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Archive for the ‘Social Security Disability’ Category

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I’ve been saying this all along, but now it’s official. Please pay attention.

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Invasion of PrivacyPrivate disability insurance companies are well aware that American citizens are not required to give permission to release SSDI files in order to receive disability benefits. However, it’s often Americans themselves who are entirely oblivious to the fact that they are not required to give up their private SSDI records in order to receive disability benefits.

Although all group insurers position requests for SSDI files as “necessary in order to give your claim every possible consideration”, the truth is that insurance conflicts of interest exist that allow insurers to use SSDI information to their own benefit. While it IS true that group insurers ARE entitled to copies of SSDI initial award letters to verify offset information, it is NOT true that claimants must give up copies of their files in order to receive benefits.

What makes SSDI information so attractive and essential to companies like Unum, The Hartford, Aetna, Reliance Standard, CIGNA etc., is SSA Form 831 that is generated internally at SSA giving specific listing numbers under which claimants are awarded benefits. Should one or more of those listing cite “mental or nervous” disorders, Unum and others will use that information to limit benefits to 24 months under the Plan Mental and Nervous Limitation provisions.

In the past, Unum’s efforts to “invade” SSDI were pretty scary, although I don’t believe the company’s efforts to obtain information have improved all that much. I heard stories of claims managers insisting claimants remain on a conference call phone line with SSA in order to get through the menu and allow the claims handler to speak with a DDS (Disability Determination Specialist) about SSDI claims. No claimant should allow this by the way, but Unum in particular feeds on SSDI information to use it against claimants to deny claims.

To be clear, claimants ARE NOT required to sign SSDI Authorizations releasing information to any insurance company, and can protect all file document information as private health information. Claimants are only required to provide a copy of the initial award letter so that insurers can begin offsetting benefits as appropriate. If insurers are so prone to errors in offsetting SSDI awards, they should not hold claimants responsible or demand repayment for their own mistakes. At some point insurers need to get this right.

“Notices of Favorable Decisions” resulting from ALJ Hearings should also NOT be forwarded to any insurance company since these letters contain information that can be used adversely to support termination of claims. It is normal to receive the “Notice of Favorable Decision” first and the actual approval letter from SSA about a month later. Only the actual approval letters should be provided to insurers.

In any event, the motivation of any insurer in insisting claimants provide copies of their SSDI files is to look at the award listings, obtain the name of the DDS (person who made the decision on your claim), and use the information to support a denial or limitation of benefits to 24 months. Unum’s request is deceptive because the company, “is not asking for the file to give your claim every possible consideration”, but to use SSDI determinations to back-up claim denials.

Clearly, the intent, or purpose of the request scam to obtain SSDI files is to use the information against claimants. Unum’s usual mantra is to say in the denial letter, [paraphrased] that “Unum was able to obtain more recent medical information that SSA did not have at the time of the initial award, and therefore Unum disagrees with SSA’s approval and is denying the claim anyway.”

Apparently, the profitability denial numbers added up because Unum hired Lucens to chase down SSDI financial information from unsuspecting claimants – little more than an administrative nuisance.

Again, I’m glad to say that most insurers do not actively pursue copies of SSDI files. The exception is Unum, and on occasion The Hartford. Claimants are NOT required to sign SSDI Authorizations to release files to Unum or any other insurer.

I strongly recommend that claimants consider very carefully whether they want to buy into the SSDI file disclosure scam or protect the privacy of the information given to SSA. Remember, the real intent of insurer SSDI file requests is to obtain information that can be used against you, not for you.

Just say no.

 

 

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SSB ApplicationsPeople are always emailing me asking if they can “get away with this”, or “get away with that” when receiving SSDI. I do not answer these types of questions because I do not support what is not truthful.

A reader sent me the below article and I thought I would pass it along. As most of you know I do not recommend using social media at all when receiving benefits. However, not everyone listens to good advice.

It’s important to remember that most people who apply for SSDI are in fact honest. However, those who are receiving benefits by fraudulent means threaten the continuation of benefits for those who ARE honest. This is equally true for those on disability.

Social media is not recommended for anyone receiving disability benefits regardless of the source.

I also have to add that my readers should note that this article comes from the New York Times and decide for yourself whether it is credible or not.

https://www.usnews.com/news/national-news/articles/2019-03-11/trump-administration-wants-to-monitor-disability-recipients-social-media-accounts

 

 

 

 

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Bad ideaDespite the number of posts I’ve written recommending against third-party SSDI advocates, I still get phone calls from insureds who were talked into hiring GENEX, Allsup, Advocator’s Group and other companies as SSDI Advocates. Despite all of the information out there about how awful and negligent these companies are, claimants are still persuaded to sign-up – a very bad idea!

