Ignoring Best Advice Won’t Get You A Paid Claim

I’ve been in the private disability claim business for over 25 years, and in that time one subject I have consistently stressed for successful claims is not communicating with insurance companies on the phone.

Despite the many articles on this blog explaining in detail why it isn’t a good idea to share verbally with claims handlers, insureds continue to call and  begin with, “…when I spoke to Unum….or, when I spoke to my claims handler.” Obviously, I’m not getting through.

If disability insurance were any other type of business, insureds would insist on having everything in writing. Would you really sell a used car without a bill of sale?  As adults, we are all well aware of the “he said, she said” impossibilities of attempting to resolve differences, and yet when it comes to managing claims insureds are more inclined to “spill the beans”, or, “give away the farm”, than recognize the importance of prudence and restraint.

Private disability insurers train their specialists to use “selective documentation” when it comes to conversations with them. This means, diary records document only what is favorable to insurers (or, that which progresses the credibility plan of denial), at the expense of all else said that favors insureds. A Unum claims specialist who is rude and says, “So why aren’t you going back to work?” clearly isn’t documenting what he/she said, only your response.

Those who are taking opioids or other depression and pain medications shouldn’t be speaking to any insurance representative on the phone. Perception and reaction can be distorted and therefore responses cannot be relied upon to be accurate or in proper balance to questions asked.

When I ask callers why they speak to their insurance reps on the phone I hear, “Because I thought I had to.”

OK. Let’s be clear. No group ERISA Plan or IDI policy contains provisions requiring insureds and claimants to communicate with insurers on the phone. Disability contract documents may contain provisions requiring you to cooperate, but certainly insureds can be very cooperative with written communications. “In writing only” is the only way insureds can accumulate complete records of all of their dealings with any insurance company.

Insurance specialists know that if they can reach you on the phone and get you talking, you may just give yourself work capacity – a great outcome for a claims specialist whose performance reviews are based on how many claims they deny.

As I said I’ve been giving the same advice about requesting all communications in writing for 25 years; and, insureds may be reading, but some are clearly not listening.

Contrary to verbal communications my advice and recommendations concerning insurance website portals is fairly new due to the advance of technologies that allow Internet interactions. It didn’t surprise me to find out that insurance website portals present the perfect façade for tracking Trojans, and documentation to allege insureds have work capacity. Accessing insurance portals could be said to be another method of covert surveillance…along with social media.

One recent Unum denial letter cited an insured’s use of its website portal as evidence of work capacity and denied the claim on that basis. Although Unum recommends using its website portal, it uses the fact that you go there to deny claims. As a result, I’ve never recommended that any insured receive emails or communicate with insurers through any website portal. Still, people keep going there to receive communications knowing full well that they are risking benefits.

So, why do you think insureds and claimants deliberately go against best advice and practices? I’m not a psychologist by any means, but it seems to me that because the claims process is stressful, worrisome, and frustrating, the only way insureds can “feel better” is to subject themselves to verbal or direct contact to obtain reassurance. Literally, insureds “take a breath” and feel calm about their claims after a “good chat” with the claims handler. Oh my……..

In other words, a phone conversation or website contact “calms the nerves.”

As a consultant I can only make the recommendations and communicate best advice; it’s up to insureds and claimants to listen and follow through.

I don’t really mind being ignored, but I do mind when I hear about claim denials that should never have been allowed to occur. I can only point you in the direction of success, but it is up to you actually implement the expert’s advice.