Looks like Lincoln Financial is on a hell-bent rampage to obtain SSDI files from their claimants. DCS continues to receive calls “checking with me” about next steps in handling the requests. Although I’ve written many articles about so-called third-party paper chasers I thought I’d try again to get the word out about Lincoln’s unreasonable requests.
As with all insurance issues, the Employer Plan is the prinary resource. If you’ve received Lincoln’s request, through Claimify, to sign a SSDI Authoriation dig out your Employer’s Plan and examine it for provisions requiring you to provide your SSDI file as proof of claim. I’m pretty sure there is no such requirement in your policy, but to engage in best practices, read your own policy carefully for specific provisions requiring SSDI files as proof of claim.
If there are no provisions in the Plan requiring you to sign away your SSDI files, then you have the right to “say NO”. I am always asked the same question, “Can Lincoln deny my claim if I don’t provide it?” The answer is “NO” since no insurance company can punish you for not giving them something that isn’t required in the first place. I don’t know what it is about this that is causing so much claimant angst.
If the plan doesn’t say you have to do it, then your claim cannot be denied regardless of how much Lincoln screams and scratches and spits and yells. This goes for Unum claimants, too, even though Unum seems to be nicer, but more deceptive about it. Again, I think it’s important for all insureds and claimants to realize that the extent of their relationship with any insurance company is only what’s written in the Plan or Policy. Granted, ERISA insurers have discretionary authority, but to “interpret” assumes logically that the language must be in the Plan in the first place.
For as long as I’ve been in this business, one of the most difficult “old wives tales” to break is the belief that claimants can’t go against their insurers. There have also been reports that attorneys believe the same thing, saying, “Oh, go ahead and give it to them, the’re going to deny your claim anyway”, or. “It’s not that important, let’s not make waves.” Attorneys today aren’t putting up much of a fight on claims management issues anyway, but that’s an article for another day.
Claimants are also reporting to me that Lincoln’s claims reps, “are just awful.” At least Unum tries to “sweet talk” their claimants into giving up the files, probably a more deceptive presentation. Lincoln claim specialists are “nasty’, one claimant reported, and “I don’t want to have to talk to her ever again.” Other claimants report Lincoln is threatening to deny claims, which of course they cannot do, IF there are no Plan provisions requiring SSDI files as proof of claim, they can’t deny claims for that reason.
Again, my 25 year experience tells me that there are basically two sets of insureds. First, there is the insured who is scared into submission and will say and do anything in order to receive benefits, and second, those who are willing to defend the language in their Plan or Policy. Of the two, the second is by far the most successful. Once insurers now “they’ve gotcha, claims are eventually denied.
So, NO you don’t have to sign away your SSDI file, IF there is no requirement in your Plan telling you you have to. Just write the claims handler a letter informing that you prefer to designate your SSDI file as Private Health Information “PHI” under HIPAA, and absent any Plan requirement to do so, you respectfully decline to sign the Authorization.
Offer that you are willing to answer any questions, if submitted to you in writing, you’ve already provided your SSDI approval letter as proof of SSDI offset. You may also want to request that your claims specialist call OFF Claimify so they will stop harassing you. Don’t deal with Claimify directly, it’s 5 minutes wasted you can never get back. Claimify has deaf ears.
If you have any other questions about this, don’t hesitate to give me a call.
