Holiday Q & A
I was hoping to get a settlement from The Standard, but they declined. Do they ever offer settlements? Not very often at all. Disability claim settlements are called “compromised” settlements because both insurer and claimant give up value in order to...
Bad Santa Claims Management
I don’t know to what extent my readers are actually interested, or care about what goes on at this time of year relative to their claims. It’s always been my experience that insureds and claimants have no idea what the review process entails and how...
New Claims – Don’t Forget About the Initial Review
Disability claims internal reviews are not done in random; there is a hierarchy to the review that most claimants either don’t know about, or perhaps do not understand. When claims are submitted for payment, insurers will begin with an “initial...
How Do I Know If My Claim Is Targeted?
Those in the know always talk about claims that are “targeted” without letting insureds know how they can tell. “Targeted”, in a general sense, means that claims are identified, using internal criteria, to be aggressively risk managed with the objective of denying the...
Unum Out Of Control For Year-End – Again
It’s beginning to seem like deja vu with all of the claim denials Unum is making. The public is again beginning to realize the company’s unfair tactics to back-up their denials. My initial reaction, especially, is the one item in the Multi-State...
Settlements, Settlements, Settlements
If you’ve been hoping to rid yourself of your disability claim, now may be the time to do it. Lump-sum settlements are being offered, not only Unum (known as the settlement guru), but by other insurers as well. While in the past, I have often argued against...
Why Social Media Is A Deal Breaker
People love to talk….and share….and exchange selfies. In the last 25 years, social media exploded to where a cell phone is a more protected personal object than a wallet. BUT, since the inception of the Internet and the World Wide Web, we’ve also...
Surveillance Isn’t A Game
There are many times when I get the feeling that my articles about insurance surveillance are not taken seriously. I guess people are going to do what they are going to do, but “surveillance isn’t a game.” Most insureds just don’t get...
Q & A And News
What do I do when I can’t get my insurance company to respond at all? Now is the time to start sending in complaints to defend your claim. If you have an ERISA claim, contact your regional office of the EBSA (Agency of the US Department of Labor). If you have an...
“Red Flags” And How To Prevent Them
One of the most helpful best practice articles I’ve written to date has to do with “Red Flags” and how to prevent the “suspicions” that creates them. You will find my former articles on the subject using the Search button from...
Physicians Should Bill The Insurance Companies
Medical bill and health insurance form with calculator Treating physicians have already started complaining about the frequency of information requests and phone calls they receive from disability insurance companies. I expect it to get worse in the next two months....
Unum’s Mental Illness Scam – This Is Important!
In 2001, as part of the NAIC Multi-Settlement, and California Settlement Agreement with UnumProvident, it was agreed that Unum would NOT continue to backdate Mental and Nervous claims in order to deny after 24 months. It identified this practice as unfair, and Unum...
Insurance Docs Contacting Your Docs
With the return of egregious claims practices comes aggressive insurance physicians who are hired by insurers and the insurance industry to conjure written back-up to support claims denials. The philosophy of “do no harm” quickly turns into “do as...
Friday Q & A
Is using an insurance company website portal a good idea? In my opinion, “No”. I’ve been told that insurers have placed tracking software in the program that follows your computer wherever you go. On the other hand, there are certain things that can...
Sunday Q & A
What do I do when my doctor starts complaining about filling out my disability forms? More and more treating physicians are preferring to “sit on the fence” just short of certifying disability. Or, they just don’t want to bother with the paperwork...
It’s All In Your Head
One of the newer elaborated categories in the DSM-V (2005) is called “somatic symptom disorder.” According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), somatic symptom disorder (SSD) involves one or more...
How To Include Peer Statements In The Record
First, I would like to set some ground rules for such letters since writing the wrong thing is worse than saying the wrong thing. Please pay attention to what I’ve listed below before you attempt to obtain “peer statements” for your file. The letters...
Fee Reduction To December 31st
I’m sure most of us have been watching the deterioration of our economy making it harder and harder to make ends meet. At the same time, insureds and claimants are also watching the aggressive “risk management” insurers are now inflicting...
Is Appealing A Claim Worth it?
Here we are at the end of the 3rd Qtr.and I’ve been receiving more calls than usual about claim denials. This means people are asking for attorney referrals and my advice regarding filing an appeal. I’ve been saying for years now that it is unwise to file...
What Do I Do Now?
In the last few months readers read several posts from me describing the awful claims situations they may find themselves in. If you don’t remember, please review my posts for the last month or so. The question I’m guessing many people have is, “OK...
