Feeds:
Posts
Comments

Archive for the ‘Uncategorized’ Category

Silly MeIn 2015 CIGNA was slapped with a Multi-State Settlement Agreement very similar to that of Unum Life Insurance. The CIGNA investigation resulted in discovery indicating the company engages in unfair claims tactics, and it was fined.

Here we are three years later, and the company is still engaging in unfair tactics to deny payable claims. Case in point is CIGNA’s denial of a Life Waiver of Premium based on its own IME wherein the examining physician said the insured was unable to work. From the IME report CIGNA alleges it was able to abstract restrictions and limitations that lead to the finding of alternative occupations, and the Life Waiver was denied.

Next step is to deny the disability claim at the change in definition. Without allowing the insured’s physician to write a rebuttal, CIGNA denied the claim most assuredly to recapture a $2M financial reserve prior to year-end. It’s mind-boggling!

I also begin to wonder about the CIGNA people, who by the way, are so paranoid they don’t include their last names to identify themselves on letters. Claims handlers know exactly what’s going on, but usually choose to hurt people in order to protect their jobs.

Because of the very large monthly benefit, this case may very well wind up in court. In my book CIGNA remains one of the “bottom feeders” in the disability world of unfair insurance companies. Disbelieving its own IME is a new low even for CIGNA.

Read Full Post »

deceptionYesterday, one of my callers said, “I don’t know if you know this or not but most of the attorneys in Illinois read your blog!” Well, I sincerely hope so. I’ve been writing blog posts since 2001, as I said back then, “to provide information at least equal to that of the insurance companies making decisions to pay/deny claims.”

In the last 17 years or so I’ve posted many articles attempting to convince and persuade private disability insureds that private disability products should NOT be trusted or relied upon for long-term financial security. And yet, everyday I have a new caller say to me, “If my insurer denies my claim I don’t know what I’m going to do.” Unfortunately, these are mostly ERISA folks relying on employer-provided benefits that provide the least protection of any insurance product out there.

I think the word “skulduggery” perfectly describes the business of private disability and here’s why.

  • Employer Plans and policies are contracts of adhesion meaning the insured or claimant has no say in what the policy says or means.
  • There are provisions limiting maximum duration payouts and benefits for mental health and “self-reported illnesses.”
  • Disability insurers target and devise strategies to “stack the deck” against insureds to limit their overall liability for claims. (In other words, they deliberately reduce their risk and liability acceptance rates.)
  • The overall profitability focus is to identify legitimately payable claims and deny them in order to increase profitability. This is done via internal strategies that focus on various elements of the claims process.
  • Insurers spend very little for training of claims management staff.
  • Claims handlers are forced to sign template letters they do not write and/or do not agree with.
  • Employer Plans “offset” other income to help finance their overall liability for claims, therefore, there is always a threat to estimate SSDI if claimants do not immediately apply.
  • Claims handlers do not have the autonomy to make claims decisions. They are the lowest rung of administrative review and act as a buffer to protect managers who DO make claims decisions, but do not present to the general public.
  • Insurers manage claims to deny rather than to pay. This is a direct indication of a “conflict of interest” as both payers and reviewers of claims.
  • Insurer strategies include deception, trickery and invasions of privacy to document work capacity when no work capacity exists.
  • Insurers deliberately encourage fear and anxiety to convince insureds they should do whatever the insurance company requests even when it is an out of contract demand.
  • Insurers place frequent unexpected phone calls in an effort to require insureds to respond spontaneously rather than providing questions in writing and allowing them time to actually think about their responses.
  • Insurance physicians contact treating physicians by phone to convince and persuade treating docs that patients can return to work.  There is always a deceptive element in documenting doc-to-doc calls.
  • Insurers always offer low lump sum settlements representing only a percentage of net present value. At least a 20% profit is realized on settlement claims.
  • Insurers “target” various impairments for denial, such as CFS, FMS, chronic pain, HIV, depression, Lupus and MS.
  • Insurers “target” various occupations for denial such as RNs, Attorneys, Physicians,  Anesthesiologists, and others where the occupation is defined in the national economy.
  • Insurers often recalculate claims and arrive at outrageous overpayments in order to curb cash flow problems.
  • Insures use “reservation of rights status” to engage in “off-Balance Sheet financing” to reduce liabilities and maximize profits.
  • Insurers do not know much about actual “disability”, but center only on removing the financial reserve for profit at the expense of insured or claimant.

