Bad Faith Is Hard To Prove
The laws in most states imply a duty of good faith and fair dealing on behalf of the insurance company. This duty requires the disability insurer to act reasonably in the handling of claims submitted to them by insureds and claimants. Even though disability polices do...
It’s A Mess Out There
If you’ve recently tried to work through the menus, or customer service lately you know how disrupted and chaotic the claims process really is. It’s no longer an issue of “lateness” or “waiting in line”, but issues surrounding the accuracy of information provided, or...
A Bit More Harassment
Apparently, Unum has a new strategy of phoning insureds several times to “remind” them they have paperwork due. I really don’t know what the purpose of that is since most insureds DO turn in their paperwork on time. Is this just to give their claims handlers something...
Way Too Nice……..WTH?
I guess it must be a sign of our times. I have always been forthcoming with claim information even so far as giving attorneys information when they call, or those who are just asking questions as to “what to do next.” In fact, some of my clients have often told me...
Check This Out
Please look-up the ICD-10 Code of Z28.310 on the Internet. Just search ICD-10 Code Z28.310. If you do not wish this code used in your medical records, be sure to inform your medical treatment providers right away. You can ask that it be removed as well.
Unum – Rotten To The Core
Given the current state of the economy, more and more claimants and insureds are attempting their own appeals and are getting taken to the cleaners. This may turn out to be one of the most important posts you will read this year. There are two clearly defined...
No Doctor Shopping Allowed
This subject is going to be a little touchy and I can already see some of my readers getting a bit miffed. It’s still and important topic for all insureds, and listening to this article could save your claim. So, I’ll take the heat. First let me say that...
No Such Thing As Paperwork Reduction Act
Insurance companies are absolutely, crazy paranoid about not having enough information about YOU and your claim. They have always been an industry overburdened with paperwork anyway, but when it comes to disability claims, well……chasing paperwork is the...
Unum’s Having Problems Paying On Time
Unum has always had problems getting checks out on time around the holidays, and sometimes for no reason. Recently, checks haven’t been released on time and I’m getting quite a few calls about it. If your check is late, call your rep and ask, “When...
Ophthalmologists, Orthopedic Surgeons And Other Physicians Who Do Not Support Disability
There are certain medically credentialed physicians that generally refuse to sign disability paperwork certifying patients are unable to work. The top two are Ophthalmologists and Orthopedic Surgeons. These specialities should not be given as “primary” on...
Having A Baby During Disability
Having a baby while receiving disability benefits is NOT a good idea for LTD. While most STD claims provide for maternity leave, it is expected that insured women will return to work after 6 weeks maternity leave. Disability insurers often will NOT take the position...
Working Together To Provide Assistance In Trying Times
For the last several years disabled insureds have been struggling financially to meet obligations given the rising inflationary economy and increased cost of living. Although it’s been difficult for everyone, I can imagine how hard it is for those to live and...
Insurance Medical Reviews-Misrepresented And Biased
Although medical review is perhaps the most important part of the investigation of a disability claim, it is also the most frequently used “stack the deck” procedure initiated by all US insurers, and everyone knows it! That’s right. It’s not as though it’s a big...
Old Rules -More Aggressively Managed
In order to continue to receive benefits in 2023 ALL of the following criteria must be met. If not, claims will be considered vulnerable to risk management and denial. It might be a good idea to consider whether your claim would benefit from an expert. If so, please...
Returning To Work Isn’t Easy
Most individuals who find it necessary to leave work for a medical disability express the desire to return to work at some point in the future. Returning to work is a normal part of our American work ethic, and most everyone believes that returning to work is the best...
Very Unnecessary Claim Denials
Due to the end of the year profitability results I have unfortunately seen several claim denials, which in reality should never have happened. These denials are referred to as “failure to provide” terminations. Insureds and claimants have a responsibility...
Linda’s Christmas Message
Yesterday, I was watching the George C. Scott version of “A Christmas Carol”, and it occurred to me how easy it would be, in our day and time, for people to become a Scrooge of the modern age. Cries of “Are there no prisons?” “Are there...
When Do Disability Insurers Cross The Line?
All disability insurance companies have the right to fully, and fairly investigate the facts of claims submitted to them for payment. The insurer also has the right to conduct surveillance and to make sufficient inquiries in order to determine insureds inability to...
A Word About Malingering
The definition of malingering as defined by most disability insurance companies is: “the deliberate exaggeration of psychological and/or physical complaints for purposes of tangible secondary gain.” (i.e. monetary rewards, etc.) According to the organizations who...
Advance Pay And Close – A Likely Scheme
Most disability Claims Manuals state the following: “An Advance Pay and Close is a claims management tool designed to help an insured return to work when there is a reasonable and expected return to work date/plan. By offering an alternative payment method, we are...
