Apparently, Reliance Standard is targeting claims with associated mental health issues in order to deny them after 24 months of benefits. This is not the first time insurance companies have tried this particular unfair claims practice, as evidenced by the Multi-State investigation of UnumProvident in 2004.
For those Reliance claims with primary physical impairments, and secondary depression or anxiety, it is being reported to me that the company is throwing out the physical diagnosis and alleging “depression” is the REAL cause of disability and should be limited to 24 months of benefits.
As I indicated, this unfair claims practice was used by UnumProvident 20 years ago but was thrown out by Regulators, particularly in California, where the practice was outlawed. As bad as it may sound, Reliance seems to be following Unum’s example by implementing many unfair claims practices to deny claim and garner more profit. I also heard through the attorney grapevine that Reliance management “order has gone out” to deny more claims. Using mental health issues is the way they are doing it.
The typical “scam” is to internally review the primary diagnosis, let’s say cardiomyopathy, and throw it out as a cause of disability. Then, a second review is done with the resultant write-up indicating depression is the real cause of disability.
Think about what a great opportunity this must be for disability insurers. Most physical diseases leading to disability cause depression. Loss of job, and financial resources contribute to the anxiety, and before long clinical depression becomes a reality.
In fact, in 2004 Unum linked its Psyche/Cardiac units together because of the prevalence of heart patients to develop depression. The way I remember it, Unum denied many claims after 24 months by determining “depression” was the real cause of disability after, say a CABG x 5. (Coronary Artery Bypass Graft)
From what I’m seeing Reliance Standard is well on its way to making a lot of money using the “depression” angle to deny after 24 months.
I have always recommended that my clients use ICD-10 Code F06.31 for Secondary Depression,”Mood disorder due to known physiological condition with depressive features.” This coding makes it very difficult for any insurer to classify a disability as a “stand alone” clinical depression. The primary physical diagnosis is always emphasized, with F06.31 as secondary.
Be very careful of SSA as well. Most insurers request copies of SSDI files in order to get the listing codes to see if SSA awarded benefits for mental issues. Once they have your SSDI file, the claim is denied because “we agree with SSA.” Never allow your insurance company to obtain a copy of your SSDI file.
It’s unfortunate that Reliance Standard is building a public reputation as an egregious disability company. I am also recommending that those who are denied should contact their employer and provide a written statement as to what Reliance Standard did to deny your claim. If employers STOP buying Reliance’s Group Plans, they may change their claims practices in a hurry.
Claimants may also write to their regional EBSA (Employment Benefits Security Administration of the US Department of Labor) I doubt whether the Regional DOL will actually help with anything, but the substance of the complaint will be on record. The more complaints, the more likely the DOL will have to act accordingly.
If you need assistance managing your Reliance Standard claim, please feel free to contact me for a phone call. Remember, the best claim appeal there is, is to not have a denial in the first place. Once a claim is denied, it’s too late for me to help you.
DCS@metrocast.net
