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Only Physicians Can Take An Insured Out Of Work

This is an issue primarily for those with IDI policies such as doctors, dentists, surgeons and highly paid executives. There seems to be a misconception among these insureds that they can decrease their hours, stop doing certain procedures, sell their businesses, and...

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“I don’t get it…………”

Yesterday I was speaking to a DCS caller about a claim situation in which Unum denied her claim twice, finally overturning the appeal and paying the claim “because she was awarded SSDI.” In the course of the conversation, I inquired about why this claimant...

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What Everyone Should Know About ERISA Appeals – Part III

WHAT IS AN APPEAL? An appeal is a claims process whereby insurers are asked to review their previous denial   decisions to determine if the original denials were correct. Through supplementation of the Administrative Record or claim file insureds and claimants have...

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What Everyone Should Know About ERISA Appeals – Part II

FIDUCIARY DUTY The U.S. Department of Labor defines “fiduciary duty” as a responsibility of employers (Plan Administrators) to administer disability Plans solely in the best interests of the participants and to decide indeterminable issues in favor of the claimant....

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Pre-Existing Conditions by Linda Nee

Nearly all group LTD polices contain some type of pre-existing condition provision. These provisions protect the disability insurer from paying claims for conditions that existed before insureds became effective on the current policies. There are many types of...

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What Everyone Should Know About ERISA Appeals – Part I

The purpose of this article is to be an educational and informative resource to private disability insureds interested in obtaining basic information concerning “Appeals”. It is not intended to be legal advice. DCS, Inc. refers all of our clients with disability claim...

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Merry…..Surveillance In The Everygreens?

Just a quick reminder that surveillance teams are out in full swing trying to locate early shoppers carrying parcels, walking malls, and putting grandkids on Santa’s lap. Remember, the new normal of disability claims investigation includes activities checks with...

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ERISA “Any Occupation” Investigations

Employer sponsored group Plans nearly always contain a definition of disability which includes the following: “After 24 months claimants must be unable to perform the material and substantial duties of ANY occupationfor which he has training education and experience.”...

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Insurance Physicians Practice Voodoo Medicine by Linda Nee

There’s an old saying, “If someone can’t do their job, they should teach.” Insurance companies typically hire physicians, who for whatever reason, can no longer perform clinically but want plush jobs paying big money. Insurance medicine, including IME physicians is a...

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SSDI Overpayments – The Right Thing

Most people who read Lindnee’s Blog contact me because they know I will always tell them the truth about their claim situations and because I have the knowledge and experience to provide accurate answers. This is one of those siutations. I seem to be hearing a...

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Fibromyalgia And Unum – A Sunday Editorial by Linda Nee

Unum’s Fibromyalgia Position Statements and Guidelines (7/29/2002) Just before leaving Unum in 2002 one of its physician consultants handed me a copy of Unum’s “position statement” regarding Unum’s handling, review, and philosophy in administering fibromyalgia claims....

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Unum – Talk About Scary, Spooky And Shady…

I think it is exactly the appropriate time of year to talk about Unum’s “scary, spooky and shady” claims practices that are heralding 4th quarter profitability and causing insureds a great deal of grief. Unum’s investigations appear to be over...

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Unum -News Updates

Just entering into 4th Qtr. profitability results Unum is denying large numbers of claims attempting to prepare for an economic recession in the spring. As a result of Unum’s targeting of claims for profitability, I’m already aware of several claim denials...

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Holidays With No Money – Late Checks

We are quickly approaching the holiday season and that could mean delayed checks and late benefits from insurers. While Unum by far has the most difficulty in getting checks out on time, hardships over the holidays from not receiving benefits on time can happen to...

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