Despite that many insureds believe “profitability periods” have no affect on them, thousands of disability claims are denied each quarter and year-end as the result of pressure placed on claims handlers to deny more claims. End of the quarter profitability periods are a type of high-stress, pressure activated harassment that management places on those who do the dirty work in the claims departments.
For 3rd Qtr., the search for vulnerable claims began on October 15th, and by September 1st, daily roundtables, or “huddles” are taking place demanding claims handlers inform managers of expected denials. These “recommendations” are not “guesses” at this point, and claims managers depend on their direct reports to “roll-in” denials to meet profitability targets. Your claim either will, or won’t be a part of the targeted denials for 3rd Quarter.
The expectation that CO_VID is lessening the effects of “targeting for denial” is not true since most insurers are trying to recapture any losses from payments having to be made. In fact, it’s a big mess right now with insurers trying to scramble to locate vulnerable claims they can deny.
What I’m seeing is that claims are being denied for “ridiculous reasons”, such as “claimant sent in the forms, but we didn’t get the patient notes.” Denials are increased when untrained, inexperienced “A” type personalities with big egos take over claims and take pride in denying more claims. Finally, managers who operate on the “fudge factor” promote and glorify people who can deny more claims than others. Unfortunately, insureds and claimants get caught up in the head jumping of the race to garner profits and end of the quarter becomes a free-for-all.
Therefore, when my warnings go out to be careful around the end of the quarter and year-end, they should be taken seriously. IMEs and surveillance are at least doubled at this time. Requests for patient notes, questionnaires, and phone calls are also doubled. We are headed for insurance bombshells for third-quarter and it is recommended that insureds pay attention.
