Earlier in the week, someone said to me, “If I do that will I make my insurer angry?” “Oh, boy”, I thought, “here we go again.”
Throwing aside my first instinct to reply, “Do you care?”, I realized the correct answer is not that simple. It’s quite common for insureds to “personalize” insurance companies because their only contact is a person, the claims handler, who of course, is human. But, in reality, insurance companies are nothing more than “entities” that operate off of the concept of profitability.
The role of an insurance claims handler is to follow the instructions given to him/her in order to process and document the illusion that you are not disabled. Each insurance company has its own set of rules claims handlers must follow in order to achieve results, most of which they are held responsible for and are performance managed as to whether they meet internal objectives or not.
What is hard for insureds to understand is that it is all about the management of paperwork. Last year I received several calls from terminated Unum employees describing to me the reasons why they were fired. Reasons included, misusing the company phone and exceeding allowed data limits, failure to mark flups (follow ups) as completed, failure to complete flups, etc. The persons you come into contact with are only concerned about following paperwork rules, because it can mean the difference been “Exceeds” or “Good” performance ratings.
Also, claims handlers have no vested interest in YOU. What I mean by this is that claims handlers DO NOT HAVE AUTONOMY TO MAKE CLAIMS DECISIONS, MANAGERS DO. Claims are always identified by claim numbers, and unless insureds deliberately keep putting their names in front of claims handlers, most claims handlers don’t care about any one person enough to “get angry.” Besides, the mantra of insurance companies is to “keep their cool” and show YOU to be the crazy party, not them.
One of the worst things insureds and claimants can do, is NOT challenge a request or policy because they are afraid of “getting someone angry.” Let me say, that as a former Unum Lead Specialist I was required to mentor claims handlers in my unit, and by far they were “A”-type personalities, puffed up with power.
The truth is, though, that there are rules and laws managed by insurance legal teams that take a dim view of claims handlers overstepping their authority, which is only administering/pushing claims through the review process. Beyond that, claims handlers have no authority and their only interest is documentation, referrals, and processing letters they don’t write. This is all they are held accountable for.
Claims handlers have been known to be rude, mouthy, and outright arrogant because this type of behavior works very well in coercing insureds to do or provide what they want.(Another reason why communicating only in writing is a good idea.)
This, of course, shudders insureds to the bone, thinking they “made them angry.” In my opinion, I really think insureds who avoid “making insurance companies angry” at all cost really fear losing benefits. Insurance companies can only deny claims when provisions of the Plan or policies are not met, not because those in charge of claims get angry.
Remember, no one inside the insurance company cares about YOU. They care about your CLAIM and the amount of financial reserve that when released will have an immediate impact on profit. Insurance companies are long in the tooth, having been around since the 1800’s. They expect insureds to challenge their unfair claims practices, but yet insurers still play the numbers, and probabilities of the “law of large numbers”, meaning the more claims they sell, the more probability there is that more claims will be denied.
Insurance companies don’t get angry, they aren’t human. Representatives of insurance companies are not permitted to deny claims without specific proof insureds no longer meet the definition of disability. There are rules, even for insurance companies, and “retribution” is frowned upon by insurance legal counsel because it’s difficult to defend in court. For ERISA claims, “retribution” is the exact opposite of “fiduciary duty” meaning the insurance company is required to act in the best interests of claimants.
The last thing insureds want to do is NOT defend their claims because they are afraid of “making someone angry.” In the end, they stand a much greater chance of having claims denied by not managing them properly, and/or insuring all Plan and policy provisions are met.
