As I’ve written so many times, insurance companies are constantly focusing on “setting up” insureds with documentation that any prudent person could read and agree insureds should not be on claim, but working.
Every day insurers are putting something in your file stacking the deck for future denials. The problem is, while insurers may still use roundtables as a source of “consensus back-up” it often isn’t documented and placed in files for all to read.
There is an excellent post on this blog about the early beginnings of roundtables called “huddles” explaining how team meetings in cubicle aisles evolved into full-blown roundtables attended by all of the business interests of the company. Managers, VPs, attorneys, vocational reps, medical staff (RNs and physicians), and claims handlers usually attend roundtables to discuss future steps that should be taken to deny claims in the future.
Although Unum always took the position that the overall objective of “roundtables” was to train claims handlers about the claims process, its real intent and motivation was obvious to all those who were required to attend. No one believed Unum’s story justifying the existence of roundtables and the company took quite a beating for conducting roundtables specifically designed to deny more claims.
Today, while it appears insurers do congregate to discuss claims, it is done “in plain sight” so as not to attract too much negative attention as an unfair claims practice. Still, company meetings to discuss claims are still taking place – quietly, informally, and in plain sight.
Historically, the concept of “roundtable review” has been the most “experimental” claim denial strategy ever devised by insurance companies, having been re-engineered in format and scope many times over. From 2000 – 2008, it became obvious that Unum frequently changed roundtable formats in accordance with what worked to deny greater numbers of claims and what didn’t. It is suggested that Unum is still doing that today.
Disability claims can be “round-tabled” at any point in the claims process, meaning a group of people associated with writing claim-added documentation assemble to discuss what actions need to take place in order to produce credible terminations of benefits. The roundtable process itself is very derogatory toward claims handlers whose only role is to “present” the facts of the claim and sit quietly while management tells them what to do next.
Bottom line, claims submitted to insurance companies are reviewed periodically by a collection of business related persons who direct “next steps” needed to be done by claims handlers to further support future denials. Claims “presented” to the roundtable may or may not include all of the facts of the claim, and ultimate decisions are made to pay or deny in the future.
Genex (Unum) has often been a part of the “review” process, particularly when the company is used as a triage review source at the very beginning the of claims review process. Genex’s involvement in the review process is a “conflict of interest” and was recognized as such by the Multi-State regulators.
Insureds can be assured that there are groups of people reviewing and speaking about claims on a frequent basis, not necessarily openly, but they are talking about how to “stack the deck” with next steps to document large numbers of denials. Claim denials are planned, prepared for, strategized, documented, and then implemented.
Whether you call these “huddles” or meetings roundtables or not, the process has the same motivation as a grand jury without insured representation. Any person who thinks the disability claims review process is fair will likely be disappointed in the future when the inevitable denial letter arrives.
Sad, but very, very true.
