I am so often asked what the state of the claims processes are these days and I haven’t really taken the time to explain. First, I think we need to recap what’s happened over the last few years that continues to affect the way disability claims are now managed.
COVID 19 set the insurance industry back nearly 10-15 years in terms of customer service, adjudication of Plans and policies, customer service and federal and state law compliance. The way the process is now working is not likely to change, which is a sad note to an industry that once thrived.
Today, most disability insurer’s claims handlers are still working from home. At the same time as financial management is saving millions in fixed costs, claim review processes are below standards by any measure. While in the past, disability insurance was best micromanaged, it is unlikely management today has very much control of day to day operations.
A large percentage of insurance handlers do not speak English well. While I have no idea where the industry is getting its people, I do know from personal experience that it does not seem possible that these workers are well informed, or trained, about disability Plans and policies. When asked, they just don’t know the answers, even managers. I recently had a MetLife manager tell me that she didn’t know employer group plans were subject to ERISA. When I suggested she research the matter, I never heard from her again.
Most other insurance companies are still in a generalized state of confusion. There is no Customer Service; phone menus are confused, calls are dropped, and insureds wind up getting a 45 minute run-around just to get answers to their questions. Those of you who are managing their own claims know what I’m talking about. It’s frustrating, even when you do get someone on the phone, they barely speak English and don’t understand what you’re saying.
Therefore, to rely on confusion to receive monthly benefits may not be a wise choice. Be prepared to manage the chaos, there is no other way.
There is quite a bit of claim sitting on someone’s desk doing nothing, and going no where. Have you ever wondered why you never hear from anyone? Or, it takes so long for your insurers to make decisions? Why aren’t you getting status letters anymore?
Well, in my experience lately I’ve had to insist that claims handlers “go find the file”. Or, “go find the paperwork we faxed.” Sometimes the claims handlers actually do find the file buried in a pile on someone’s desk. Most insurers are probably in violation of ERISA timelines most of the time.
Don’t allow your insurance company to literally “sit on your claim.” If your claims handler is basically unresponsive, ask to speak to a manager and keep bumping up the line of supervision until you get answers. Do this in writing so that your letters get in the file officially.
I’ve been hearing the phrase “brain fog” a lot lately – again. Unfortunately, the phrase has long since become a disability claim stereotype that makes most claims handlers laugh. A few doctors are still using the term, too, which doesn’t help.
I always objected to the term because it is nonspecific and doesn’t point to detail about what is actually happening to you.My recommendation has always been to use specific words to describe what you call “brain fog.” For example, “I have difficulty remembering situations, or interpreting what is being said to me. Occasionally, my memory fails me, and I have trouble understanding, or remembering important things.” This explanation is far better than simply saying, I have brain fog.
Another saying that has become a laughing matter is, “I have good days and bad days.” I’ve seem more claims handlers roll their eyes on this one than you can imagine.The reason is that EVERYONE, even healthy people have “good days and bad days.” Some see this phrase as “an excuse” to justify walking around the Mall for a few hours. Regardless of the reason, it might not be a good idea to say it.
Well, I hope these few tidbits are helpful to you if you are managing your claim on your own. All of the insurance companies are confused, claims are sitting at the bottom of someone’s pile, and sometimes you need to help dig them out.
Have a Happy Sunday and be well. Please contact me, if you need assistance.
