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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.

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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!

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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.

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There has been a great deal of interest in GENEX lately, therefore, I did some research and discovered the ownership history of the company, included below.

Of interest is that GENEX was acquired by The Provident Companies and then became a part of the 1999 UNUMProvident merger. According to the below timeline Unum remained owned by Unum until it was acquired by Apax Partners until 2014.

GENEX, Allsup, Advocator Group and a few other “industry advocates” are not recommended by me for assistance with SSDI applications. If you would like more information please read my other posts regarding the “advocates” I’ve mentioned. These groups, although recommended by insurers have conflicts of interests and generally do not represent claimants very well.

Also, of note, is that Unum is using ECN, owned by GENEX, as its IME network. I recently had some dealings with ECN and it completely bungled arrangements for transportation. The entire process was made worse by ECN. Why was I not surprised?

In my opinion, GENEX appears to have diversified into a company that offers many services but may. not be very good at any of them.

1978

  • General Rehabilitation Services incorporates in Pennsylvania October 23

1993

  • Merges with General Care Review Inc.

1994

  • Name Changed to Genex Services Inc.
  • Merges with Bluebird Acquisition Corp.

1997

  • Provident Companies Inc. acquires Genex

1999

  • Provident merges with Unum creating UnumProvident Corp.

2002

  • Genex acquires ROI

2004

  • Genex acquires Integrated Benefits Management (IBM)

2005

  • Genex acquires Independent Review Services (IRS), a medical diagnostic networks and independent medical examinations provider. The network becomes Genex Medical Diagnostic Network.

2007

  • Trident IV, a private equity fund managed by Stone Point Capital, acquires Genex.
  • Genex acquires Choice Medical Management from Unisource Administrators, changing its name to Choice Provider Network, A Division of Genex Services Inc.

2008

  • Genex acquires American Rehabilitation Inc., a regional case management services provider to the workers’ compensation (WC) market.

2009

  • Becomes one of four largest radiology networks in the U.S. after acquiring Professional Diagnostic Management, a national radiology service provider to WC market.
  • Genex acquires Claimetrics’ telephonic case management business.

2010

  • Becomes largest case management provider in the U.S. by acquiring Intracorp’s WC and disability case management business from CIGNA.

2011

  • Genex acquires acquires Network Synergy Group, a national occupational healthcare management company that provides physical and occupational therapy network services.

2014

  • Apax Partners, a private equity investment group, acquires Genex.
  • Genex acquires M Hayes, a leading case management firm for the WC and disability insurance markets.

2015

  • Genex acquires leading case management firm ICM.
  • Genex acquires CID Management, a leading WC provider of utilization review software and services.
  • Genex acquires medical bill review leader Alpha Review Corporation.

2016

  • Genex acquires IME leader Med-Eval.
  • Genex acquires OMAC, a leading IME provider in Pacific Northwest.

2017

  • Genex expands IME services through ECN acquisition.
  • Genex expands pain management services through PRIUM acquisition.

2018

  • Stone Point Capital, a private equity firm, acquires Genex.

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Friday Q & A

What is Life Waiver of Premium?

LWOP is a provision in most life insurance policies that waive payment of life insurance premium when insureds are determined to be disabled from performing ANY occupation.

For example, if you have been approved by Unum for benefits beyond 24 months, AND you have a life insurance policy by, let’s say, Mutual of Omaha that contains a Life Waiver of Premium provision, you should contact MofO and submit paperwork so that your premium for life insurance can be waived.

There is also a provision in most disability policies that waives disability premium while the insured is disabled. To be sure, you need to check your life and disability insurance policies to determine what premium can be waived and when.

It is important to note that LWOP and disability premium is only approved when insureds are determined to be totally disabled from ANY occupation, a much higher burden of proof than just disabled from performing one’s own occupation.

Does Unum Discriminate Against Insureds Over 65?

Yes, but in a way you may not realize. For insureds with IDI polices that pay Lifetime Benefits under certain conditions, (Accident vs. Sickness), Unum has several tricks up its sleeve to NOT pay Lifetime Benefits.

