In the last six months or so I’ve been writing one article after another about the changing disability claims process so that insureds know how to handle things. Still, I am receiving phone calls from insureds and claimants sharing their anxiety when things aren’t going as they expected.
I’m not really sure what else I can say that insureds would listen to, but I’m going to give it a shot.
Post-COVID, insurance companies have made internal changes to their claims process that prioritizes paper chasing and reviewing.This is achieved by remote (worldwide) resources, third-party paper chasers, with a small management holding it all together. As a result, insurers are more inefficient than ever in the following ways:
- Reorganization to “team” management of claims instead of one person. Unum, for example only signs letters now on a first name basis. This is to prevent assumptions that this one person is managing your claim. If the objective of “the team” is to tussle paper, then there is no point in having just one person have access to your claim. You never know.
- Significant lack of personal contact with any member of the team “touching your claim.” Customer service is largely non-existent, therefore, this is not the best time to be calling insurance companies every day. ( You shouldn’t do this anyway.)
- Third-party paper chasers are harassing treating physicians until they get what they want. You doctors may begin to complain and ask for help to stop the nuisance calls.
- A dedicated concentration of getting requested paperwork, surgery and consultation dates, contacting secondary doctors, insisting they can’t pay claims without a certain piece of paper, and any other claim protocols directed by the higher ups.
- Insistence of speaking with you on the phone. Don’t get pulled into this one, and keep asking for all communications in writing.
- Timelines are non-existent. Letters are sent out two weeks before they arrive, or so the story goes. Always date and initial paper communications (envelopes) on the date received.
- Forget ERISA. 99% of claims handlers do not know what that is and timelines mean nothing. No one is enforcing ERISA these days.
- Process Administration errors. Letters you receive don’t make sense; it’s almost as though they are written to someone else. (Untrained claims handlers make many mistakes!) I wouldn’t take any letter communication seriously without verifying what it’s about.
- Loss of paperwork, or delayed posting from communication centers to claims handler desktop. I’ve found the most accurate verification of receipt of paperwork is with customer care, if you can get someone to talk to you.
- It now takes upward of a year to get an appeal decision once a claim is denied.
- Claims handlers are only dealing with “recent” paperwork, probably don’t have access to your entire claims file, and won’t remember any last conversation you’ve had. For example, if you signed Unum’s “Optional Authorization to Provide Information to Third-parties”, on which you indicated “written communications only” at the beginning of your claim, forget it, no one is going to see that paperwork today. That’s why they are still calling you.
So, what to do about it you might ask? What’s the new strategy? Well, I can’t tell you everything because as a Consultant I offer services to manage it. But, here are a few tips.
- Stop making all those phone calls! You’re never going to get the same person, and you can’t rely on what anyone tells you. Understand very clearly….these claims handlers aren’t trained to do anything else but chase paper.
- Document everything in writing. Send faxes, write letters, request information be placed in your file.
- Try to stay within your given deadline to submit update paperwork. If deadlines can’t be met, send a fax informing when the paperwork can be sent in. Don’t call and ask for an extension, it won’t be documented.
- Date and initial all communications received.
- Communicate only in writing. No portals. Emails are OK if you save them.
- Keep a journal of all actions taken on a claim.
- Turn down the anxiety. For example, if you receive a letter sounding like it applied to someone else’s claim, send a fax and ask directly what you wanted to know. Be prepared emotionally for the negligence and inefficiency. We know it’s going to happen so just deal with it and be done.
- Start filing internal complaints again. Get your concerns on the record. The complaint itself won’t go anywhere, but your letters will go into your file.
- Download only the most pertinent information to your impairment and ask that it be placed in your file. Don’t overload, just make sure what you add to the file is relevant to your medical condition.
- DON’T POKE THE BEAR! You can’t argue with someone who doesn’t know anything about your claim. Work with the system, albeit as bad as it might be, to achieve what YOU want. Avoid proving any issues or creating “red flags.”
- This is not the time to push the envelope on medical restrictions and limitations. Surveillance is the major tool of choice insurers use to “Gotcha!” Remember, it’s not what they see you doing, it’s how they INTERPRET what they see you doing. “Seeing is believing” and you can’t take it back. STAY OFF OF SOCIAL MEDIA. Just don’t do it!
- Remember Murphy’s law? If you think it can’t happen to you, well, you might be surprised how often the worst things can happen to people who think it can’t happen to them. It can happen, and it eventually does, if you don’t pay attention to what you do and say. If you get on the phone and OVER SPEAK your claim, (a nice way of saying “you talk too much”, you may regret it later.
I really hope that this blog post convinces you to pay attention to what’s going on with your claim. This information is extremely IMPORTANT, when it comes to managing disability claims. I know there are readers out there who are trying to manage claims themselves. The worst things you can do is to get upset, overreact, talk too much, and let fear take over to the point you do exactly the wrong things.
To be clear, you’re going to be dealing with complete failure of disability insurance companies to provide insureds and claimants with a fair and equitable review of their claims. Paperwork will be lost, “We didn’t get it” is now a famous capstone statement. There will be no one to complain to.
Finally, I want to leave you with this message: THEIR MESS ISN’T YOUR MESS. While it’s not your responsibility to clean up the errors, it is important to CORRECT errors that affect your claim; and, you can do that by putting the facts in a fax or letter that goes into your file. Forget the phone calls, you are wasting your time!
In two decades insured’s have gone from being victimized by “STACKING THE DECK AGAINST YOU” to “52-CARD PICK-UP”, literally. If you have any questions, please feel free to give me a call. I’m here to help.
