The changes that have been made in the claims review process since COVID have already proved to be disastrous for many insureds attempting to work through the system on their own. Please read the various changes that have made managing your own disability claim more difficult.
- Lack of cohesion and centralized management over the claims process that produces fair and objective decisions in a timely way.
- Diversification of the claims review process so that no one internally “reviewing claims” has a macro view of the entire process. Division of claims review into minor tasks creates total chaos that is nearly impossible to penetrate particularly without appropriate supervision.
- No one claims handler can answer questions about everything involving disability claims. Handlers are told how to perform their own little job tasks but can’t answer questions outside the box.
- Minimum training on how to “adjudicate” a disability Plan or policy is provided. Claims handlers are NOT decision makers and even those who are do not know enough about contracts to make decisions involving millions of dollars in financial reserves.
- There is no centralized management of hundreds of claims handlers working independently all over the world. Communications are strained and sporadic at best.
- Claims handlers openly display rude and sarcastic attitudes when dealing with insureds. Most are “A-type” personality people hired specifically “not to give away the farm” and have no compassion or understanding for disability. Remember the claims manager who said, “Insureds are not worth anything, but you just like to see one tumble down the stairs every now and then.” This epitomizes how insurance companies view insureds.
- There doesn’t seem to be any cohesiveness to the review process. There is generally not any one person who can answer questions about your claim. Customer Service bit the dust quite a while ago, so we shouldn’t be surprised when it’s difficult to get someone knowledgeable to talk to.
The real question for insureds is how to deal with chaos, inefficiency, and negligence in order to ensure benefits continue to be paid.
Here are my recommendations:
- It is essential that all communications must be provided in writing only. No one within the company is documenting accurately, or remembering anything you say.
- Stay away from insurance websites, even when you can upload or download information. It is not wise to keep checking the portals because they may not be up to date. Frequent checking of portals also indicates anxiety, which for most disabled persons just adds to their problems.
- Make sure all of your communications are added to your official file (Administrative Record) or claim file. I don’t believe there is any such thing these days as an unsanitized file.
- Make sure paperwork is sent in on time.
- Do not “put up with” receiving letters two weeks after the date written on the letter. Never accept short due dates. Enforce your policy or Plan giving you 30-45 days to return requested paperwork.
- Keep track of who you are speaking to. Print out fax confirmations of receipt when faxing paperwork.
- DO NOT speak with claims handlers on the phone. Insist they contact you only in writing.
- If you can’t understand the claims handler you’re speaking to, ask to speak with someone who can speak better English.
- If you need help, ask for it.
- File a complaint if your insurer acts outside of what would normally be considered “fair and equitable claims practice.
It is not easy to have to deal with businesses that are so inefficient. If you cannot defend your Plan or policy, consider retaining experts who can help you.
If you wish to contact me, or want to obtain more information about my services, please visit my website at: http://www.disabilityclaimssolutions.com
Tel: 207-793-4593
