Demanding Surgery As “Appropriate Care”
Somewhat connected to the previous post is the issue as to whether an insurance company can threaten to deny benefits unless you have surgery. Think about this. If an insurance company could force insureds to have surgery, they could potentially kill a lot of...
Regular And Appropriate Care
Although I’ve written several articles on “Regular and Appropriate Care”, the long buried issue of Unum’s CXC Employer Plans is once again showing it’s face in the review process. In the mid-90’s and earlier, Unum’s Group LTD...
Disorganized, Inefficient And Late
Although I’ve written about the current chaotic state of most insurance companies, I wonder just how seriously insureds accept that information and run with it. Have you tried to contact a claims handler recently? Or, has your insurance company sent out a second...
The Latest In A Long Line Of Scams
Given my 25 year experience managing Unum claims, it’s been true that there is NOT much Unumm wouldn’t do in order to show positive profitability at the end of a quarter. I’ve lived through 90 Codes, integrating ERDs with financial reserves,...
What Do I Do When My Claims Handler Is Rude?
Years ago, although disability insurers were unscrupulous with their claims management, customer service and verbal communication was a priority. In fact, at one time Unum, for example, demanded its claims specialist sign an “oath”, if you can...
Unum – And The SSDI Scam Continues….
Unum has currently changed its SSDI template letters to encourage claimants to submit SSDI files without question. DCS, and this blog frequently reminds claimants that Unum often does not ever tell the truth about why they have such an interest in SSSDI files....
What? Are You Kidding Me?
First, let me say that this post is not about the hundreds of good ERISA disability attorneys who go the extra mile to represent insureds, and are successful. Hats off to them; thank goodness they are still taking on new clients. BUT…. This article is about...
So What’s The Big Deal About Quarterly Profitability?
Although all insurance companies have their own unique way of managing their disability claims decision-making, I’m going to use Unum as a typical example. The difference between perception and reality is that insureds tend, or chose to believe, insurance...
End Of Second Quarter Profitability Approaching
Just a reminder that June is the end of the 2nd Qtr. for insurers. It looks as though they are already gearing up to deny targeted claims. We can identify insurer’s intent because of increased phone calls, requests for information and more and more threatening...
Linda’s Philosophy – The Value Of A Bag Of Cookies
Years ago on Lindanee’s Blog I suggested to my readers that on occasion they give a delicious bag of cookies to the staff in their doctor’s offices as a thank you to those who spent time keeping them well. Depending on how you feel about cookies and...
“Better Than Sliced Bread” Really Means No Bread On The Table
In the 70’s and 80’s Individual Disability Income Replacement policies were sold as the most. modern innovative solution to disability insurance coverage. The industry’s agents sold these policies as “better than sliced bread” insuring...
Treating Physicians Should Charge To Provide Patient Notes
Many treating physicians are not aware that they can invoice insurance companies for their time, and other administrative costs, to provide insurance companies with patient notes and completed forms. But, be careful. Insureds and claimants need to pay for the...
Unum – Authorization Mistakes
Although I’ve written about this issue for approximately ten years, I find it continues to happen so often that the subject is worth mentioning again. This is an issue insureds disabled with behavioral issues needs to pay particular attention to. Unum is in the...
Voodoo Physicians Are Always Out There
All insurance companies have their favorite physicians they use to support claim denials. In the past, many of them worked directly for the insurance company, but have long since retired. Unfortunately, these insurance physicians continue to leave their ethics by the...
Living With A Disability Claim – When Anxiety Becomes A Secondary Impairment
Having a disability claim that supports a family is very difficult to live with. When working, people know that work equals pay, and as long as they work, they’ll get paid. Not so with disability claims since the insurance company has all the control and...
Full OF It
Just a quick mention to my readers that if any Unum claims handler tells you they have to speak with your treating physicians before rendering an approval, please note Unum is “full of it.” There is nothing in any Unum Plan or policy that requires a...
Properly Completed Medical Paperwork
Today, it is very important for your treating physicians to take the time to complete update forms and other reporting of medical conditions in a clear, specific and concise manner. Insurers look for very detailed information concerning restrictions and limitations...
Friday Q&A
The Hartford never sent me forms for my annual update, should I call them and request? Actually no. You do not have to do The Hartford’s job for them. As a general rule, “Only give an insurance company what they ask for” applies here, and nothing...
The Hartford – WHAT Customer Service?
In the past I considered MetLife to be a “raising the dead” company when it came to Customer Service, but in recent times, it looks like The Hartford is the top grave exhumation company when you want to speak to someone to ask questions or resolve...
So You Want To Speak Directly To An Insurance Company?
Part of the training of your average claims handler includes something I call SIL, or “selective interpretative listening”. It is presumed by the industry that there is a difference between what insureds actually say, and what the words mean in terms of...
