One of the issues I was made aware of in 2019 and more recently is the ongoing trend of claimants and insureds to consult claims handlers for advice on how to manage their claims.
“I need to stop working” four months from now, can you explain to me what the process is for total disability?” I can actually visualize that sneaky smirk on the claims handler’s face when she says to herself, “Of course I can, honey.”
As a Consultant, I am always amazed when these situations occur. Most insureds are aware disability insurers make profit by denying claims not paying them. And yet, when claims handlers deliberately say, “Do you have any questions?”, the flood gates are opened with, “Can you explain to me…?”, or “Can you tell me what will happen if I…..?, and worse yet, “Please tell me what I need to do for total disability..?”
Claims handlers are not really good sources of information because they aren’t trained very well in Plan or policy adjudication. They used to be, but in the last 10 years or so claims reps are kept deliberately ignorant so they can truthfully testify, “I don’t know” to every question in depositions.
Today, claims specialists are the bottom rung of the risk management ladder and are little more than Administrative Assistants. Management uses them as a “buffer” to communicate information on behalf of managers and VPs – the real claim decision makers.
But, the idea that insurance companies who investigate claims to deny and make profit are to be trusted to provide guidance and valuable information to insureds is a belief that rarely results in paid claims long-term. In fact, claims handlers are paid to do exactly the opposite.
Another good example is using the Unum website portal. A few months ago, an attorney sent me a denial letter from Unum to an insured who used the company’s website portal on a regular basis. Unum sells its online portal to insureds as a way to share emails and documents. However, in this case, Unum denied the insured’s claim because, “you are able to use, upload and communicate with us on a regular basis using our website portal.” Ouch. Deceived again.
Claims handlers have also been known not to tell the truth, whether it is done deliberately, or because they aren’t trained well and have no idea how to respond is up for grabs. How do you know you aren’t being led into the black hole when you ask any insurance company for help to manage your claim? Truth is, you don’t.
DCS does not recommend that any insured or claimant seek advice from claims handlers who are trained, compensated and paid a yearly bonus to deny claims. You never know whether you are told the truth, or being led down the path to denial.
You don’t put a fox in the hen house and expect him not to eat the chickens.
