So many times I hear claimants telling me “how good their employers are” and how helpful they are when applying for disability. I quickly remind them that the two parties to an Employer benefit Plan are the Employer and the insurance company. Many times, it turns out that employers have third-party administrators (insurance companies) who actually review claims and render ATP (advice to pay) to the employer. These entities are also NOT on your side. Probably the worst of these administrators is Sedgwick who always seems to be on the employer’s side.
The purpose of HR Departments is NOT to help employees, it’s to protect the employer from possible employment and human rights violations. Those claimants who can’t stop talking to HR usually find themselves in trouble eventually. Employees applying for disability are risking their claims when they just can’t stop talking to HR, or even peers left behind. Keep in mind that employers do not want to pay claims any more than insurance companies do, and are very hard to get information from.
Employers basically:
- Want all employees to return to work in some capacity. The costs of recruitment can be staggering, not to mention a reasonable training period. Although the ADA (American’s with Disabilities Act) appears to be favorable to employees and claimants, it is not. It does not guarantee employees a job when they return to work, and gives employers many reasons why they don’t have to hire back those on disability, or offer accommodations.
- Refusal to provide copies of the Plan. Under ERISA employers are only required to provide employees a SPD (Summary Plan Description), but not a copy of the Plan adjudicated by them, or an insurance company. The insurance company tells you, “Get a copy from your employer”, and vice versa. Claimants often find themselves going back and forth between the two entities trying to get a copy of the Plan. The truth is both the employer AND the insurance company are fiduciaries to the Plan and should provide a complete copy of the Plan when asked to do so. As strange as it may sound, employers often cannot provide claimants with a copy of the real Plan because they don’t have one themselves.
- Self-insured employers will have access to your medical records, particularly if there is no third-party administrator. Usually, the insurance company will redact any mention of your medical issues, but not all companies do this.
- Employers also manage FMLA and often get mixed up. In order to approved for FMLA the doctor must document an END DATE. Employers often use the FMLA endnote as a claim end date, and that’s not what it is at all. The physician should be advised on how to report an end date where it is clear, it is not intended to end benefits.
- Employers are not on your side Period. The employers’ goals are to have a person sitting in your seat doing your job. It can be you, or someone else. As I mentioned, so many claimants tell me, “But, my employer is so good to me, and very nice.” That’s probably true through STD, but when you transition to LTD and it’s clear you aren’t coming back, HR attitudes suddenly change and things take a turn for the worse. Suddenly, a demand is made that you come back to work, or be terminated, but that’s always a possibility after the FMLA 12 week status ends.
Therefore, it’s not such a good idea to get real chatty with employers. What HR is told by you is always used to review your claim. Insurance claims handlers are in touch with HR all the time. Be careful here and realize what’s at stake.
If you are interested in finding out more about coming on board as a client, please feel free to contact me via my website located at: http://disabilityclaimssolutions.com, or email: lindanee.dcs@gmail.com. Tel: 207-793-4593
