Disability Claims Solutions

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Out of whackI’m beginning to wonder if any of the claims reps at Unum actually read the Plans and policies they manage. Or, is the company hiring too many outside paper chasers without explaining contractual timelines. Either way, requests for medical information are obviously in “hurry up” mode and it’s out of contract. (Check out more on Unum’s money problems in the comment section.)

For example, in the last week I read two letters to treating physicians demanding either a form filled out or patient notes within 10 days!

Depending on the version of Group Plans claimants have, “proof of claim” must be provided at their expense within 30-45 days of its being requested. Claimants should always date and sign when they received records requests.

This is pretty standard wording for ERISA Employer Group Plans. For IDI contracts, insureds are permitted “90 days after a period of claimed disability” to provide requested proof of claim. In both cases, this also includes requests made to treating physicians.

Letters sent out to physicians demanding paperwork within 10 days is not only out of contract, it’s unreasonable, since physicians are unable, in most cases, to process patient records requests that soon. In addition, these same letters have a very threatening tone advising physicians Unum may not be able to continue benefits if records aren’t received.

Although most treating physicians want to be supportive, they are throwing their hands up in the air fearing if they don’t meet the unreasonable deadlines patients will suffer. This kind of disruption and unexpected use of the nurse manager’s time causes friction, and it’s not the patient’s fault at all.

This problem stems from Unum’s debacle of hiring third-party paper chasers to request medical records. Claimants and insureds are reporting harassment from contacts nearly every day to sign various Authorizations.

DCS, Inc. recommends sending a fax to the claims handler along with a copy of the page from the ERISA Plan or policy citing the provision timeline for providing “proof of claim.” The fax should acknowledge the request, but also document for the file that the timeline is outlined in the Plan or policy and should be adhered to.

This is what happens when an insurance company loses control of the claims process.