Disability Claims Solutions


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No execptionsWhile it appeared, during these last difficult months of national lock-down, that insurance companies were relaxing requirements to provide proof of claim, particularly affecting “new claims”, in reality most insurers today have reversed the Mr. Nice-guy persona and are refusing to pay claims.

DMS, for example, is demanding on-time submission of proof of claim for new applications without considering that physician’s offices may still be closed to patients for regular care. Letters to insureds seem almost resentful and punitive, insisting that policy provisions are written in concrete and will be enforced.

Additionally, I have been made aware that Unum resumed its unfair practices and is denying claims indiscriminately. Worse yet, is that Unum is not overturning denials on appeal, forcing insureds to enter into litigation in order to receive what is owed to them at a time when money is scarce. Word is from several attorneys I have connections with that Unum clearly isn’t paying claims on appeal.

Perhaps it was all too good to be true for disability insurers to relax their policies and strategies long enough for claimants/insureds to get their feet on the ground. But, what this tells me is that the insurance industry was hit hard in 1st Qtr. profitability and needs to recover losses for that time period.

Most small businesses do not have a standing-by customer base it can easily stab in the back in order to stay afloat financially, although insurance companies do. The reversal of “cordiality” we’re now seeing from insurers is sending a very clear message, that, “we intend to enforce the Plan or policy” regardless of national safety measures, unemployment, or collapsing financial structures.   “We’re done cooperating!”

What insureds need to understand is that while most states remain in social isolation, insurance companies have re-grouped, organized remote working from home, and are now working in “business as usual” mode to deny every claim they can get their hands on. Perhaps some insureds may be able to juggle in person consultations with physicians, most still can’t do that without fear of getting arrested.

Consider. Impaired, disabled individuals are in a select group with multiple “risk categories” that could attract any number of viruses and diseases much less COVID-19. The insurance industry’s insistence on adjudicate policies regardless will undoubtably place insureds in harm’s way by insisting on “proof of claim” in order to receive benefits they are entitled to anyway.

Refusing to overturn and pay legitimate claims on appeal also contributes to financial hardships to those who need disability benefits in order to survive.

It is my recommendation that potential claimants/insureds wait, if they can, before filing insurance claims, particularly if “proof of medical disability” is currently not attainable.

It is indeed unfortunate that insurers have reversed their “nice guy positions”, but not totally unexpected.