I think we can all agree that insurance companies have their own agenda that has nothing to do with insureds’ benefits, or adjudicating policies. While it’s common knowledge insurers do NOT make money by paying claims, but by denying them, some people are still asking claims handlers what they should do to manage their own claims.
To begin, I would like to remind my readers that claims handlers represent the bottom rung of the claims review latter. Insurance companies spent millions dumbiing down those who touch claims and they’ve gotten exactly what they paid for. Most claims handlers today only know what they are told by management and have no particular knowledge or skill to respond to questions about Plans or policies.
In addition, most insurance legal departments send out directives advising claims handlers not to discuss ERISA, or other potential litigation questions because they don’t want the “dumb” claims handlers raining on their show later on in court. Therefore, for most claims handlers, contractual topics are off the table. Although there is nothing wrong with asking an insurer to verify “your meaning” of a provision in writing, insureds should not be asking claims handlers to “tell you what it means.”
Despite the fact that insurance companies aren’t required to tell you the truth, an inaccurate or misrepresentation of a policy provision can do more harm than good, particularly if insureds act upon the informatiion. Doesn’t it make sense to you that claims handlers may entice, encourage, and lead insureds down a denial path without telling them accurage inforamtion? In fact, the agenda is from a claims handler’s perspective, not to say anything contrary to the company agenda or common practice.
I received several calls last month from insureds who not only ask claims handlers what they should do, but send emails asking questions such as, “What do I need to do to get my benefit approved? What information should I send in to be approved? Should I go back to work? What is the maximum duration of my claim?” Although these questions may seem benign to you, it is not the claims handlers job to tell YOU what you should do when it comes to managing a disability claim. If they do advise you what to do, how much confidence should you have that the information given is correct?
Insureds and claimants have a responsibility to support their claims recognizing insurers represent “the opposition”, not “the advocate.” Therefore, the cry, “Please, please help me I don’t know what to do” to a claims handler creates an impression of weakness and vulnerability that it is likely insureds will do, say or provide anything they are asked to even though the requests are out of contract or unreasonable.
Insurance companies should not be your primary source of information. And, while I’m on this subject, neither should friends, neighbors, or family, even if some of them are lawyers. If you ask two friends for their opinions, you will generally get 6 answers!
However, the worst source of information comes from insurance companies. It’s like asking the thief robbing you in an alley, “What should I do?”