Third party SSDI agencies work for the insurance companies who sell their services not you. In fact, Advocator’s Group is not an advocate at all, but an extended arm of the companies they represent and work for. The overall goals of a third-party SSDI advocate are:

  • Claimants can be more easily persuaded to file for SSDI if they are assured “an advocate” is involved. A recommendation from the insurance company is usually enough persuasion particularly when they sell the service as “free”.
  • Third party advocates share and communicate all information received with the company that hires them. This means any communications from SSA, forms, medical records etc. are available to the insurance company.
  • Insurers want to make sure all of their claimants file for SSDI. Hiring a third-party advocates assures that, Unum for example, can be reassured the application was made.
  • Third party SSDI advocates will refuse to take a case if after they review it decide SSDI will not be approved. Therefore, it’s cheaper if GENEX refuses cases that might be denied at first.
  • As agents for insurers, third-party advocates work explicitly for the insurance companies that hire them and all information is disclosed to them.
  • Overall goal is to obtain SSDI approval decisions regardless of what SSA listings are used – for example, mental and nervous listings that limit benefits to 24 months.

DCS does not recommend claimants “go along” with insurers when these third-party advocates are pushed at them by claims handlers. Most claimants I’ve spoken to don’t even know they have a choice in who they hire to advocate for them, mainly because, Unum, for example, doesn’t give them a choice. Unum’s letters just say it is referring you to GENEX or Advocator Group and that’s it.

I recommend that claimants seek out SSDI attorneys in their general locality, perhaps in the same county, who can represent them without any obligation to anyone other than clients. Any information obtained or provided to your SSDI attorney is “privileged” and cannot be shared with the insurance company. If you want to keep your SSDI information and file private (which you have a right to do), there is no problem doing so.

Specialized SSDI attorneys are all equally good because that’s all they do. I don’t recommend hiring an attorney unless he/she specializes in SSDI, and can show a history of SSDI approvals particularly through the Administrative Law Judge hearing stage.

Finally, local SSDI attorneys are familiar with the ALJs and most likely have presented before them many times before. Third-party Advocates have not had such experience, and in a majority of cases attorneys aren’t even assigned to your cases.

The overall message here is that no claimant is required to “buy into” the sales pitch of hiring any third-party SSDI Advocate recommended by disability insurers. You have the right to hire your own attorneys. Since SSA regulates fees that are on contingency, meaning your attorney won’t get paid until you do, there is no immediate cash outlay to hire your own attorney.

It occurs to me that hiring any third-party Advocate is a type of estoppel in that while applying for SSDI is sold as a good thing for claimants, the information obtained in support of SSDI, when turned over to insurers, can also be used against claimants to deny claims.

SSA allows payment of fees at the time of the award of 25% of retroactive benefits up to a maximum of $6,000. SSDI attorney fees are deducted from the retroactive payment automatically. Although not widely known, claimants can challenge the amount of fee paid to their attorney if the attorney put in a minimal amount of time or effort.

So why do claimants still bother with companies like GENEX, or Allsup, Advocator Group, and Human ARC? Probably because claimants are deliberately given the impression that turning the process over to the popular insurance SSDI gopher seems to be the shortest distance between two points.

It really is a bad idea to turn over SSDI advocacy to any agency recommended by your disability insurer. SSDI Advocates DO NOT WORK FOR YOU. It’s a much better idea to find your own SSDI attorney and protect your “privileged information.”

To terminate any current relationship you have with a third-party Advocate simply send a fax to claims handlers letting them know that you are terminating services with GENEX, Allsup, Advocator Group etc. and that you either are in the process of finding your own attorney, or already have your own attorney. Once you have retained your own attorney, have him/her write a brief letter informing your insurer that they represent you. A release is generally sent to your attorney from the previous Advocate so that SSA is aware of the change in representation.

Once SSDI is awarded, any attorney’s fees indicated to have been paid are deducted from the overpayment owed back to the insurer.

Finally it has been reported to DCS, Inc. over and over again that internally referred Advocates are highly unreliable, do not maintain reasonable communications, hire paralegals not attorneys, rarely return calls, and generally make a big mess of the application process leaving claimants not knowing where their application is in the process. This is consistent with the overall goals of outside Advocates meeting the needs of insurers, not claimants.


If you have any questions about this, please feel free to give me a call. Although I do not do SSDI applications anymore I certainly can answer your questions. Claimants should be represented by attorneys in their own counties or administrative districts.

