FAQ'S

Can Unum force me to have a drug test?

Although you may want to check with an attorney in your state, to my knowledge no insurance company can force you to have a drug test without a subpoena or having a policy provision specifically requiring drug testing as a condition to the payment of benefits. Certain employers providing health care routinely require drug testing, but to my knowlege disability insurers do not require drug testing because the results would be in the insured’s favor in most instances for disability purposes.

Although some insureds may come to believe insurers have the authority to make requests outside of policy provisions, it’s just not so. The only relationship insureds have with insurers is what is actually written in the policy contract.

Can the insurance company conduct surveillance?

Yes. This is another area where a qualified consultant will be able to help you recognize the signs of investigative surveillance and help you understand how this information will be used to potentially terminate your benefits. Insurance companies cannot deny your benefits solely on what they are able to film on a CD. Insurance company procedures are often abused in the area of surveillance.

Most insureds view surveillance as an invasion of privacy, and it certainly feels like that. DCS can help provide strategies to manage surveillance as well as the stress and emotions that go along with it.

With your signed authorization, the insurance company can obtain records for: loans, mortgages, bankruptcies, credit history, marriages, divorces, adoptions, employment history, motor vehicle report, arrests, military records, court orders, liens, police records, all medical, dental, and hospital records, welfare and human services records, information from neighbors, professional licenses and complaints, insurance or malpractice records, air travel hours redeemed, country club or physical gym memberships, golf dates and times, incorporation records, better business bureau records, records subject to the Freedom of Information Act, on-line chats, on-line websites, FICA payments, mental health records, and records from other insurance companies including social security, and workers’ compensation. And, this is just the short-list.

Today’s technology allows insurers to obtain more information about you than you can imagine. Access to social media such as Facebook, LinkedIn, Twitter and other chat groups may provide insurers with information that can be used to terminate claims. Many of insurer website portals have hidden tracking cookies that follow you as you browse the Net. Those on disability are recommended to stay clear of social media when they can.

Most definitely, yes! Although you should always check your policy to determine if your submission to an IME is required, nearly all disability policies contain mandatory provisions requiring IMEs. Many insurance companies are now putting language in the LTD contacts which compels claimants to “cooperate” with the insurance company. If the insurance company feels you are not cooperating, they could terminate benefits for refusing to show up for medical evaluations.

It is extremely important to be prepared for an IME in advance. Preparation of a personal folder and other documents is an excellent idea. DCS can assist you since being prepared for an IME can make the difference between keeping your benefits or losing them. These consultative services are very important to insureds.

In today’s insurance environment it is extremely important for ERISA claimants and IDI insureds to obtain legal assistance in preparation of an appeal. Although in the past consultants have been able to assist, most laws now forbid consultants to “represent” claimants or insureds during the appeal process.

The ERISA folks may not be able to convince attorneys to take their cases when monthly benefits are less than $3,000/mo., AND it is common for attorneys to charge back and forward fees of up to 30% of future benefits to age 65.

This is why it is extremely important for insureds and claimants to obtain claims management assistance while claims are still paid in order to avoid terminations and denials in the first place. DCS, Inc. still maintains its 98% success rate with assisting claimants to support claims. Although there are no guarantees of maintaining paid claims, the assistance of DCS, Inc. can make the difference between a paid or denied claim.

In general, yes. If you received a lump sum payment from Social Security for the same period of time you received unreduced benefits from your disability insurer, then you MUST repay the insurance company since you were overpaid in previous months. Social Security must be allowed as an offset first, before the insurance company can require you to repay the lump sum from Social Security. To be sure, claimants always need to check their policies for offset provisions.

This issue does not generally come up for Individual Disability claims because the reduction in benefit is not written into IDI policies. However, for group (ERISA) LTD policies, there is most often a contractual provision which allows offsets from monthly benefits for primary and family SSDi awards. Check your policy carefully to determine if your insurance company is allowed to reduce your benefit. The provision is usually located in a section of the policy titled, “Other Monthly Income.”

Bottom line…………..insurers can reduce your monthly benefit for SSDI awards if your policy says it can. The important thing is to know well in advance of an unforeseen disability what you are entitled to and what the insurance company can take away.