Insureds and claimants need to be knowledgeable concerning their disability claims, Plans and policies, so that they are able to recognize when they are being told a lie. Unfortunately, many insureds are so afraid of NOT receiving benefits that they will do whatever their insurers tell them to do, whether it is contractual or not.
In this new age of disability claims review, I’ve found that either claims handlers are completely in the dark, or, they are deliberately trying to circumvent the system to produce profit during certain cost periods such as end of month, a quarter, or year-end. I’ve found that the new generation of claims specialists are untrained, and their performance is based solely on passing the claim from one person to another for a specific action. Most claims handlers can barely speak English, therefore, it’s obvious to anyone who has to deal with them that they are nothing more than glorified Administrative Assistants.
The most popular “lie” that’s told to claimants in particular is: “We need to review a copy of your SSDI file in order to complete our investigation.” Rest assured this is not true.
First, no insurance company on this planet has provisions in its Plans requiring SSDI files as “proof of claim.” Why? Because they know they can’t do it. Social Security and private disability insurance are two different things, they DO NOT collude together, nor are decisions made with the full knowledge of each others.
Social Security does NOT allow the release of SSDI files without the permission of the applicant on form SSA-3288 “Consent for Release of Information.” (Please note SSA does not release files on the basis of an insurance company’s in-house authorization.) This is why disability insurers hire what I call, third-party paper chasers, to obtain Form 3288 from claimants. And, they are relentless. Insurance companies are not being truthful when they tell you they HAVE to have a copy of your SSDI file. Internally, insurers may set an administrative requirement to obtain SSDI files, but it’s not written in any Plan or policy that YOU, the claimant or insureds MUST provide the file. YOU DON’T HAVE TO. Furthermore, I’ve never recommended that my clients provide SSDI files, and here’s the reason.
In the process of reviewing claims, SSA uses a federal Form 831, which contains the name of the DDD (Disability Determiner) and the listing under which each applicant is awarded benefits. Insurance companies are always looking for the listing which states the applicant has been awarded SSDI benefits for MENTAL HEALTH. You may recall that nearly all ERISA Plans contain provisions limiting benefits for mental and nervous conditions to 24 months. The rush, rush, rush to obtain SSDI files is to find Form 831 searching for mental health listings. If found, claims are immediately paid under the Mental and Nervous provisions of the policy limiting benefits to 24 months.
Unum, for example, writes in its letters, “We are requesting that you allow us to obtain your SSDI file so that we can give your claim every consideration.” Another lie. Insurance companies are really devious. I’ve seen denial letters come across my desk explaining that the insurance company has more recent information than what was available at the time SSA approved benefits, and they have the right based on the new information to deny claims.This is how it is often true that insurers can deny claims when SSA approved SSDI benefits.
When a disability specialist tells you “But, we need a copy of your SSDI file in order to approve benefits,” it’s OK to say, “That’s a lie. Please email me a copy of the page from my Plan that requires me to provide a copy of my file.” I say this all the time, and of course, they never do because the Plan authority doesn’t exist. YOU ARE NOT REQUIRED TO PROVIDE YOUR SSDI FILE TO ANY DISABILITY INSURER. You can simply say, “I choose to designate my SSDI file as Private Health Information (“PHI”).”
A great way to circumvent all this is to use an attorney to apply for SSDI. I recommend this anyway, but that’s an article for a different day. Everything you provide to your attorney is “privileged” and won’t be disclosed anyway, including all that’s in the SSDI file.
Insurance companies also lie about other things, but I’ll address that in different posts. Nevertheless, don’t allow your insurers to lie to you. Call them on it. Get it in the record. It’s OK to just say “No.” Be knowledgeable, or work with someone who is. It’s always a good idea to be smart about your claim. It is never a good idea to just do what the claims specialist tell you do, especially when you know it’s wrong.