While I could go on and on about how the internal review process really works, I think you get the idea. None of the disability insurance products sold today are reviewed fairly and objectively which is why those who have these policies should never put all of their eggs in the private disability basket that’s likely to remain empty.

The private disability industry operates as a fear instilled means of selling disability policies insurers have no intention of paying, if they can help it. Nearly all group employers today hire third-party medical providers who are paid to discredit claims. These organizations consist of highly qualified medical doctors who are able to act as expert witnesses in matters of litigation. This is just another layer of “stacking the deck” against insureds and claimants.

I realize when I write articles such as this one, I generally scare the heck out of people. However, the reality of private disability insurance is that it should be realistically viewed as short-term compensation supplemented by your own Plan B, or other sources of future income. To rely on, or trust the “skulduggery” of the disability insurance industry guarantees a very complex and frustration-filled claims process that never ends.

Those who rely on the long-term income from private disability will be disappointed when the insurance company gets around to targeting them. Although I am well-known for my frank and accurate reporting of private disability, DCS, Inc. dedicates itself to a more positive perspective of managing claims successfully rather than continuously focusing on the “skulduggery” of insurers. It is far more important to know how to identify the deceptions and how to manage them.

In my view, it is always better to have a realistic picture of your financial future rather than a sudden fire bell in the night you can’t manage or put out. Furthermore, the future of private disability in the age of merger and consolidation appears to be disadvantageous to those who invest and trust in the products sold to them. Insurance in general can no longer be trusted to provide what it is that was promised and paid for.

And, by the way, Lindanee’s Blog is open to everyone with an interest in private disability, in particular attorneys searching for accurate information to the hard questions about private disability claims. You’ve certainly come to the right place!

 

 

 

 

 

 

 

Read Full Post »

Evil SantaHere is an email I received from one of my clients. She wanted to share her experience, feelings and emotions about being watched and surveilled.

Tonight, I was followed. I thought I would share it with you to give your readers insight on how it can happen, and how it makes a person feel.

I live in a middle upper-class neighborhood that is not easy to sit around the corner and do surveillance. At the entrance to my neighborhood, as I was leaving, I noticed a small white car sitting there on the side of the road. The only reason I thought it was odd, is because it looked like it had decal stickers with three numbers and the word “news” something like 632 NEWS. The sticker or decals clearly looked like something someone could buy at Walmart and stick on their car. It also did not advertise any of the local news stations company names that obviously I would know.

Still, I didn’t think too much of it because we have many college students that come home and attempt to use models from our neighborhood or experiences people have had from our neighborhood for their news or art. I probably got about 5 miles down the road when my daughter, who was at dance practice, called and said she had the wrong pants at dance. So I turned around and went home. I got my daughters pants and proceeded to leave again.

I came up to another neighborhood and noticed that same car was sitting at my building entrance and observed it quickly do a U-turn almost causing an accident trying to turn around so fast once the car saw me. Now, the surveillance is starting to get my attention. And no, I wasn’t being paranoid because I wasn’t even thinking about that. Those of us  with long-term disability insurance all have paranoia to some degree, but I truly didn’t think it was something I had to worry about at this time.

You see, I have been home all day taking two naps, eating my healthy meals, and conserving energy so that I could attend my sons first 45 minute flag football game.  I was very excited because he was so excited and couldn’t wait for me to see him. Now even though this has my attention I’m still not too concerned until I pull into EarthFare  to meet my mother and hand off my daughters pants for her to take to my daughter’s dance class. Guess who’s 4 or 5 cars down.  The same car!