Dates of disability are extremely important since most policies define Lifetime benefits in terms of “at what age claims are filed.” For example, if disability is filed before the age of 60, the policy pays Lifetime benefits. If over sixty, benefits will be paid only to age 65. Unum does everything within its power to refuse earlier dates of disability, particularly for Accident claims prior to the age of 60 where Lifetime benefits are indicated.

What most insureds with IDI policies don’t realize is that IDI policies DO NOT STAY IN FORCE beyond the age of 65 unless the insured returns to work full-time. Although there are several versions of guaranteed insurability, in general, at some advanced age insureds must return to work full-time in order to keep their policies in force.

As a matter of protection, it may be advantageous to pay the extra premium for both Accident and Sickness Lifetime Riders that makes Unum’s bad faith to deny benefits much harder to pull off.

This does not mean benefits for a prior claim cease at age 65, but it is a contractual condition indicating a return to full-time work is required in order to keep the policy in force after some advanced age.

Any IDI policy can go away at an advanced age while paying a prior Lifetime claim.

What is an ATP when referenced with a STD claim?

Employers have a choice to “self-insure” or “fully insure” Short-Term Disability (STD). This means employers can actually fund their own STD, or buy STD Plans from Group insurers who pay benefits from a separate Group STD Plan.

Employers who choose to “self-insure” their own STD Plans, generally hire the same Group insurers as ‘Third Party Administrators” (TPA) who investigate STD claims and render “Advice To Pay” (ATP) back to the employer.

Although employers choose to pay their own company-paid STD, managing and reviewing claims is NOT something most employers want to become involved with. Therefore, employers typically hire TPAs who render ATP back to the employer. I know insurance jargon can be confusing, but I’m finding more and more employers are actually self-insuring STD investigated by third-party administrators.

LTD is rarely self-insured.

Can Unum Offset SSDI COLA?

Generally “No”, but check your own Plans to be sure.

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“Our lives begin to end the day we become silent about the things that matter.”

Martin Luther-King Jr

 

Although I haven’t written a blog about  “fear” in a long time, a recent email from a “scared” insured reminded me how dangerous fear can be to one’s claim and the continuation of benefits.

For disability claim purposes, “fear” causes insureds to say and do, and NOT engage in actions that defend, protect, and support one’s rights under the terms of a Plan or Policy. Simply put, insureds are too afraid to help themselves.

NCDI_Logo_color I found this out the hard way when the sister non-profit corporation I created, the “National Coalition of Disability Insureds” (NCDI), failed in membership because insureds and claimants were too afraid to participate publicly. NCDI was created to assist insureds and claimants form a common interest in effecting change through the state departments of insurance with a united public agenda.

At the time I mistakenly assumed that insureds who were harmed by unfair claims practices would be interested in coming together to put pressure on the DOIs to regulate and oversee disability insurers as they are mandated to do by state law.

The response was exactly the opposite. Not only were insureds too scared to have their names associated with NCDI, they expressed insane phobias that somehow insurers could deny their claims if they participated in petitions and letters attempting to change a very unfair and biased review system. NCDI no longer exists because insureds refused to participate openly, but wanted their assistance to be anonymous. You DON”T change anything with unseen faces.

For a long time I was a defender of insureds rights all by myself to the tune of around $40,000 in legal fees to defend the rights of insureds to fair and equitable review. I don’t do that anymore…..frankly, if insureds refuse to help themselves, I decided to stop being a protestor of one.

Today, insureds are more afraid than ever, of Unum in particular. Somehow this company manages to cause their insureds extreme worry and anxiety even though the company is worse than it has ever been. Insureds are treated disrespectfully, with unreasonable demands, harassment, and continued targeting of claims for denial. State authorities and DOIs turn blind eyes to the unfair collection and misrepresentation of medical documentation. And the abuse goes on….and on….and on.

Insureds are more than willing to bend over at every request, regardless of how out of contract it is, engaging in phone conversations and dialogs used against them; lose physicians because of frequent harassment for records; and many other unfair claims practices.

