Each insurance company seems to have developed their own “tell” identifying them as unfair disability claims reviewers. Recently, Unum, for example, came up with a brilliant ruse to lose benefits under former policies. The perpetrators seem to be over enthusiastic claims handlers who think themselves clever enough to “outsmart” their insureds and claimants.
Unum’s recent “trick” was as follows. A Unum claimant’s employer adopted a combined STD/LTD plan that was effective in 2000, but updated their plan additionally in the next year to include and/or remove provisions in the prior policy. One of Unum’s claims handlers requested a field visit, but found out the new policy failed to include a requirement to give such an interview. Her next step was to talk the claimant to back dating her date of disability so that the policy in force was actually her employer’s former Plan. This plan DID include a provision compelling the claimant to submit to a field visit, AND a lesser benefit.
Of course the Unum rep would have to pay the claimant a small additional benefit to back date to an earlier date of disability, but then the claimant would have to submit to a field visit, a lesser monthly benefit, and the possibility of losing benefits under the old policy. Back-dating dates of disability could lead to pre-existing condition denials as well. Claimants should be on guard when Unum attempts to “back-date” dates of disability.
Prudential, on the other hand, has a large bag of tricks. One of their most popular strategies is to deny STD within 2-3 weeks of maximum duration and then allege claimants failed to meet the elimination period for LTD. Prudential has been doing this for quite some time, and getting away with it. In addition, Prudential denies LTD claims on the say-so of Registered Nurses who have no particular expertise in the area of impairment. In other words, Prudential takes the cheap way-out and allows RNs to make medical decisions without experience, education, or training. Prudential’s claims handlers misrepresent what is said during phone calls so it’s best to request all communications in writing.
Reliance Standard doesn’t hide anything and has been known to falsify prescriptions for FCEs by changing dates using photocopiers. Reliance Standard’s managers buy-in to the company’s deceptions in order to deny more claims. Those who have active claims with Reliance Standard need to watch the paperwork very carefully and verify what is being communicated at all times.
MetLife is basically a “ghost company” because it’s never there. Phone calls aren’t returned, no one knows where the claim is, managers have no idea what’s going on, claims handlers disappear for long periods of time, and customer service is non-existent. The only time I’ve actually reached a living body at Met Life is when I contact “corporate” and ask their assistance to get me someone to speak to. Because of its chaotic internal procedures claims decision take forever and ERISA timelines are never met.
CIGNA does just about everything wrong which is why the company was recently fined and cited as a result of a Conduct Market Examination involving Maine, Massachusetts and Connecticut. In fact, CIGNA is so disorganized and horrible, every aspect of its internal claims review procedures involved, “we don’t know, and where is that paperwork again?”
The point I’m making is that the entire disability insurance industry is corrupt. It’s important to realize from the beginning how important it is to stay on top of information provided to you by any insurance company. Claims handlers are not always truthful, and policy provisions cited in letters to you may or may not be accurate.
Here are a few pointers for you to consider:
- No disability policy on this planet I am aware of actually requires insureds and claimants to speak directly with insurance companies on the phone. Consider. If you are taking pain medications, antidepressants or other medication with cognitive side-effects, it isn’t a good idea to trust information provided to your insurer at any time. You have the right to request that all communications should be in writing thereby giving you an opportunity to actually “think about” your responses. In addition, there will be no question as to what is said or responded to. Of course, you are required to provide your insurer with continuing updated information, but you can do that adequately in writing. Why would you risk speaking impromptu to an insurance company which potentially can deny benefits at any time? Get everything in writing…..it’s just good business.
- Keep an administrative journal or file of every piece of paper you receive from your insurance company.
- Obtain a copy of your group STD/LTD policy as soon as you become enrolled, read it, understand it, and ask questions. Know in advance what your bottom-line benefit will be after SSDI awards. Think about the fact that your insurer will ask for all SSA lump sum money back for your and for your dependent SSA awards. Plan to live on reduced benefits of around 60% of your pre-disability earnings.
- Never OVERSPEAK a disability claim! Provide your disability insurer with all of the information you are asked, but do not provide any information that isn’t asked, or asked for. Avoid getting “chatty” with any claims handler, and again, request all communications in writing.
- Beware of questionnaires which are deliberately stacked with questions about your activities. Less is more when answering questions about family, personal activities, hobbies, gardening, laundry, computer time, etc. These questions have nothing to do with your definition of disability in your policy. Questionnaires are “wolves in sheep’s clothing” disguised to encourage you to give yourself work capacity.
- Never make-up information you don’t know because you think you must have a response. An example is when you are asked what your “restrictions and limitations are.” This question is best answered by your physician. Never attempt to provide answers you don’t know. Refer your insurance company to your latest APS statement which, of course, should outline your R&Ls in detail.
- Don’t be intimidated by long, long letters from your insurer. Look at the letter closely. Chances are, the letter is page after page of regurgitated policy provisions deliberately included to scare and intimidate you. Circle only those parts asking for information, or requests “to do” something. You’ll find that what is important in the letter is only a few sentences. Insurers love to write 6-12 page letters to convince you they are right and you’re wrong.
- Realize that disability insurers are NEVER acting in your best interests, but their own. By and large, disability claims are managed by financial reserves (money and profit), not what is best for anyone’s health or well-being.
- Don’t take what your insurer does or says personal. All disability insurers do what they need to do to deny more and more claims and it is never about the individual personally, only the profit potential of the claim.
- Accept the fact that claims representatives aren’t truthful; do not document information accurately; and receive increased salaries and performance bonuses based on how well (and quickly) they can deny claims. Internal physician reviewers always receive yearly percentage bonuses for supporting the company agenda of denying more claims. Your claim could be a game of Texas Hold’em where you lose most of the time because the odds of winning are against you!
- Be very careful of attorneys who promise quick results from YouTube or Internet marketing. These attorneys are expensive and have back/forward fee structures you will have to live with as long as you have your claim. Be proactive, and avoid claim denials rather than hiring attorneys who line their pockets with your much-needed benefits.
Disability insurance is a very poor long-term investment, and insureds should not totally depend on financial assistance from disability claims. Those who do depend on benefits from STD/LTD policies are often left out in the street with no financial support at all. And, it’s not their fault.
The industry of disability insurance is profit motivated, and corrupt. Please take a moment to think about what you can do to positively protect yourself from insurance tricksters attempting to unfairly deny benefits you are entitled to.