I am receiving more and more calls about insurance companies trying to deny claims. And, although I’ve been writing blogs about the rampage, I suspect insureds may not be taking me seriously.
Unum in particular seems to be harassing claimants about chasing medical paperwork. To make matters worse, Unum still employs third-party paper chasers to request patient notes, sometimes calling treating physicians more than once a day.
OK, so we’re back in the throngs of bad faith and unfair claims practices, which means insureds and claimants should also raise their own “red flags” when contacted by claims handlers.
In today’s terms, I doubt whether claims handlers actually have access, or read, the totality of your claim file – ever. It appears insurers are only managing the latest information and nothing else due to possible huge backlogs of claims, and new systems assigning “first name teams” to manage claims as groups. No one person manages files anymore, and with phone communications going to hell, customer service is a thing of the past. Insurance companies never actually do what they say they will do, keeping insureds sitting on the edge of their chairs waiting for responses.
Use of satellite communications all over the world isn’t making things any easier for insureds. The question now is, how to manage the changing insurance environment for successful payment of benefits. I have always said that the best defense for appeal is to ensure that claims are not denied in the first place. I don’t find that insureds are actually taking any steps to do that because they don’t know how bad it really is out there.
Unfortunately, I’m finding that many insureds are running to the offices of attorneys who are falling all over each other trying to get cases. While attorneys may have some experience litigating claims, they often have little experience managing claims. Attorneys always make the mistake of trying to litigate claims BEFORE the claim is denied, which is exactly the wrong thing to do. I’ve spoken so often about this, I feel the info is a bit redundant, but insureds will either take the advice or not to make sure any attorney contact is with an experienced, reputable person.
Basically, insurers have gone back to the old “risk management” activities such as surveillance, requests for Independent Medical Evaluations (IMEs), excessive medical reviews by their own doctors, sanitizing claim files by negligence, and internal scams such as those having to do with Social Security offsets and overpayments. Insurance companies have systematically removed “last names” from their written correspondences thereby exonerating “team members” from any accountability for what the letters say. Let’s face it, disability claims, or should I say the management of disability claims, is in peril and so are insureds and claimants who depend on their benefits for financial support.
No doubt there are readers out there who would say, “Linda, you are always so negative!” Well, please don’t shoot the messenger. (There’s a lot of that going around lately, too.) My thinking is that insureds would rather know what’s going on, than not know.
In the end, the claims review process just slipped back 20 years to ways that do not support “good faith and fair dealing”, nor do they support “fiduciary duty for ERISA claimants.”
The Texas Hold’em” stack the deck is back folks! It’s best to be prepared, and know what’s going on.