I haven’t worked for Unum for 17 years, and although I am probably the foremost expert in disability claims management in the country, I am undoubtably a very small spoke on the Unum wheel.

During the time I’ve had my consulting practice I’ve managed between 85-100 Unum insureds at any given point in time resulting in a success rate of 98%. Those who reject my assistance because they fear retribution in some way often throw away their best chance of preserving benefits long-term.

What is really worrisome to me, however, is that insureds who are continuously “fearful” often say and do things they normally would not do. Those who manage their own claims based on fear have a 50% more chance of claim denial than those who are more willing to defend their Plans and Policies in a professional way.

Thus, the reasons for my writing this blog is to remind insureds that they have rights under their Plans and Policies, and are not obliged to give up those rights because they  are afraid of retribution. Insurers can only deny claims if insureds no longer meet the definition of disability and would not risk the semblance of retribution – it’s costly to defend wrong doing legally.

I am frequently asked, “Can Unum deny my claim because I turned down its offer of settlement?” No, they can’t. However, claims ARE returned to the “risk management barrel” when settlements are refused. Claimants often accept settlement for fear of losing benefits all together because of a refusal of Unum’s offer.

Insureds’ “fear” seems to permeate every aspect of disability claims management from obliging a Unum out of contract request, to refusing expert help, to being too scared to turn down a Unum low-ball settlement offer.

Bottom line? Insureds and claimants stand a much better chance of receiving benefits long-term when defending their rights under their Plans and Policies.

“Fear of everything” isn’t necessarily going to get you what you want, namely,  a paid claim.

 

 

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Friday Q & A

Allsup is requiring me to let them get into my checking account. I don’t think this is  a good idea. What do you think?

To begin, DCS, Inc. doesn’t recommend clients, (or anyone else), use Allsup for SSDI assistance. Although most insurers also suggest giving them access to bank accounts, it is never a good idea to do so.

In fact, most insurers are either asking for access, or arbitrarily including the permissions in their authorizations, which you may not notice if you don’t read the Authorization. Never give any insurance company access to financial accounts. Frankly, insurers make far too many mistakes to trust that they wouldn’t $0 out your personal accounts by mistake.

Beyond this, I don’t recommend Allsup for SSDI assistance, much less being able to access personal banking accounts. This also goes for GENEX and Advocator Group.

Are IME Addenda a good thing?

Actually….no.

Some IME physicians’ reports are written in a way that both appeases insurers with an agenda to deny claims, AND medical ethics with a phenomena I call “sitting on the fence.” From the insurance company’s point of view, having an IME physician “sit on the fence” does not provide sufficient proof to deny claims. When this happens, insurers will go back to the IME physician with more specific questions to encourage IME physicians to be more precise in their reports.

The important thing for insureds to know is that when IME reports are forwarded to treating physicians or attorneys, they should make sure any existing addendum and responses are also included. Even attorneys make the mistake of not following up with requests for any “addenda” and only find out about it when litigation begins.

Another way to describe requests for IME addendum is “putting words in the IME physician’s mouth.” Care and follow-up need to take place to make sure insureds and their representatives have the opportunity to review the addendum as well as the original IME report.

The fortunate thing is that some IME physicians respond to addendum requests by still “sitting on the fence.” When this happens either a second IME will be requested, or claims will continue to be paid.

Can I quit my job while on disability?

This question seems to come up a lot.  No one quits…..NO ONE QUITS when it is necessary to stop working due to a disability. “Quitting” means that you make a decision to stop working even when not disabled. If your physician provides you with medical restrictions and limitations preventing you from working THAT’S NOT QUITTING, AND IT’S NOT RESIGNING!

Medical disability is entirely different from “quitting’ your job. You simply notify HR that your doctor recommends that you stop working and file for disability. You aren’t even required to explain what your disability is. Technically, you are on medical leave and if you qualify for FMLA, unpaid medical leave begins to accrue for 12 weeks, sometimes more. If you are asked to resign, you explain in a short letter that your doctor is recommending that you not work for medical reasons.

No one resigns or quits when leaving work for a medical disability. There are several good posts about the subject already on Lindanee’s Blog.

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