It has come to my attention that insurers are targeting neurological disorders because this category of disability is often “subjective”, meaning there are few tests to prove patients have what they say they have.
Although there are more than 600 classified neurologic diseases the top identified include: headache (migraine), stroke, Alzheimer’s, ALS, Epilepsy, neuromuscular disorders, Bell’s Palsy, cerebral palsy, diabetic neuropathy, acute spinal cord injury and neurological anxiety.
One of the most common “tell” signs of an insurance company’s impairment target scheme is when it chooses to aggressively risk manage common disabilities that have limited “objective evidence”, or depend on “clinical diagnosis”. Targeting the “most vulnerable” of impairments is a sure sign insurance companies are out of control.
Objective evidence is defined as lab tests, x-rays, CAT Scan, MRI, or other specific medical tests that can be pointed to as proof of diagnosis. Clinical diagnosis means that your physician listens to what you tell him, and based on his “clinical” history with you, renders an opinion as a diagnosis. By the way, ERISA Plans and policies DO NOT require objective evidence as proof of claim, even when insurers insist they need to have it in order to pay claims.
What insureds are going to see more of in the coming months are letters stating, “there are no restrictions and limitations, or tests available to verify your diagnosis.” Insurers will request PATIENT NOTES as a show of good faith, but in the end it will allege there is no proof you have what you, or your doctor, say you have.
Insurers just don’t want to waste their time challenging claims, like cardiac diagnoses, when there are many tests that prove the patient’s heart isn’t functioning well. Therefore, impairment targeting is the first rung of “risk management” because it is immediately profitable.
It wouldn’t surprise me to also see depression and anxiety claims on the “stack the deck” platform either. Migraines seem to be a #1 target these days. Chronic Fatigue, FMS, and Lyme disease are just around the corner. Insureds with these types of diagnoses should always make sure their medical information is as I’ve described many times. Also, check out the 24-month provision in your Plans or contract to see how “subjective impairments” are defined.
We are now living in a very different environment of managing disability claims. Be aware, and respond accordingly.