As I indicated in another post, I’m counting on my readers to share this information with others. Claimants need to know they have choices, and do not have to follow the direction of the very insurers who benefit from from their own referrals.

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No harassment zoneDCS is receiving quite a few calls from claimants alleging daily phone harassment from GENEX looking for sign ups for SSDI assistance. Unum’s letters are deceptive giving claimants the impression insureds have to go with GENEX when in fact they do not.

Even though I’ve written about this so many times, I will repeat myself again……Claimants DO NOT have to go along with any third-party SSDI company such as GENEX, Allsup,  or Advocator Group, in order to file for SSDI. Although most insurers make it sound as though claimants have no choice, that is certainly not the case.

First of all GENEX has a conflict of interest. Since Unum advertises that this service is free to claimants, how IS GENEX being paid? GENEX works for Unum, provides all of your information to Unum, and acts as a conduit with SSA to continue to provide information to Unum.

In addition, not all of GENEX’ “help” is from attorneys and there are disadvantages of using GENEX such as reported failure to return phone calls and keep claimants up to date on the status of their applications. Current reports to DCS indicate GENEX calls claimants every day to harass them until they eventually sign up with them. I don’t recommend doing that.

I recommend that claimants find SSDI specialized attorneys in their own location or county. If you later have to appear before an Administrative Law Judge, chances are that your local attorneys know these judges and know what is expected for presentation. National companies such as GENEX would not have that advantage.

Finally, all information provided to an SSDI attorney is PRIVILEGED and insurers cannot get access to it. In fact, I do not recommend to claimants that they sign ANY SSDI authorization to release information. Claimants often do not realize that there is no Plan or policy provision requiring them to release SSDI information to anyone – insurers, GENEX, or Lucens.

DCS doesn’t recommend signing SSDI Authorizations. But, the next hysterical question I always get is, “But will they cut me off?” Good grief……if there is no provision in any Plan or policy requiring you to disclose your SSDI information, how could Unum or any other insurer “cut you off” for not giving permission to get it? This is fear talking, not understanding of how Plan/Policy works.

In any event, phone calls from GENEX everyday is harassment you do not need to put up with. Notify your claims handler, in writing of course, that you either have or will be retaining a SSDI attorney, and you would appreciate it if they would contact GENEX and stop the phone calls. When you actually do have a SSDI attorney, have him/her write a letter on their own letterhead informing Unum they are assisting you.

Finally, insurance companies reduce the amount of overpayments due by the 25% paid to an SSDI attorney, so you are not paying the fee twice. Don’t let GENEX, Unum or any other insurer push you to hire their third-party advocates to help you with your SSDI application. AND……..you don’t have to sign any authorizations to disclose your SSDI files; you may choose to keep that information private.

It’s not in your best interests to sign any SSDI authorizations to disclose.

 

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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.

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After receiving several more calls this week about Unum, Lucens, overpayments etc., I think it’s time to include a post on Lindanee’s Blog about insureds’ rights to keep Social Security information private. To my knowledge there is no Plan or policy on this planet that contains provisions requiring insureds/claimants to release SSDI files to disability insurers as proof of claim. Claimants are not required to disclose their SSDI files and may choose to keep any requested SSDI information private.

Some claimants really need to get their heads wrapped around this basic truth about disability accountability since SSDI and private disability are two separately distinct sources of income. SSDI is a federal entitlement, paid for by workers and their employers so that employees can have the expectation of receiving federal assistance for retirement  and/or disability.

Employer provided private group disability insurance is an employee benefit provided to “participants” to replace wages with reduced financial help. The intent of private insurance is that it should be considered temporary since group Plans are written adverse to claimants from the beginning.

Private insurers have no control over SSA or SSDI, and Social Security doesn’t keep up with what disability insurers do. To make matters worse, insurers such as Unum position disclosure requests as “we want to make sure we give your claim every possible consideration”, while The Hartford positions its requests as demands claimants are expected to provide.

However, if the Plan doesn’t specifically require the disclosure of SSDI files as proof of claim, you don’t have to sign SSDI Authorizations at all. This is NOT something you have to do in order to keep receiving your benefits. To put it another way, insurers CANNOT DENY BENEFITS ON THE BASIS THAT YOU REFUSED TO RELEASE YOUR SSDI FILE. THEY HAVE NO PLAN OR POLICY AUTHORITY TO DO THAT, AND THEY KNOW IT.

Having said this, since Unum’s Group STD/LTD Plans DO authorize the company to offset for SSDI Primary and Family awards, claimants ARE required to provide any insurer with the original SSDI approval letter so that offset amounts can be verified and overpayments calculated. Please note, I said “SSDI Approval Letter”, not a letter of “Favorable Decision” from an Administrative Law Judge.

