Twenty years ago inssurance companies took big hits to their public reputations when “bad faith” and unfair claims practices were disclosed to the general public. Attorneys crawled over each other to make millions on bad faith, and many of them did. Since then, the ever lingering bad faith reputations continue, but have had a lesser effect on getting claims paid. Disability insurance companies just don’t manage claims that way anymore.
While some insurers continue to “hang on” to unfair claims practices (Guardian), most have found it unprofitable to take the risk of large litigation fees in order to push a principle, even for profitability. In the last two decades, insurers have reconsidered their claims practices and are managing claims with less concentration on bad faith and egregious claims practices, and more on better medical and occupational claims management that is actually consistent with Plan and policy provisions.
In my opinion, insurers have grown weary of paying claims based on unclear and non-specific medical reporting. Treating physicians who simply write, “Cannot return to work”, or “out of work” on medical forms are risking future benefit payments for their patients. This is why in the last two decades physicians have grown more and more reluctant to support disability except under catastrophic circumstances. In fact, many physicians are now requiring their own Functional Capacity Evaluations in order to fill out the Capacity Section of most disability forms. Nevertheless, the approval of payment of benefits today, depends on whether the medical reporting of restrictions and limitations passes the scrutiny of medical review.
Occasionally, I still get phone calls from potential clients who are looking to “make the insurance company pay” and describe to me in detail what I call “the whodunnits” of bad faith and “screw you claims management”. After 25 years of experience on both sides of the disability claims fence, I can safely say that no one claim will ever put a dent in any insurance company, regardless of what they may have done. Since the ultimate goal of every insured is to “get paid”, it makes more sense to spend time ensuring the information provided is of a quality level both in specificity and detail, making it more difficult to deny claims.
Being on the same track with your insurance company is so important. It does no good to try and document what you believe is “bad faith” when all your claims handler is looking for to pay claims is a good set of medical records. I’ve resolved more than one conflict with just asking what the problem is, and resolving it. It does no good in today’s terms to continually challenge “the intentions” of insurers, when all you need is a conversation with treating physicians demanding better reporting.
Twenty years is a long time to hold bad faith against any insurance company, although I haven’t eliminated it entirely in some cases. However, if you want to have a paid claim, then bolster it with good information, both medical and occupational. I don’t think company agendas are the problem anymore, but irate and rude “A” type claims handlers, who like one manager from Unum once wrote in his Facebook, “Insureds and claimants aren’t worth anything, but like a slinky I like to watch them fall down the stairs every now and then.”
Times have changed, and insureds need to adjust to “the New Rules” of perfecting claim information rather than ranting on about how bad stories are on the Internet about this company, or that one. Better information reporting seems to be the key to paid claims and it is important to know HOW to report, WHAT CONTENT and CONTEXT to document and WHAT TO SAY, AND NOT SAY. Most bad faith is a thing of the past.
If you have any questions about managing your claim please feel free to give me a call to discuss coming on board as a DCS Client.
You may also visit my website for more information at: http://www.disabilityclaimssolutions.com
