. Medical information without specific “restrictions and limitations” is useless to support disability claims.

In the end, insurers are “going to do what they’re going to do”, but you, on the other hand, can take the necessary steps to ensure the accuracy and completeness of what is being sent to the insurance company now.

Insureds who attempt to control the internal claims procedures of insurers generally regret it in the future. Insurance companies aren’t going to change what they do and most requests from insureds wind up on a “pay no mind list.”

The best course for insureds is to make sure they are knowledgeable and are taking all the necessary steps THEY can to place information in the record that makes it more difficult for insurers to deny unjustly.

Constant attempts to convince claims handlers to do things your way is not a winnable conflict and only adds more confusion, anger and frustration to the claims process. Those insureds and claimants who focus on their own actions with respect to claims are the most successful.

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