Despite my previous posts about Claimify, I received as many as 20 calls this past week from claimants who were still unsure of what to do with the company’s requests for SSDI information. It seems as though both Unum and Lincoln are using Claimify to chase after SSA Authorizations.
After the first few, I began to realize that the major question was, “If I don’t sign the Authorization can they (Lincoln, Unum) deny my claim?” A light bulb went off for me when it became clear that claimants still do not understand the nature of the relationship between themselves and insurers whey they are receiving disability benefits.
To begin, let me say that there are no ERISA Plan or Policy provisions that require any claimants or insureds to disclose SSDI information from their SSA files. YOU DON’T HAVE TO DO IT. Because SSDI is an offset in group Plans, and a possible benefit in IDI policies, it makes sense to provide SSDI Award Letters at the time of the award so that the insurance company can code the offset correctly. Beyond that, insurance companies ARE NOT entitled by Plan or Policy authority to demand Authorizations to obtain complete files or SSA financial information.
Without Plan or Policy authority requiring disclosure, insurers CANNOT force you to sign Authorizations releasing SSDI information from SSA files, nor can they deny claims because you refused to do it. Simply put, insurance companies cannot deny your claim because you didn’t do something the Plan or Policy doesn’t require you to do. When claimants express concern that if they don’t sign the Authorization claims will be denied, well, that’s fear talking. In the end, the only relationship that exists between claimants/insureds is what is written directly in the Plan or Policy. Don’t give your insurer credit for more authority than they really have.
SSDI and private LTD insurance are two different types of benefits. Still, insurers want to know certain details from SSDI files that will help them support claim denials, actually pretty sneaky since they never disclose the real reason why they are requesting the actual file.
These are:
- Form 831 in your SSDI file discloses the “listing” codes under which you were awarded benefits. Insurance companies are looking for “listing codes for mental and nervous” causes. If SSA assigns any type of mental and nervous listing code to your claim, the insurer could defend a mental and nervous denial beyond 24 months.
- Form 831 also discloses the DDD or SSA person who made the decision regarding your claim. Companies such as Unum have been known to contact this person in an effort to persuade approval or disapproval to meet the needs of the insurance company.
- The insurance company is looking for additional financial information that can be used to calculate, recalculate over and over again, overpayments alleging money owed that they can deduct from benefits. You don’t have any say about this, by the way, but you can say, “No” to signing the SSA Authorization.
Either insurance companies are “nickel and dimming” you to death with recalculations, or denying claims after 24 months for mental and nervous impairments. SSDI files will help them do that even though SSDI file requests are positioned as, “…so we can give your claim every possible consideration.” Don’t believe that cover story because it’s not true.
Claimify is just another third-party paper chaser hired by insurers to harass claimants until they sign the SSDI Auths. If you don’t want to sign it, you don’t have to, and “NO” the insurance company can’t deny your claim because you choose under HIPAA to designate your SSA information as Private Health Information “PHI”. There is no need to be scared. Send your claims handler a fax and “respectfully decline to sign the Auth.” You should also ask the claims handler to notify Claimify to stop asking for it. Never deal directly with Claimify since you won’t get anywhere.
Claimify, and its requests for SSDI Authorizations is nothing more than an administrative nuisance and should be treated as such. You don’t have to give any insurance company your SSDI file, and you can just say “NO”.