When I left EarthFare, I decided to take a back road that I knew would dead end and had lots of construction. I then took multiple different routes until I finally ended up in the parking lot of my son’s flag football game. The car continued to follow me the whole time. To be honest with you, I took all those alternate routes because it took quite a few jags and turns before I could believe I was actually being surveilled.

It’s in the evening and for some reason, I think many of us don’t expect it in the evening. So I get out and start walking towards my sons flag football game. I then stopped and waited.  Guess who finally came through the gate – the person I saw in the white car. He was wearing a sports like shirt with blue, and I think gray or white, or maybe all three colors that almost looked like a coaches type shirt. He had a big camera bag and a hard clip board, trying very hard to look like a news reporter.

I would go a little ways and he would go a little ways then stop and quickly act like he was writing something as he was staring at all the different flag football games. I made eye contact with him a few times as I was texting my husband to please hurry up and come meet me. My husband arrived.  I purposely walked past this man and told him to please not follow me anymore and I proceeded to continue to my son‘s flag football game on field four. He continued to follow me. I would walk 3 steps and stop, he would walk 3 steps and stop. Now it was very obvious. I purposely pointed at him and my husband who was fed up turned around and started rushing towards him to confront him. I’ve never seen anyone move so fast. He quickly ran away and disappeared. I am sure he just hid somewhere else to watch me. I wasn’t going to let it completely ruin my excitement to watch my son’s first game. I sat in a chair and focused on him.

I was gone from my house for approximately 1 to 1 1/2 hours. I did nothing out of my restrictions or anything that I’ve ever claimed I couldn’t do so the peeper investigator did not get anything on me. Nor will he ever.


I want to thank my client for sharing this experience with me. Here we are heading into the holidays and claimants are forced to deal with being followed by their insurers making them feel guilty, uncomfortable and angry at disturbing their privacy. Most investigators today are pushy, arrogant and often do not care if they are confronted.

In the past, investigators slid down in their cars trying not to be seen, but today they stand right in front of you with video cameras daring you to get into a car and drive away. The simplest of things, like watching a son’s football game, is turned into a peep show for the purpose of denying legitimate, payable benefits.

I do know that Unum’s surveillance investigators are out in full force. Please do not exceed your reported medical restrictions and limitations.

Thanks again to my client for sharing with others. I do welcome emails from others who wish to share their thoughts and case stories. I will post them, if you send them to me in an email.


Read Full Post »

Carrot and StickNot surprisingly DCS, Inc. is giving its top “Stick” to Unum Group for its overwhelmingly deliberate chaotic claims review process where there is every indication the company is managing claims to “deny” rather than “to pay.”

It has become increasingly evident that Unum lost control of its claims process by outsourcing and indiscriminate firings to save costs. Unfortunately, Unum’s regular firings have resulted in a highly negligent claims process using old technology and ill trained claims personnel. Therefore, Unum remains DCS’ “top stick” for unfair claims review based on its own ignorance and mismanagement.

During the last year Reliance Standard’s hands have been slapped by the courts for engaging in unfair claims practices. Having worked through Reliance’s claims process on many occasions, and having written several consultant’s reports for attorneys on appeal, I can reliably state that Reliance is not a company that should ever be “relied upon” to say the least. The company seems to have and make up its own rules particularly when ERISA disclosures are required. Reliance Standard is definitely our second pick for a DCS stick award.

Mass Mutual, a formerly “not so bad” claims reviewer, is leaving a bad taste in the mouths of insureds looking for timely decisions. The company’s misrepresentations of its own policies in combination with untimely decisions makes Mass Mutual a top “stick” when it comes to paying its own stockholders. It is sad to watch a “mutual” company treat its owners the way it does.