One would normally assume Unum could calculate overpayments correctly and not be overly concerned with “mistakes” as they are now. It would also be appropriate for Unum, or any other insurer, to ask you if you received additional letters from SSA increasing benefits for “additional earnings.” SSDI COLA does NOT increase SSDI offsets – you actually are allowed to keep these increases. You are NOT required to provide any insurer with COLA increase letters from SSA.

Now, enter Lucens. Lucens is Unum’s third-party SSDI paper chaser. I’ve received many calls from claimants who are literally “flipping out” about Authorization requests from Lucens – “Who are these guys?” “Why am I getting this request when Unum already has all of my SSDI information?” “Can Unum deny my claim if I don’t sign it?”…..and more.

To make matters worse, Lucens’ Authorization is designed to “look like” a form from SSA, when it is not! The purpose of Lucens Authorization requests is to get you to give up financial data (and more) from your SSDI file so that Unum can chase over payment mistakes the company will ask you to pay back. I’ve written several articles about how Unum is “nickel and dimming” its claimants with minimal offsets after alleging much larger overpayments due.

Bottom line, you don’t have to sign any Authorization giving Unum or Lucens permission to obtain information from your SSDI file, and “No” they can’t deny your claim if you respectfully decline to sign it. Unum has its own SSDI Authorization that’s valid for two years. Why two years? Unum’s SSDI Authorization actually lists SSA Form 831 disclosing the name of the DDS (Disability Determination Specialist), and SSA listing codes for the basis of awarding benefits. Claimants should never sign an SSDI Authorization valid for two years!

Obviously, Unum is attempting to determine if SSA awarded benefits under any mental or nervous listing code so that they can “agree” with it and terminate benefits after 24 months. Unum may also attempt to contact your DDS by making you stay on the phone with the claims representative through the SSA menu. This should never be allowed to take place.

To the extent that these potentially illegal and out-of-contract requests are allowed by claimants is reasonably explained by the fact that so many people are scared and intimidated by Unum and believe they have to do everything Unum requests even if it is inappropriate and deceptive.

One claimant who called me had already contacted SSA, and several attorneys asking what she should do with the Lucens Authorization. She didn’t get any answers because SSA reps are often not aware of private disability Plans, and of course attorneys, are not experts on ERISA Plans and don’t realize there’s no requirement to agree to Unum’s demands. Generally, instead of defending the Plan policy, some attorneys recommend signing the Authorizations to avoid any future conflicts, often not in the best interests of anyone.

When the claimant contacted the Department of Insurance they just told her, “Well, don’t sign it.” Alas, an accurate answer, although she did contact me to confirm it.

From what I’m experiencing in my own consulting practice alone, there is considerable angst, anxiety, stress and worry over these Lucens requests for SSDI information. Unum’s requests for signed SSDI Authorizations are deceptive.

I’ve read many Unum denials stating [paraphrased] that because Unum has more recent information than what was available to SSA at time of the award, they disagree and deny the claim anyway. Unum isn’t trying to give your claim “every possible benefit” and its obvious when you see the results of the end-game. That’s deceptive.

Therefore in summary:

  • You do not have to sign any Authorization giving insurers the right to obtain your SSDI files. Your Plan or policy does not contain such a requirement.
  • Insurers cannot deny benefits for your choice to keep SSDI information private.
  • Private insurers have no influence or contact authority with SSA unless you give it to them by signing SSDI Authorizations.
  • Lucens is Unum’s third-party gopher of SSA information. When contacted, notify your claims handler that you “consider your SSDI file to be “PHI” (private health information) and that you consider it confidential and choose not to disclose it.”
  • Unum’s own SSA Authorizations asks for disclosures of SSDI information potentially favorable to denial, or subject to misrepresentations of issues in “conflict of interest” with the rights and privileges of group LTD Plans or any semblance to fiduciary duty.
  • Conference calls to SSA with Unum claims reps on the line should not be permitted for any reason.
  • The only duties claimants have is what is specifically required in their group STD/LTD Plans. There is no requirement to allow disclosure of SSDI files, and therefore, claimants may choose to hold all SSDI information (with the exception of initial award letters) private and confidential. It doesn’t matter who’s asking for it, Unum, Lucens or GENEX.

If you have any further questions about SSDI Authorizations, Lucens, or Unum’s alleged overpayments, please feel free to contact me. I hope this post clears up the questions concerning SSDI file disclosures.

 

 

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