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Posts Tagged ‘Survivor benefits’

Friday Q & A

Is there a Survivor Spouse benefit in case anything happens to me?

Yes. Nearly all private disability policies and plans contain a “Survivor Benefit” provision.

See the following example below.

“WHAT BENEFITS WILL BE PROVIDED TO YOUR FAMILY IF YOU DIE.

When Unum receives proof that you have died, we will pay your eligible survivor a lump sum benefit equal to 3 months of your gross disability payment if, on the date of your death:

  • Your disability had continued for 180 or more consecutive days; and
  • You were receiving or were entitled to receive payments under the plan.

If you have no eligible survivors, payment will be made to your estate, unless there is none. In this case, no payment will be made.

However, we will first apply the survivor benefit to any overpayments which may exist.”

Please note that if the Plan or policy had a 90-day Elimination Period, the insured would still need to have been totally disabled for 180 days. The succession of “survivors” is generally spouse, children and then estate. Ex-spouses have no claim to survivor benefits unless there are dependent children of the deceased.

I recommend that all insureds include any contractual Survivor Benefits provisions among financial papers so that the information is available if anything happens. Three months of gross benefit can sometimes be significant.

Does SSDI have private investigators? Do they conduct surveillance?

I am told that SSA does employ private investigators to conduct surveillance on those occasions when fraud is suspected. I sincerely doubt that SSA is able to fund surveillance for everyone, but when suspicious fraud is reported, SSA will conduct surveillance.

SSA fraud is usually reported by neighbors, ex-spouses and others who are in positions of observing those who receive SSDI benefits. The cost to the American people of those who engage in SSA fraud is in the millions.

What’s up with Lincoln Financial? I’m having a very hard time with this company.

Lincoln is another “bottom feeder” company I group with Aetna, MetLife, CIGNA, Reliance Standard etc. Claims handlers are sometimes savvy, and sometimes not. In my experience, the company does NOT overturn appeals and forces litigation in order to pay what is already legitimately due.

Of late, Lincoln seems to be attempting to deny claims without updating medical information. The company employs “cheap” medical review resources (doctors who are not board certified), with disastrous results. Unfortunately, Lincoln is one of those companies employers run to when they reject Unum, but for employees, this choice is not always the best.

Why is Unum sending a private investigator to my house?

Field investigations are generally not good news and despite what Unum tells you, field visits are risk management activities requested to conduct interrogations looking for “inconsistency of report.” In addition, field reps attempt to encourage insureds and claimants to provide information, not only about themselves, but about their families. Hence, it would also seem Unum engages in “personal profiling”.

Unum often conducts “tag surveillances”, the day before, the day of, and the day after a field visit is conducted.

There are many good articles on Lindanee’s Blog having to do with “field visit” investigations. Just type in the subject “field visits” to see the posts.

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Consulting ServicesDisability Claims Solutions, Inc. is a fee based, national consulting organization that provides expert claims management services to those with private insurance. I offer free initial consultation.

If you are interested in becoming a DCS client, please feel free to visit my website at: http://www.disabilityclaimssolutions.com

Telephone: (207) 793-4593
Fax: (207) 274-2331

Detailed information about DCS, Inc. can also be viewed on this blog by clicking the “Consulting Services” Tab from the Lindanee’s Blog Home Page.

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death benefitDCS, Inc. received a call this week from the family of a deceased Unum claimant inquiring about Survivor Benefits. Apparently, the claimant left work due to illness in January, returned to work in June and died suddenly in July. A disability claim was never filed. Although the claimant’s spouse filed a claim with Unum to obtain the Survivor Benefit, it was denied. The spouse had not read her husband’s copy of the policy but filed the claim with Unum based on “what someone said.”

Survivor benefit provisions are often overlooked in group LTD policies although they can be an integral part of family planning. Unfortunately, like everything else in Unum’s policies, there are specific provisions under which the claimant must qualify before any surviving benefit can be paid. Most Survivor Benefit Provisions are written the same:

“When Unum receives proof that you have died, we will pay your eligible survivor a lump sum benefit equal to 3 month of your gross disability payment if, on the date of your death:

– your disability had continued for 180 or more consecutive days; and

– you were receiving or were entitled to receive payments under the plan.

If you have no eligible survivors, payment will be made to your estate, unless there is none. In this case, no payment will be made.

However, we will first apply the survivor benefit to any overpayment which may exist on  your claim.”

In the opening example the claimant returned to work in June therefore his disability did not continue for 180 days. Had he remained out of work beginning in January, and filed a disability claim, his spouse would have been eligible for survivor benefits when he died in July. This is a very sad situation since the family had not actually read the policies (there were actually two policies from different insurers) and had no idea what the surviving spouse could have been entitled to.

The wording, “you were receiving, or were entitled to receive” suggests claims must be payable, approved claims as well. This means that if Unum denies a claim before the claimant dies, benefits aren’t paid either.

There is no advantage to “waiting’ to file disability claims. Insureds and claimants who meet the definition of disability and have been precluded from working by their physicians should immediately file claims under the terms of their policies. There are some insureds who prefer to “wait and see” if they can go back to work, which may or may not happen. Extending a date of disability further out on a 180-day Elimination Period may not be the best decision to make.

The situation of denying survivor benefits actually occurs quite often when claimant’s die during the elimination period. No survivor benefit is paid because claimants were not disabled for 180 consecutive days. The word “consecutive” is important here. If there is a return to work, the clock starts ticking all over again when the claimants leaves work a second time.

DCS, Inc. recommends to all insureds and claimants that they “dig out” their policies and locate the Survivor (and Terminal Illness, if applicable) provisions of their policies. Explain the benefit to your spouse and let them know where a copy of your policy is located should anything unexpectedly happen to you.

In order to obtain the Survivor Benefit spouses must submit a copy of the death certificate, or if there is no spouse, a copy of the death certificate and an appointment of executor of an estate, or fully executed last will and testament.

Survivor benefits contained within a disability policy are equal to 3 times the gross benefit and can be significant. Reading the policy is extremely important for both claimants and their spouses. In any case, actions taken to obtain benefits should never occur based on what “someone said.” Read the policy and understand the provisions first.

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