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Although my first obligation for time is dedicated to the clients who actually retain and pay me, I do try to return as many calls to insureds who take their valuable time to call or contact me.

Of late, I have been receiving inquiry messages from my website in addition to phone calls. The problem is that no one seems able to answer their phones when I return calls or respond to messages.The real tinker is when I hear messages that your mailbox has not been set up or is full. In this instance you won’t even know I returned your call because I can’t leave a message.

This blog was started as an offshoot to articles I wrote for Jim Mooney’s “Inside UnumProvident” newsletter approximately 15 years ago. At that time, there was so much inaccurate information out there about private disability insurance, the intent was to provide “information as least equal to that of the insurer who is reviewing and making decisions to pay or deny claims.”

I’m happy to say that the primary focus of Lindanee’s Blog is to “inform” the general public by giving accurate information about the claims process. In addition to providing fee-based consulting services, I do try to return as many calls and answer inquiries as I can.

To that end, if I call you back and you’re not answering your phone, it’s unlikely I will try a second time. A solution to this is to let my answering service know of a good time to reach you and when you will actually be available to answer your phone.

I’m happy to speak with you, but time is limited. If you leave a message because you have an important question, it may remain unanswered if you don’t answer your phone.

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Friday Q & A

Does Liberty Mutual hire police departments to investigate claims?

I think it is highly unlikely that any police department would use its officers to conduct insurance investigation. It is entirely possible, however, that some individual police may moonlight as  insurance investigators, but some towns, counties etc. have rules against taking on part-time jobs.

Assuming that most policemen/women tend to be honest, insurance companies would have a hard time influencing or controlling their reports. Police departments are also understaffed and would not allocate resources to insurance investigation. If anyone has any different information about police involvement, please let me know.

That said, IF the state Attorney General has reason to believe there is insurance fraud involved, and IF the issue of investigation rises to the state level, police resources could be used as deemed appropriate. But,  police departments are not utilized routinely, as far as I know, for insurance investigation.

Lucens wants an Authorization from me and I don’t want to give it. What will happen to me?

I receive many inquires about the infamous Lucens, Unum’s paper chaser, and the answer is really quite simple – Just say “No.”

No Unum Plan or policy requires claimants/insureds to give up private SSDI information as proof of claim. And, I’m going to say this again, “The only duties or enforceable accountabilities for claimants/insureds are those specifically written in the Plan or policy contract.” Claimants, for example, have a Plan duty to provide requested information within 45 days of requesting it at their own expense, but the requirement to give up SSDI files is not there.

The problem is that claimants are so scared. Yesterday, a caller said to me, “I don’t want to make Unum mad at me.” As I have said so many times in my articles those who are too scared to defend their Plans, policies and claims usually wind up with denied benefits.

In any event, there is no contractual Plan or policy provision requiring you to sign SSDI Authorizations. Just say “No.”

Can an insurance company take more than 90 days to make decisions on claims?

According to ERISA, group insurers have an initial 45 days to make decisions but can toll for another 45 days, a total of 90 days. However, who is enforcing the law? I know claimants call me all the time to ask about ERISA’s timelines but they are nothing to get excited about.

While the U.S. Department of Labor has jurisdiction over ERISA, breach of ERISA timelines is not regarded as a serious violation. Usually, exceeding timelines is sometimes cited by a judge during the administrative review of claims and can contribute to the “arbitrary and capricious” standard used by the courts.

Although, citing the breach of ERISA timelines may be a useful tactic during the management of claims, insurers put these allegations on a “pay no mind list” because they know the violations are virtually unenforceable at the time.

 

 

 

 

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What is Unum’s “aspire program?”

I’ve already written a post about Unum’s “Aspire” program that sends carefully selected, top-claims deniers to Disneyland for yet more indoctrination and brainwashing. Management gets a great deal of control mileage by using the “Aspire Program” to push claims handlers to be “experts” at meeting the company’s termination agenda.

I’ve never understood why adult employees who, in my opinion, are already working for Ali Baba and the Forty Thieves, would want to go to Disneyland for a week to be indoctrinated. I’m hearing a lot about this lately so it must be time for Unum management to make their picks.

Resignations

The topic of resigning from work before, during, and after disability is by far the most frequent question I receive. There is an excellent post on this blog called, “Resignations – A Disability Claim No-No.” I strongly suggest that you search this topic and read the post.

In short, no one should “resign” from a job when leaving work for disability reasons. NO ONE. Basically, employees should notify HR that “my doctor is recommending a period of total disability as of a specific date.” There is a big difference between notification of impairment and “I quit.” Please read the above mentioned post.

Why would Unum want to look at my SSDI file?

Whenever Unum asks for additional information it usually means it is looking for something and SSDI files are no different in motive. To begin, the Multi-State Settlement Agreement stipulates that Unum should “consider” SSDI information before making their own liability determination. So, Unum requests SSDI files to cover their behind. Not that it actually “considers” the information, but at least if they have it, Unum can say they did.

