It really surprises me that disability insurers are allowed to stay in business with the kind of mess they are creating with disability file management. A New York Life claims handler was totally unaware that a claimant was entitled to a copy of her Administrative Record after her STD claim was denied. Another company was so diversified that I was told, “I can’t answer that here, you need to be transferred to another department.” It doesn’t take long to realize that you are speaking with people who know absolutely nothing about adjudicating an ERISA plan or insurance policy.
While I’m not going to repeat the logistics, it doesn’t help when claims handlers are located so far away from the central point, if there is one. Managers are few and far between, and I’ve discovered they really don’t know very much more about the claims process than the claims handlers. What is particularly disturbing is that claims are denied for what I call stupid and unimportant reasons. “Your doctor didn’t say the sky was blue”, or “…this wasn’t written in the patient notes.” Deniability seems to be “anything goes” and insureds who are unaware themselves are just letting it go. Remember, end of June is also the end of the second quarter, and all hell is likely to break loose.
I am also bothered by the fact that employers who employ third-party administrators seem to think they can act anyway they want to and have no idea what a “fiduciary” responsibility is. I’ve seen employers put their disabled employees on a “pay no mind” list and boot them out as soon as the FMLA runs out. Some employers, are actually complicit in a few schemes along with the third-party administrators to not pay LTD claims at all.
For those of you who have been on claim a while, don’t be fooled into thinking everything remains the same. It isn’t. More than one person reported to me recently that a surveillance team has been window peeping and hides in a car in nearby alleyways. Investigators have been known to sit on the top of roofs just to look down on female claimants sunbathing with their tops off. Although illegal in most instances GPS trackers are now located in your phones and most people can be found anywhere. Most surveillance takes place now from 500 yards away right through your bathroom window. Illegal, mind you, they are still doing it, and not reporting that they do it.
I think it’s time for claimants and insureds to sit up and take notice what’s going on with their claims. If you need assistance, please give me a call and consider coming on board as a client. I’d love to have you.
