The purpose of this blog is to bring insureds up to date with current insurance claims strategies that insurers still use to deny claims. With so many insureds thinking they can manage on their own I thought it would be a good idea to point out those areas where the insurance company is “out to getcha.” You’re going to have to manage all of this.
Insurance companies are using old hack (retired) physician resources to review medical information in lieu of requesting in person Independent Medical Evaluations. While most insureds are wiping their foreheads and saying, “thank goodness”, insureds should be very cautious because these reviews will never agree with your physicians’ medical reviews. You should know that specialities such as PM&R (Physical Medicine and Rehabilitation) and Pain Management are inappropriate for wealthy, high financial reserve accounts.
It’s fairly typical now for insurers to harass your treating physicians to obtain medical information.Calls to treating physicians may take place more than once a day, irritating the most cooperating treatment providers. Third party paper-chasers are out there harassing the doctors who are treating you.
Most claims handlers are located off-shore and can barely speak English, much less read or adjudicate your policy correctly. There is no such thing as a centralized facility where claims handlers are supervised. Claims handlers are located all over the world, most often in third-world countries
ERISA employers have gotten into the claims management game and often set up internal processes to stop claimants from entitlement to LTD. Higher paid jobs often include severence pay that disqualifies from long-term benefits.
Insurance companies have once again initiated “tag surveillance” using all of their electronic and digital resources to watch insureds. Surveillance is the second most profitable denial tactic next to IME requests for disability claims.
Insurance companies are more prone to lose paperwork and claims handlers rarely read the entire file. Only recent information about your disability is ever read. It’s important not to send “old information” to an insurance company, they won’t ever go back, consider it, or read it.
These are just a few of the continuing egregious claims practices used by the major US insurers.
