The Standard just denied a ME/CFS claim using the age old argument of “subjective and self-report.” The recommendation to deny was made by a sole internal medical reviewer who stated, “there was no testing or objective evidence to prove the diagnosis.
Insurers have been denying CFS claims going all the way back to Unum UK in the 1990’s when physicians assisted the British government on how to deny ME/CFS claims and make it look legitimate. In fact, a great deal of research by Unum physicians was provided to the UK eventually leading to ATOS, the electronic system that controlled disability decisions. Although ATOS in the UK has since been discontinued, it is common practice for insurers to deny CFS claims.
Here is the United States insurers use “self-report” as cause to deny claims even when treating physicans strongly recommend disability. It’s no great surprise that insurers are still using the same unfair tactics to deny claims. The Standard, one of my defined “bottom feeders” is apparently jumping up the scale on CFS claims for 4th Qtr. profitability.
Claimants are receiving letters from CIGNA threatening benefits if claimants do not sign SSDI Authorizations to obtain files. One claimant received three letters demanding the signed release “so that we can decide your continued eligibility for benefits.”
Of course, this isn’t true. CIGNA knows quite well that it cannot force any claimant to release SSDI records. Readers should know by now that the reason why all insurers demand SSDI files is to inspect Form 831, locate aproval listings, and determine if benefits were paid on the basis of mental and nervous disease. This way insurers can limit benefits to 24 months. Although this should be “end of story”, some claimants are really intimidated by these letters.
Insurers such as Principal, and certainly others, are getting into the practice of sending out what appears to be questionnaires asking exactly the same questions that were answered on initial application or update forms. I suspect that claims handlers other than Unum’s are not reading files to determine what is in the file and what isn’t. Frivolous requests for information need not be answered multiple times.
The best example of this are the questions asked by field investigators when the same information is submitted to the file multiple times. Keep in mind that it’s not the questions field investigators ask that is important, but the rant, rant, rant some insureds get into that provides information not asked. Field investigators really don’t care about the template questions, but report only the rants.
Please be cautious of repetitive questions asking for information you’ve already submitted.
One of my clients reported to me that one of this year’s most sought after gifts is a surveillance door bell that can be easily hacked to provide information to the insurance company. Disability insureds should not have Alexa, or any other “talking” device inside their homes, or any of the versions of doorbell surveillance. Be very careful of any devices you have, including your cell phones that can be used to spy on you.