In addition, Mass Mutual is using the IME process to “stack the deck” against legitimately impaired insureds. It is not uncharacteristic for insurers to hire top medical hacks to discredit claims. Mass Mutual is our top pick for using IMEs bought and paid for to deny claims.

Although there are no real “carrots” in the private disability industry anymore, baby carrots are awarded to Northwestern Mutual and Principal for at least trying to pay claims fairly. These are the only two carrots among the sticks that seem to stand out from the packs of wolves circling the forest.

In fact, DCS, Inc. is still recommending Northwestern Mutual and Principal over Berkshire/Guardian for those searching for IDI professional disability coverage.

Sadly, there are no group STD/LTD insurers that are recommended for group insurance at this time. They are all equally bad.

Read Full Post »

Another growing trend to disability claims management is the concept of “concierge medicine” often referred to as retainer, or boutique medicine. The overall concept of concierge medicine is when the patient pays an annual fee or retainer to receive care, in this case, directly related to one’s disability.

For private disability, this means the concierge physician completes all of the disability paperwork. Those who retain concierge doctors often pay between $300-$500 per month, or a fixed yearly fee whether the doctor’s services are used or not. It is estimated that fewer than 800 to 5,000 doctors in the U.S. practice concierge medicine.

I’ve had a few clients with concierge physicians over the years, but the newer groups of doctors have set up “electronic” systems of communicating with their patients rather than having face to face consultations in an office. One concierge physician, charging a client $300+ per month, gave her an App to put on her phone for communication purposes.

When I spoke to him he admitted that all of the texts, and emails from the patient are placed in the patient’s file. Patient files are accessible to private disability insurers. Personal and private conversations you thought would not appear in your patient file, actually will.

When it came to filling out disability forms, this same doctor had no idea how to fill it out for private disability and seemed put out that he had to actually DO something other than answer texts and emails. In my opinion, $300/month is a pretty stiff price to pay for social App medical care.

I want to point out a few things that makes the newer type of concierge medicine dangerous for those with private disability claims.

— First, most insurers do NOT accept records of texts and emails as proof of “regular and appropriate care.” Insurers look for actual in person consultation on a regular basis. This is why I DO NOT recommend that any claimant/insured substitute emails to physicians as proof of consultation. In fact, I don’t recommend communicating with physicians by email anyway, since emails are placed in the patient files and patient files are “discoverable” in a courts of law.

— Social media type communications are more informal and patients tend to say things to their doctors that they shouldn’t. Normal in person communications are often not put into the patient notes, but everything you say in a text or email goes into the patient file. Patients with disability claims should never assume any privacy or confidentiality when “texting” physicians because the actual text or email goes directly into the patient file as written. Can you imagine what an insurer could do with an email stating you had your grandchildren over for the weekend when you felt better?

— Although most concierge physicians will tell you their electronic transmissions are all HIPAA approved, you’re still dealing with Internet, Wi-Fi, Apple, Google, electronic systems that can be hacked regardless of any protections the doctors think they have.

— It is estimated that concierge physicians can earn up to $300,000/year for providing services to patients they rarely see. Boutique physicians may make themselves available to you upon beck and call, but I wonder if it is “safe” medicine, or a way for the more unqualified physicians to make money. Care must be given to “check out” physicians offering concierge services to make sure they are board certified in their specialities.

I suppose there might be occasions when concierge physicians could be useful, such as when a specialist says “There’s nothing more I can do for you”, and disability forms still need to be completed. This is, of course, assuming that you can find a concierge experienced in private disability paperwork. Another possible reason to retain a concierge physician is when the patient is forced to use large HMO facilities like Kaiser, but need a physician who is able to complete paperwork on time.

Still, communicating with your doctor via phone App encourages patients to use a more informal manner of communication that can be the demise of any disability claim, and the communications are placed in the record as written. Texts and emails are NOT acceptable proof of regular and appropriate treatment.

By the way, one concierge physician recommended that I obtain the patient records from his software and remove the texts and emails before sending to the insurance company.

