It’s really hard NOT to trust your disability insurer when you are unknowledgeable of the product and process. Human nature, basically willing to trust, particularly with business-type transactions often relies on asking questions from a source more concerned about the scam than they are about helping anyone.
Having said that, it is also true that asking any insurance company what you should do in any given situation will result in a prejudicial or biased answer. Do you really think Unum, for example, will tell you what to do to support your claim when it already has you on a target list, two steps away from a denial? It’s not going to happen. Still, out of desperation, some insureds will trust their insurance companies to the point of going blindly down a devastating path to an unpaid claim.
Disability insurers operate on the “law of large numbers”, meaning that the more policies sold, the less they have to pay. This allows them the opportunity to make a profit, pricing premium based on a 60% payout rate. BUT, if insurers just paid the legitimate claims and refused the fraudulent ones, no company would ever make a profit because the payout rate (LAR) would always exceed 60%.
Therefore, disability insurers MUST devise claim strategies that increase the number of denials so that profit can be earned. They’ve been doing this for years and believe me insurers are experts at it. No one inside any insurance company cares that you are sick, and no one is there to advocate for you. For some, this may be a painful reality, but disability insurers do not want you to file claims that create long-term financial reserve liability decreasing profitability.
Clouding the issue is also that some insureds regard claims handlers as “friends”, “because she’s really been very nice to me.” Claims handlers are actually taught to be nice, until they aren’t. In addition, claims handlers are sitting on the bottom rung of the risk management ladder and are performance managed on how well they can contribute to claims denials. No one gets promoted for paying claims because paid claims are documented against the employee as a “gig”. (I’ve kept all of my Unum performance reports and I can prove it.
I have to laugh sometimes because even the claims handlers themselves are unaware that paid claims are held against them. However, every claims manager keeps track of how many denials each person is able to pull off, and awards, or punishes accordingly. As I said, no claims handler gets an “Exceeds” performance rating by paying claims. The most successful claims handlers are selected to go to Disneyland as a special award. Tells you everything you need to know doesn’t it? This is in addition to the March yearly bonus paid to all employees if they meet profitability targets.
Therefore, it is extremely unwise for any insured or claimant to think there is an amicable relationship between them and any claims handler because there isn’t. It may come across as caring, friendly and sympathetic, but it isn’t really. You never seem to see the readiness to stab insureds in the back. I know the imagery is tough here, but painfully accurate.
Asking claims handlers what you should do is a major mistake in the disability claims process. If you do not know what to do, or can’t figure it out on your own, consult someone who is qualified to give you more information. In my opinion, neither Consultants nor Attorneys should tell insureds what to do, but rather provide a quality level of information so that insureds can make the best decisions for themselves.
I know it must be hard for people, especially those without support systems around them, to NOT trust their disability insurers. Still, it’s the wisest course of action that allows insureds to advocate for themselves in support of their own claims rather than allowing an insurance company to blindly lead them down a path of denial. It is far better for you to find out more information, and then YOU decide what you should do.