Today, Unum is asking for SSDI files for the intended purpose of chasing down nickels and dimes of offset errors, mostly from those who have been on claim for some time. The longer you’ve had SSDI approved, the more likely there are to be errors in calculation which presumably Lucens is helping them with.  Unum’s calculations are bizarre and m most people can’t even figure out where the overpayment came from.

In addition, Unum is looking to get a copy of SSA Form 831 in order to determine if mental health listings were used to award benefits. If so, Unum alleges they “agree” with SSA and will limit benefits to 24 months.

Unum’s letters that encourage signing of the SSA Authorization claiming, “we want to make sure we give your claim every consideration” is fabricated untruth. Once Unum obtains SSDI files, it still denies claim benefits saying, “we have evidence that SSA didn’t have at time benefits were awarded and therefore we disagree with the decision SSA made.” What a racket! Why give up your SSDI files when your Plans and policies do not require you to do so?

How do I show 20% of disability earnings?

This question really illustrates a huge misconception. In order to be eligible for continued benefits while working, insureds are required to have at least a 20% earnings loss based on pre-disability earnings, sometimes “indexed” pre-disability earnings. Sometimes it’s helpful to look at this issue from the opposite direction.

Part-time workers cannot exceed 80% of pre-disability earnings and still keep their benefits. Therefore, claimants who are working part-time really need to keep track of their earnings and make sure they do not exceed 80% of pre-disability earnings. Therefore, claimants will have also met the 20% earnings loss requirement by not earning in excess of 80% of pre-disability earnings.

How long will I receive my benefits?

Technically, you are entitled to receive benefits as long as you meet the definition of disability as written in your policy or Plan. However, we all know that insurance companies determine who does, and who does not meet, that definition and benefits can be denied at any time.

Because of the certain “conflict of interest” in that insurers are both payor and reviewers of claims, benefits from private disability are uncertain at best.

ERISA Plans pay until age 65 (or normal retirement age), but IDI policies either pay to age 65 or provide for Lifetime benefits.

 

 

 

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DCS, Inc. received many calls this month regarding Unum’s SSDI paper chaser, Lucens, and its frequent requests for signed Authorizations to obtain SSA information. In recent weeks, it appears the company is sending out second notices, particularly to Unum’s claimants who have been on claim for quite some time.

This makes sense. SSDI calculation errors are probably more likely for someone who has been on claim a long time, sometimes 10 years or more. You may recall it was my opinion that Unum is chasing every nickel and dime due to overpayment miscalculations, and increases in earnings due to additional earnings.

Claimants are still panicking about these requests to sign Authorizations. If you read your ERISA Plans, there is no Plan burden of proof that any claimant must turn over their SSDI file to Unum. I’m assuming those who receive SSDI have already provided Unum with a copy of the original approval letter, probably years ago.

Besides, no one should be signing a Lucens Authorization valid for two years. Unum is also after the SSA Form 831 to find out under which listing the applicant was approved. It’s not rocket science to figure out that Unum is after Mental Health listing so that it can limit benefits to 24 months. This is in addition to attempting to recalculate a fictitious overpayment over many years of offsets.

If you would like more information concerning this reminder, please contact me directly.

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April Carrot and Stick Awards

Although the private disability industry seemed to be running wild this month, there are several companies that deserve “Stick” awards from DCS, Inc.

To begin,  MetLife tops the list of unfair claims practices by forcing insureds to file lawsuits to obtain benefits and benefit durations they are already entitled to. These issues mostly involve IDI policies and Accident vs. Sickness, or Residual Disability issues. MetLife has never been regarded as a fair insurer, but matters now involve more complicated issues involving misrepresentation of contract policy provisions.

Although the company has always been regarded by me to be among the ‘bottom feeders” of the private disability industry, of late, the company remains firm on its misrepresentations of contract provisions causing insureds to litigate what they are already entitled to.

Nearly every state adopted the NAIC Model Acts of Unfair Claim Settlement Practices that hold it to be an unfair claims practice to force litigation in order to receive benefits. MetLife is crossing that line more and more. Clearly, MetLife is well deserving of DCS, Inc.’s stick award.  CIGNA, The Standard, and Reliance Standard hold close seconds to the honor.

Carrots of “not bad” claims practices are given to Northwestern Mutual, a company I have sung high praises for in the past. I find the company easy to work with and more fair in administering claims. The only drawback to NWM is higher premium and an unrealistic stack of monthly update paperwork. Nevertheless, if you’re looking to buy private disability, this is the company for you. Congrats!

Note:  Nearly all private disability companies are driving more and more aggressive claims practices than ever before. The trend is to engage in arm’s length claim review” by outsourcing all of their peer reviews to facilities specifically put together to write documentation supporting “the insurer’s agenda.” Taking a step back and paying highly credentialed medical resources to do their dirty work is more cost-effective and extremely persuasive in court.

This is not to say that having a paid claim is impossible, but it takes a bit more know how than it used to.

 

 

 

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What’s the difference between 60% of indexed pre-disability earnings and 80% whether you’re working or not?