Good grief….this is actually against the law and could be interpreted as “insurance fraud.” Once information is placed in a patient file, it remains there and cannot be removed. As I remember it, Unum received a regulatory slap for “sanitizing’ its disability files, and we are not Unum after all. I couldn’t believe he told me to do that.

In conclusion, while it is possible for concierge physicians to have a valid purpose, the manner in which they run their patient business is dangerous for those with private disability claims. DCS, Inc. clients are NOT recommended to retain these physicians as the primary source of treatment. I’ve been getting the impression that concierge physicians look for ways to do less work for more money.

Finally, even if you haven’t retained a concierge physician don’t communicate with your physicians by email or text. This is not an area where technology can be substituted for actual, in person consultations with physicians who can observe and speak to you directly.

If you choose not to listen to best advice and continue to communicate with your treating physicians by text or email, avoid personal conversations and descriptions of “what you’ve been doing”, or “how you feel.” Insurers will have a field day with that kind of information.

So, while concierge medicine might seem a viable alternative to traditional treatment and consultation, it can be an invite to insurers to misrepresent and eventually deny claims. At DCS, Inc. we don’t take those chances.

ADDENDUM – 11/27/2018

After this article was published I had an opportunity to review a set of patient notes from the above referenced “concierge physician.” Every “hello”, “how are you”, and comment about what to put down on Unum’s forms was documented as texts or emails. Although most physicians are more selective with what they add to the file, this particular concierge physician actually “set up” the insured by placing every negative comment about the insurer in the patient file.

Please be very careful when you hire concierge physicians and ask to see your patient file on a regular basis.

 

 

 

 

 

Read Full Post »

Happy ThanksgivingI want to take this opportunity to wish all of my readers a very Happy Thanksgiving holiday. My town in Maine received 7 inches of snow today and the song, “Over the river and through the woods…..” , a real traditional theme came to mind that might even be more sentimental than I generally admit to.

I think we all know we are living in very different times my friends, and yet, I like to think that most of us have at least one thing to be thankful for.

Although I won’t get the opportunity of speaking directly to most of my readers, I am extremely grateful that you come to the blog looking for helpful answers to your questions.

I consider it a privilege that you allow me to help you. With that thought in mind, I wish all of you the best of holidays.

Linda

 

Read Full Post »

No helpI had a very interesting conversation with a complaints investigator from the State of Texas Department of Labor. I assisted my client in filing an ERISA complaint against Unum for harassment and abuse issues.

 

Apparently, there is no federal mandate that allows the U.S. Department of Labor to assist claimants prior to a denial. I was surprised since usually the DOL reported hands-off to claims that were denied even through the appeals process. The DOL rep confirmed that she couldn’t be involved until my client had fully exhausted her appeal rights. In fact, at least for the moment, the DOL reported to me that she couldn’t help my client until her claim was denied and payments stopped.

After explaining that “prevention is worth a pound of cure”, and that I didn’t want the worst possible thing to happen, she reiterated that there was no help available for an ERISA client as long as she continued to be paid. The investigator told me, “Congress sets the rules and this is the way it is.”

What does this really mean? It means that if any insurer acts in bad faith, or doesn’t uphold “good faith and fair dealing”, or breaches its fiduciary duty, don’t look to the federal government for help. For some reason, the mandate has done a 360 degree reversal to where the DOL won’t get involved until all appeals rights have been exhausted.

It seems as though the majority of working Americans with ERISA Plans never get a fair break. Individual Disability Income Replacement policies with state jurisdiction will investigate violations of state law.

But, unfortunately the ERISA folks having been thrown under the train by insurers have no help to get out from under the tracks and across the road. Despite the fact that ERISA was originally enacted to stop discrimination to the benefit of claimants, the laws now favor employers and insurance companies.

The working men and women never catch a break.

 

 

 

 

 

Read Full Post »

Older Posts »