If insured and claimants feel the need to yell at me, perhaps this post I wrote in 2024 may help.
When managing a private disability claim it is very easy to get into the habit of nit-picking every minute detail even when insurers pay claims without a hitch.
In fact, I’ve reviewed many approval letters, and thousands of communications with good news, only to have clients and non-clients ranting about something minor otherwise mentioned in their letters.
Believe me, I am always the first one to defend and support insureds’ positions when backed up by Plan and policy language wrapped around a stack of legitimacy. It does no good to continue to argue points that are of minor concern and can be easily addressed as the claim progresses.
A good example is the case of an insured engaged in trying to get benefits approved for the last year. In an approval letter, the insurer stated all back benefits were released, but mentions requesting records from all primary care physicians – records that were previously sent. Instead of recognizing the approval decision, the insured wrote a nasty letter addressing the insurers negligence in asking for records more than once.
In fact, it would probably surprise you to know how often I personally worked very hard to secure paid benefits only to have some clients call and tell me “something else is wrong” and immediately want to jump all over the insurer for more and more benefits even when their interpretation of policy language is incorrect. In the face of victory, it seems to me there should be a “time out” before jumping on other claim issues!
And, let’s talk about “bad faith” for a moment. Prosecution for “bad faith” is more difficult than most people think because Plaintiffs have to prove “intent to harm.” A decade ago Unum “bad faith” cases were a dime a dozen because there existed credible evidence of “patterns of practice” proving Unum deliberately devised strategies with the intent to harm insureds for profit. Multimillion dollar punitive damages were awarded.
Today, bad faith is much harder to prove. Unum, for example, tells regulators, “We don’t do that anymore”, and the company is actually believed in the courts. It’s called, “company bias”.
Nevertheless, those who throw the words “bad faith” at insurers are more likely pitching idle threats insurers know can’t be proven. It’s not a good idea to accuse insurers of bad faith out of anger or rant. If you actually do RANT, then choose words carefully, expressing the problem in professional terms.
In many respects “bad faith” is not unlike the RICO racketeering laws requiring proof of repetitious illegal “patterns of practice” that deliberately cause harm for profit as an established business practice. Bad faith is actually hard to prove.
One insured called Met Life every name in the book, accused it of “bad faith”, and told the company he was smarter than they were. The letter went on for pages. The claim was not paid, and no one should have been surprised that it wasn’t. This is why, it might be a good idea for insureds to have consultants and advocates who can communicate relevant information in professional ways.
Another category of “rant” is what I call the “who done its.” “Met Life said this”, and “Unum did that”, and “your letter is incorrect”, and “I never said that”, and on, and on and on. Neither claim approvals, nor appeals will ever be won by getting on the “he said, she said” merry-go-round back and forth with letters about, of course, the eternal “who done its.”
In most cases, insureds who are sent their claim files after denial usually extract every “who done it” out of the file and think they will win their appeal by citing every “who done it” they can find. In reality, claim approvals and appeals are won based on the persuasiveness of new medical evidence provided, not the crazy mixed up “who done its” found in the claim files.
Although the “who done its” may come across as more personal, and angering to most insureds, they should not be used as an advantage point for supporting any disability claim. [I often wonder whether it’s a good idea to let insureds review their own claim files. What they usually point to in the end are always the “who done its.”]
In summary, disagreements with insurers should always be addressed with well thought out supported facts written in a professional way. It doesn’t do any good to rant to a private disability insurer, and in the worst case scenario it could appear you, the insured, is crazy. Accept successes and allow a “time out” period before addressing anything else that may be wrong. Frequent wrong-findings set up claims as “red flags” and eventually receive the lion’s share of risk management activities. (More to complain about!)
There is nothing to be gained in getting “huffy” with an insurance company. Calling insurers names, accusing them of “bad faith”, constantly ranting about minor things that can be easily fixed challenges your credibility more than it does the insurers’.
One final thing…..claims handlers DO NOT have decision-making authority over claims. It is useless to argue with a claims handler at any level. In addition, claims handlers are dumbed-down these days and can’t answer most questions. Don’t waste your time dealing with claims handlers who are the lowest rung of the claims review ladder and little more than glorified administrative assistants.
Ranting and arguing with insurance companies is a waste of anyone’s time and reflects upon your own creditability. Find other ways to express your points of view in professional ways.
