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Posts Tagged ‘financial advisor’

Q&A ButtonWill Unum deny my disability claim for picking up my child?

Well…it might. It depends on how much your child weighs and what your lifting restrictions and limitations are. If your physician, for example, is documenting lifting restrictions of not more than 20 lbs. and your child clearly weighs more than that, then you shouldn’t be lifting your child.

I know it’s hard not to interact with your children, but the process of disability claims is pretty clear. If your insurer is conducting surveillance on the very day you decide to lift and carry your child, exceeding restrictions, then yes, Unum could deny your claim. I know it seems heartless, but when a doctor provides medical restrictions and limitations, Unum takes them very seriously and can enforce them relative to the terms of your policy. Unum won’t hesitate to deny a claim because you exceeded lifting restrictions by picking up your own child.

My financial advisor called my insurer to give “notice of claim.” Now, I’m hounded for the application. Can financial advisors and insurance agents call up insurers and give “notice of claim.”

I’m actually surprised your insurer allowed a financial advisor to request forms and give notice of claim. All good intentions aside, financial advisors and insurance agents have absolutely no idea how the claims process works, nor do they realize the possible implications of giving “notice of claim on your behalf.”

I realize agents are trying to help you, but they shouldn’t get involved in the claims process at all. Some financial advisors and agents tell insureds they have friends on the inside that can help, but it never seems to pan out well for the applicant. Financial advisors and insurance agents should stay with what they do best, namely managing financial matters and selling insurance.

What is “disability brain fog?”

This is not a term I would use to describe mild cognitive difficulties in complex thinking, memory, or ability to complete tasks.

The phrase “brain fog” became quite popular during the last decade in describing symptoms related to fibromyalgia and chronic fatigue. In fact, the term became a stereotype for symptoms believed at the time to be non-existent.

Today, the term “brain fog” is almost always associated with “imagined” symptoms generally associated with what the DSM-5 now describes as mental illness and somatiform disorders. This does not mean that patients aren’t experiencing some element of difficulty with thinking clearly, memory and performing tasks, but it does suggest that symptoms should be more clearly defined rather than using the capstone phrase “brain fog.”

Some rheumatologists and physicians still use the term “brain fog” because they are unaware of how the description is perceived in the disability claims process. Not all medical professionals who still use the term have the same definition of what it means. This complicates disability decisions even more.

I recommend to insureds and claimants that they not use the term “brain fog”, but should always describe their symptoms related to fibromyalgia specifically such as difficulties with short-term memory, thinking clearly, multi-tasking and being able to make quick decisions.

I have a really awful Unum claims handler. She doesn’t listen to anything I say. What do I do about that?

Unum’s claims handlers are “trained to miss.” In other words, they are held accountable to follow-through with the company’s agenda and protocols even though they know it’s wrong to do what they do.

Claims reps focus on micro word-snatching from things you say and write, and from patient notes with a pre-determined agenda to terminate or deny claims. Claims handlers often do not listen because they know they don’t have to.

Remember that Unum’s claims process isn’t about accurately assessing disability, but about financial reserve gain and profitability. You are virtually a claim number on someone’s desktop screen.

The best thing to do is insist on all communications in writing and respond only to the issues at hand without a lengthy defense or rhetoric. Remove yourself from situations where you may be made to “feel bad” when it isn’t your fault and you’ve done nothing wrong.

Unum’s claims handlers become robotic after a while and treat everyone the same. Because they do not have the autonomy to make claim decisions on their own, they often put insureds on a pay no mind list and document everything they say in a focused advantage to the company.

It’s best to remove yourself from verbal situations all together and do something to benefit the record by insisting on all communications in writing. It’s really hard for Unum claims handlers to be contentious in letters, and if they are, it’s in the record for all to see – including a potential judge in the future.

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Pin itGuardian has been on my radar quite a bit lately from not paying previous residual periods of disability, to irate claims handlers, to over-the-top investigations that cross the line into personal privacy issues.

Another insured called DCS today to report that already Guardian’s investigators have knocked on her door and she hasn’t even filed a claim yet! Notice of claim was given by a financial advisor (a story for another post) and as a result the company took off on investigating her with an impromptu visit from a private investigator who alleged “he was in the area and thought he’d  just stop by.”

I have never really regarded Berkshire/Guardian as a fair insurer, but for a long time my dealings with the company have been relatively good. Recently though the company and its representatives seem to have made a double-turn into aggressive investigation beyond what is required for investigation of a disability claim.

Unfortunately, the insured who called me today was a victim of two sources of awful information – a financial advisor who actually called Guardian to make “notice of claim” for the insured, and an attorney who refused to help complete application paperwork, but who recommended she apply for SSDI when the insured didn’t meet the criteria for SSDI. Oh my……

It has always been my experience that when a disability insurer seems to take an arbitrary left turn in “patterns of business practices”, management is redefining internal protocols to keep the liability acceptance rate down. I suspect in the last several years Guardian’s management increased its investigatory goals and practices and is redefining the claims process in order to pay fewer claims.

Guardian is really not doing itself any favors by gaining the poor public reputation it seems dedicated to have right now. Some have said that Guardian is not the company it used to be and many prospective insureds are moving over to Northwestern Mutual. Loss of market share isn’t a good thing for any insurance company.

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