Disability Claims Solutions


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Lately, I’ve noticed that I’m getting quite a few questions concerning the nuisance multi-page letters claimants and insureds are receiving. While they can be pretty scary, most of the letter is just BUZZ.

Due to the fact that nearly all insurers “regurgitate” or cite multiple Plan or policy provisions in their letters, the practice is having the effect of scaring people into thinking they have to immediately do what these provisions say.

Relax. Nearly all insurers maintain drop-down windows of “templates” from which claims handlers can choose provisions that apply to the topic in the letters, or at least they’re supposed to. However, every now and then insureds happen upon a claims handler who “inputs” every template the company has in order to create what I call “monstrous” communications, and they do it every time.

To begin, as a Consultant I NEVER take the cited letter provisions as absolute accuracy when I review my client letters. Unum has such a hard time locating policy/Plan copies that it’s anyone’s guess whether the provisions included are actually correct. It is always better to go directly to the policy for information concerning policy provisions and it is never OK to just accept what the insurance company says as the absolute truth.

In addition, claims handlers have to know a little bit about policies, Plans and provisions in order to accurately choose the ones that pertain to the subject of letters they send out. I’m not sure today whether all claims handlers are that savvy about adjudicating policy provisions.

On occasion there might be a reason why, let’s say Unum, is citing certain provisions. The multi-state settlement agreement stipulates that Unum let insureds know they have a right to request an IME, the same as it does.(Not that anyone would realistically do that!) Therefore, Unum insureds might notice that there is a IME provision citation in most of the letters they receive, the company is just covering its behind with regulators. It DOES NOT mean Unum is going to request an IME.

On occasion, insureds may also notice that provisions are cited in letters that do not pertain to their claim situations at all. But, citing 5 pages of policy or Plan provisions is confusing to those who are disabled and it is a real chore fishing through letters to find the one sentence that describes what the company really wants.

My advice to insureds who receive 5-10 pages of “regurgitated” policy provisions is to:

  • Verify the letter citations with your policy or Plan.
  • Carefully hunt through the letter for the few sentences that tell you what the company wants.
  • Don’t sweat the small stuff.

While most insureds will tell you these types of letters are intimidating, I seem to think the claims handlers just get carried away with the drop-down template menus. In theory, cited provisions are supposed to be included only if they relate to the reason for the letter.

Unfortunately, some claims handlers think the more provisions they cite the more control they have over insureds.

If you have a copy of your Plan or policy you already have as much information as you need to know without the letter buzz.