This IS a very confusing ERISA Plan provision for some. 60% of   pre-disability earnings is the amount of your benefit. Although some Plans pay 50% and even 66.6667%, the most common payout is 60% of pre-disability earnings.

Then, “indexing” comes into play when calculations are made for “Residual” or part-time   benefit calculations. (I’ve explained indexing in detail in another post on this blog.) The general concept of “indexing” is to adjust pre-disability earnings for inflation, even though in today’s terms inflation does not equate to large amounts of money.

The 80% mentioned in most ERISA Plans relates to maximum part-time earnings to remain on claim. In other words, claimants must maintain a 20% earnings loss in order to keep receiving partial earnings. Another way of looking at this is that claimants cannot earn over 80% of their pre-disability benefit and still remain on claim.

Can a Functional Capacities Evaluation be ordered without a doctor’s prescription?

In general “no.” An FCE requires significant physical exertion on the part of the insured or claimant. Insurance companies typically request IMEs for those who have FMS, chronic back pain, or those who report limited physical endurance.

FCEs can put certain individuals at risk for injury or severe exacerbation of symptoms. Therefore, the practice has always been for insurers to contact treating physicians and ask for a prescription, or “buy-in” for FCEs. However, the insurance industry’s abuse of the process enlightened physicians to refuse to write FCE prescriptions.

Insurance companies aren’t stupid either. They often try “sneaky” tactics such as contacting physicians who haven’t treated insureds in a long time, or contacting doctors without insureds knowing about it. Sometimes facilities administering FCEs work with insurers to not require prescriptions.

Beyond this explanation, insureds should contact me if they have any additional questions about what to do in these situations.

What’s the skinny on Lucens?

Apparently, Unum’s third-party paper chaser, Lucens is continuing to harass claimants to sign Authorizations to obtain SSDI information. DCS, Inc. received several calls last week asking about Lucens and SSDI Authorizations.

Let me say once again that there are NO Plan or contractual provisions requiring claimants to provide any insurer with copies of their SSDI records – financial or otherwise.

Therefore, if you don’t want to sign the Authorization, you can “just say no.” Unum is looking for two things, 1) financial records to re-calculate offsets to allege, “you owe us money”, and 2) evidences in the SSA listing that claims were approved in whole, or in part, for mental and nervous illness.

Those who want to keep their SSA information privileged need not sign any Authorizations to release SSDI files, and claimants should so inform Lucens they “respectfully decline.”

 

 

 

 

 

 

 

 

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Please read below the account of one insured’s experience with Student Loan forgiveness for total disability. It seems to me the “deal” isn’t what it’s cracked up to be.

Submitted by a blog reader and supporter. Thank you.

“I just have to vent about how disturbing the whole student loan disability process and how unorganized and  untimely it really is.

Forgiveness of student loans by reason of total permanent disability is handled by a company called Nelnet. They claim they are the exclusive provider of this service for the US Department of Education. When your loan is forgiven, you have to make less than the US poverty level for 3 years, otherwise your student loan is reinstated.

Three years ago when my loan was forgiven eveything went fine. But then, as you warn on your website, I claimed too much income (wife’s job) and my loan was reinstated. 

I do not believe Nelnet has any access to tax records. They just ask you to sign a statement that you didn’t work, or if you did, how much. I regret so much we answered that truthfully.

If you make too much, then you have to pay the loan again, and Nelnet gets the money. See the conflict of interest? Nelnet gets the money if your loan is reinstated, and they are also the one to decide if you are too disabled to work. They don’t do medical reviews, just doctor signature on the form or SSDI with a 5 or 7 year medical review (we are 3 year). So their only weapon is a delay.

It took them a few months, but many months ago, they claimed to be starting the reinstatement of the loan, with them as the collectors. I completed a new disability forgiveness paperwork and had the doctor sign it. Submitted it quickly. On the new applications, they have a 4 month timeline, but on these reinstated applications, they make clear on the phone they have no requirement for when they will review them. They will hold off requiring payment on the loan for 4 months, but after that, they want payment.

It’s been more than that. They STILL haven’t processed the disability application. They claim their Information Technology Department is still working on it. But the loan servicing part says a payment is due just a few weeks from now. I tried calling and asking for a forbearance for reason of disability. She granted a one month reprieve on the loan payment, with longer available after they review documentation. Nelnet insisted they needed the original SSDI approval, not a current statement (printable of the SSA website). The next day, they rejected it as too old. More significantly, the loan payment date changed, from in a few weeks to now PAST DUE of $50 with another payment due in a few weeks.

It makes me so mad that they can take forever to process this disability application claiming their Information Technology Department is working on it, but require payments from the loan which clearly the Information Technology department already worked on. And then make due dates earlier and claim something is past due days after saying it was due in a few weeks.”

(I think in cases like this I would give my Congressional Senator a call for assistance. Technically, these untimely decisions could result in Nelnet compensating you for interest on all of the payments you’ve made since requalifying for loan forgiveness. Give your Senator a good swift kick in the butt to do some work for a change and help you resolve this mess!)

 

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