Disability Claims Solutions


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I’ve been managing private disability claims long enough now to have been exposed to the "big picture", meaning I've seen what works for insurers and what doesn't.

Insurance companies, Unum in particular, always aked the question “What changed in your condition to cause you to stop working now?” The implication is, of course, “Well, you were working with the same impairment, what happened to make you stop?”

I always thought this was a very stupid question even when I found myself asking it many years ago. Today, the questiion is so grossly outdated, insurers should really be embarrassed by using the “what changed defense” against paying claims. For me, the answer was always obvious: disabled persons generally hang on to their jobs and professions as long as they can, and only stop when it becomes obvious they can no longer perform their job tasks as expected.

Back in the day, insureds jumped in fear at the question, but today  it requires  a “ho-hum” answer with exactly the same rationale as before. “I stayed with my job as long as I could, but then my physician recommended that I stop working for health reasons.” Seems logical to me.

Insurers who are repeating the old narrative are operating in the past. In today’s work environment, employers often recommend total disability when it becomes clear employees can no longer remain at work. Still, insurers are hell bent to prove that “there must be a catastrophic event” in order to cause someone to stop working. We all know that’s not true.

I always liked to turn the tables on insurers who used the “what changed defense.” “Yesterday, my client was totally disabled and paid. Today you denied the claim. What changed?” Situations where Prudential paid  STD for 25 weeks until one week before the maximum and then denied LTD benefits certainly applies here. “One day my client is totally disabled and the day after she isn’t? WHAT CHANGED?”

The well-known “what changed defense” is outdated, and in my opinion an embarrassment in today’s  management of claims. I guess the obvious isn’t always so obvious to insurers when profitability is the primary objective.