People who have been burned by a private disability company often become so angry that the eyes of revenge turn livid and efforts are made to “make the insurance company pay”, or “get them in trouble”, and even expose them to the press. While feelings of intense “let’s go get them” may help people feel better in the short-term, the reality of expending emotional stress and angst on hurting insurers is, unfortunately, lost in the wind.
First, an important concept for people to remember is that there is no agency, person, place or thing that can force an insurance company to pay a claim, not even the company CEO. The state department of insurance only has authority to “force” insurers to change provisions in policies and that’s quite a lengthy operation with hearings and lobby groups participating – maybe years. By that time, your claim is long forgotten.
State regulators will NOT take action due to one complaintant. In other words, while you may be mad as hell, regulators will not spend money on “changing the system” because of one claim or person. State regulators are required to send a letter to the insurance company, but it rarely takes any action when the insurer responds, “We did noting wrong.” It takes thousands of complaints before regulators will actually initiate Conduct Market Examinations.
For example, thousands of insureds complained about Unum in the year 2000, even to the point of contacting 60 Minutes and NBC Dateline. When the two programs went live, exposing Unum, it literally goaded state regulators into doing something. Eliot Spitzer, a real trooper as New York AG came very close to filing criminal charges against Unum before he threw in the towel with state regulators resulting in the Multi-State Settlement Agreement. John Garamendi in California filed his own state settlement agreement.
My point is, that one person’s rage with an insurer’s egregious claims practices will NOT inflict the kind of penalties insureds are looking for – not from just one claim. Your complaint becomes a number, but not THE number to require action.
I’m assuming that insureds who file multiple complaints in most situations are looking to restore benefits. Company CEO’s are figureheads not involved in day to day operations. Even VP’s of claims don’t interfere with the claims process because they hold claims managers accountable to “roll in” profits. Forcing managers to pay one claim above all others in a discriminatory way won’t produce profits. They don’t interfere.
The role of regional EBSA, namely offices of the US Department of Labor, no long have mandates to provide assistance for ERISA claims. Again, various ERISA EBSA offices may send letters to insurers, but they are not allowed to address issues until claims are denied – a bit too late in my opinion since all they offer usually is, “Get a lawyer.”
Occasionally, I hear from the person who says, “I have a friend who is close to the CEO of [some insurance company], and I wrote to him.” But, who you know, and who that person knows does not have enough clout within the claims process to get your claim paid.
I can hear it now. Insureds are going to respond to this post and say, “I complained, and my claim got paid, or overturned on appeal.” Believe me, your complaints were not the reason your claim was paid. If any insurance company can legitimately deny your claim, they will, regardless of who you know, or how much you complained, or to whom.
What surprises me is that while all the “complaining” is going on, problems with the claim remains unresolved. As a Consultant, I have always worked to resolve insurance conflicts so that “proof of claim” or claim resolution results in continued benefits. As someone who was intimately involved in the whistleblowing of Unum 20 years ago, I can honestly attest to the fact that insurers will NOT be hurt on the say-so of just one claim. The issues are much bigger than that.
Finally, all the letter writing, telephone calls, rehashing of what happened to your claim etc. is not good for your health. I’ve often referred to the anger phenomenon as a “secondary disability”, very close to requiring counseling in some cases. Emotional, time and energy is so much better spent on SOLVING THE CLAIMS ISSUES” than trying to get back at the hungry vulture trying to deny your claim. It’s not going to happen. Rant, rant, rant is seen as just that – RANT.
I hope this post helps some of you who spend so much time and energy on “getting back” at the insurance company. The only person you’re hurting is yourself when you can be more successful in working toward solving “red flags” resulting in continued benefits. If you need help in solving those problems ask for it, but don’t waste your emotional energy trying to kill or embarrass the hungry vulture. This is an issue much bigger than just your claim.
