There have been so many inquires to DCS lately regarding a company called “Claimify” that I thought perhaps it would be good information to include a blog on the subject.
There are so many companies out there now that are hired to be “third-party paper chasers” for insurance companies, it’s hard to keep up. Regardless of the company making the request, answers to claimant’s questions are always the same. NO, YOU DO NOT HAVE TO SIGN SSDI FILE AUTHORIZATIONS FROM ANY COMPANY, INCLUDING YOUR INSURERS, TO OBTAIN SSDI FILES.
First, there are no provisions anywhere on this planet that require SSDI files as proof of claim. If it’s not specifically mentioned in your ERISA Plan, you don’t have to do it. Second, claimants have the right to designate SSDI files as Protected Health Information “PHI”, as is their right to do under HIPAA. Most claimants who call me are fearful that their insurers will deny claims if they don’t sign the SSDI Authorizations. If ERISA Plans do not specifically require SSDI files as “proof of claim”, then there is no basis for such a denial. Claimants do not have to be fearful about this.
So why are insurers like Unum requesting SSDI files so often? There are two reasons: the company nickel and dimes its claimants by calculating and recalculating SSDI overpayments over and over again usually resulting in alleged overpayments, and Unum, in particular, is eternally looking for mental health listings they could use to deny claims due to mental health approvals. You may notice that Claimify requests authorizations to obtain SSDI financial information so that yet another recalculation can take place. Since this is the end of the year, Unum brass must have directed a focus on recalculating benefits in order to bolster profitability.
Unum always seems to come up with some crazy 2+2=5 formula with an overpayment of some kind. Usually, the company “forgives” most of it, if the number is large, but requires repayment of several hundred dollars.
I never recommend dealing with Claimify directly. Claimants should contact their claims handlers (in writing only) and let them know they do not wish to disclose SSDI file information and prefer to designate files as PHI under HIPAA. Also, claimants should also request claims handlers notify Claimify to stop pursuing signed Authorizations.
Claimify’s requests for SSDI files is not something claimants need to be afraid of. Just notify claims handlers that your SSDI file is PHI and you will not be signing the Authorizations. If I am correct, and I believe I am, Unum will then request all of your SSDI 1099 copies, and that’s fine. The 1099s only have a monetary figure on them, and they can be released directly from you.
