Insurance companies are continuously sending out letters to insureds stating,“We are currently reviewing your LTD disability claim and have determined we need additional information”. This one sentence seems to cause a great deal of stress and anxiety because claimants really don’t know what “reviewing” really means. Let’s talk about that today.
To begin, there is no way claims handlers can review each and every claim in their block of up to 200 claims from cover to cover every time they “touch” it. It’s quite evident that claims handlers “review” up to the top, or most current 10-20 pages of a file at any given point in time. In addition, most insurance companies have quite elaborate diary systems they continuously add to, so if they really wanted to look back, they would do so electronically through the diary system not the claim file page by page.
Rarely, do insurance companies “look back”. Although the reason they don’t go back into the files is that in the past, the company accepted the proof of loss and on that basis paid the claim. It’s really old news, and not relevant. What insurers really want to know is whether or not insureds have medical restrictions and limitations precluding work capacity TODAY and do they have the functional capacity to work in the future.
Why would the claims handler really care about what happened in the past if the company already used that information to pay the claim? This is why I always recommend to insureds that they NOT try to keep “going back” over and over again with the same information, but to concentrate on current medical R&Ls and focus on future work capacity. Anytime insureds start with the old litany of claims facts from the past, claims handlers become deaf, blind and bored.
When the insurance company uses the words “we are currently reviewing”, they mean to say that your claim came up on a “flup” (follow-up) to take some action on the claim. I’m not sure whether you know this or not, but claims handlers are performance managed as to how well they can “touch” each claim every 30 days. All claims are usually set up on the diary system to flag claims every 30 days for action of some sort. When the claim comes up in the daily diary list handlers are required “to do something”, whether its sending out an update request, or questionnaire, or making a phone call, some action must appear in the diary list and a future flup set. I’ve known Unum claims handlers who were fired for documenting actions on claims they really didn’t take.
When most insureds get these letters, they think the insurance company pulls out their file and goes through it page by page from the beginning and has decided the claim isn’t supported, so they are asking for more information. This is not the case, please stop thinking this. Perhaps the claims handler reviewed the top 20 pages or not, it’s more likely your claim came up on the diary list for action at that time. As usual, insurance letters skirt the real reasons for requesting information, and just try to scare you.
Claims are reviewed more in depth, but not routinely. If there are “Red Flags” found in the file, it, of course the file is given more attention. But, routinely, most claims handlers couldn’t tell you information about your claim that is older than 20 pages.
Letters from insurers are narrated precisely to elicit the kind of reaction most insureds give them. In my opinion, claims handlers are not well versed with your particular claim circumstances, and don’t really care other than to get back R&Ls verifying disability in the future. Insurance companies are giving you impressions through their letters that do not exist.
Claims handlers are the bottommost rung of the claims ladder and are little more than glorified administrative assistants. “Reviewing claims” interprets to “Oops, your claim is on my flup list, and I need to get it off.”
