Although people have changed in the last few years, I can assure you that the insurance industry has not. While insureds today read everything they can on the Internet and think they know how to manage claims, they fail to realize that there is an entire insurance industry in the background stacking the deck against them. While insurers may have been fairly docile during the COVID years, they have recovered and hundreds of claims are being denied through the planned facade of nicety and cooperation.
Credentials do not make insureds “smart”, nor does the alphabet soup after their names give them expertise in the claims management process. I mention this because I’ve seen patterns where Ph.D.s and highly qualified physicians seem to think “they know best” only to have their “gooses cooked in the end.”In reality, there are more denials than ever before because insurers count on the cultural changes in behavior to allow them to manipulate the disability claims process. More people are getting hurt than I’ve seen in a long time.
Sun Life, for example, is hiring medical hacks to do peer reviews rendering favorable decisions to deny claims. Most insureds wouldn’t be aware of the fact that the specialty of Physical Medicine & Rehabilitation (PM&R) is no longer regarded as a credible specialty to render opinions of Internal Medicine diagnoses. PM&R physicians have a tendency to think every insured can be rehabilitated, and that’s simply not true.
Sun Life seems to hire physicians who are not at the top of their game as one Peer Reviewer kept citing lack of “scientific evidence” as reason for denial. The use of the term “scientific evidence” is inappropriate and the term I think the reviewer was looking for was “objective evidence”, neither of which is required in ERISA Plans as proof of claim. Is this something the average insured would ordinarily know? I think not.</p?
Most insureds would also not know how to review a disability claim (their own) evaluating pre-existing conditions, time-worked eligibility, Elimination Period, Pre-existing conditions, Pre-Disability Earnings Calculations etc. A good example is a claimant who goes out on disability but then returns to work part-time working 20 hours instead of the 30 required to remain eligible under the Plan. Oops – a pretty serious mistake..
My point with this post is to point out that the insurance industry has been devising strategies to deny legitimate claims for going on 50+ years and they are pretty good at it. The notion of insureds who may think they know all the tricks astounds me. And, a lot of them do het hurt.
All I’m asking is that insureds “get it together” and realize the disability claim deck is stacked against them, beginning from the very writing of the disability Plan or policy. There are people qualified to help insureds, if they would be willing to listen to those who know, and follow best advice.
