Disability Insurer Profiles: Great-West

Great-West Life & Annuity Insurance Company (“Great-West”) is the final disability insurance provider we will look at in our series profiling insurance companies that specifically market to physicians and dentists.

See our profiles of MassMutualMetLifeNorthwestern MutualGuardian, Hartford, and Standard.

Great-West, which also goes by the registered mark of “Great-West Financial,” was incorporated in 1907, and traces its roots to a Canadian parent company that was incorporated in 1891.  Due to the nature of the economy and other factors, many insurance companies have suffered substantial losses in the past few years, and Great-West is no exception.  Great-West’s net income recently dropped from 238.1 million in 2012 to 128.7 million in 2013.  Consequently, Great-West may be looking to substantially increase its profits by, for example, denying high paying disability claims.

Company:  Great-West Life & Annuity Insurance Company.

Location:  Greenwood Village, Colorado.

Associated Entities:  Great-West Lifeco Inc.; Great-West Lifeco U.S. Inc.; Great-West Life Assurance Company; Great-West Life & Annuity Insurance Company of New York; Great-West Capital Management, LLC; Great-West Funds, Inc.; GWFS Equities, Inc.

Assets:  $55.3 billion in 2013.

Notable Policy Features:  Great-West is the insurance company that provides group disability insurance for the American Dental Association (ADA), so if you have a Great-West policy, your claim will probably be governed by the terms of the ADA’s group disability policy.

Great-West frequently sends out notices of updates and changes to the underlying contract between the ADA and Great-West, so there is a chance that you may end up with insurance coverage that you did not bargain for at the point of sale.  Oftentimes these notices are full of legalese and insurance jargon, and may be difficult to understand.  Nevertheless, it is important for you to promptly review any notices you receive, because they may impact your disability coverage in significant ways.  If you receive such a notice and are unsure about what it means, an experienced attorney can explain how the changes outlined in the notice will impact your policy.

Additionally, if you have a Great-West policy, you should be aware that your policy may contain a very strict provision requiring you to obtain proper medical care for your condition.  For this reason, if you are thinking about filing a disability claim with Great-West, you should make sure that your medical treatment is both well-documented and “appropriate” under the policy’s terms.

Claims Management Approach:  How Great-West administers your claim will depend on the terms of the policy at the time you file your claim.  Because the terms of the ADA’s group disability policy are renegotiated on a regular basis, the terms of your policy will likely change over time.  Since your initial copy of the policy may no longer be accurate by the time you file your disability claim with Great-West, be sure to ask for a copy of the current version of your policy so that you know your rights under your policy.

These profiles are based on our opinions and experience. Additional source(s): Great-West Financial’s 2013 Annual Report; www.greatwest.com.


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Disability Insurer Profiles: Standard

Standard is another disability insurer we will look at that specifically markets its policies to physicians and dentists.

See our profiles of MassMutual, MetLife, Northwestern Mutual, Guardian, and Hartford.

StanCorp Financial Group (“StanCorp”) was founded in 1906 and uses the marketing name “The Standard” to refer to its primary subsidiaries, which include the Standard Insurance Company and the Standard Life Insurance Company of New York.  In 2013, StanCorp received $351.7 million in pre-tax income, and $272.4 million (approximately 77%) of that income was attributable to profits from StanCorp’s insurance services.  StanCorp is particularly proud of its consistent long term growth and—given the fact that 77% of StanCorp’s profits come from its insurance services—StanCorp has an obvious incentive to deny high paying claims submitted by physicians and dentists.

Company: StanCorp Financial Group, Inc.

Location: Portland, Oregon.

Associated Entities: Standard Insurance Company; The Standard Life Insurance Company of New York; StanCorp Investment Advisers, Inc.; Standard Retirement Services, Inc.; StanCorp Mortgage Investors, LLC.

Assets: $22.73 billion in 2014.

Notable Policy Features:  If you are considering a Standard disability insurance policy, you should pay particular attention to whether the policy allows for total disability benefits if you are working in another occupation.  Oftentimes, Standard policies will pay nothing more than residual disability benefits if you are able to secure other part-time employment.  For example, if you can no longer practice dentistry, but you are able to teach classes at a dental college, Standard may refuse to pay you total disability benefits.  If you are eligible for residual benefits, Standard will require you to submit proof of your income every single month.

Read more about the difference between total disability benefits and residual disability benefits.

Claims Management Approach:  Standard tends to demand strict compliance with its claims procedures, and Standard will generally not be very accommodating if you make a mistake.  This can be problematic, because, for many policyholders, the claims process is unfamiliar and daunting.  If you are dealing with Standard, be sure to ask for a detailed explanation of what is required of you.  You should pay close attention to deadlines, as they will likely not be flexible.  You should also make sure that you use Standard’s forms when providing attending physician statements or other documentation of your disability, because Standard will not accept other insurers’ forms.

These profiles are based on our opinions and experience. Additional source(s): “Quick Facts About the Standard” and “About the Standard,” available at www.standard.com; StanCorp 2014 KBW Conference Presentation, available at investor.stancorpfinancial.com.


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Disability Insurer Profiles: Hartford

Hartford is the next disability insurer we will look at that specifically markets its policies to physicians and dentists.

See our profiles of MassMutualMetLifeNorthwestern Mutual, and Guardian.

The Hartford Financial Services Group, Inc. (“Hartford”) was founded over 200 year ago and now has more than 100 offices located throughout the U.S.  In 2013, Hartford’s revenues were approximately $26.2 billion.  However, in 2014, Hartford’s revenues dropped to $18.6 billion.  Given this significant decrease in revenue, Hartford will likely go to great lengths to avoid paying high paying claims submitted by physicians and dentists, and may even attempt to revoke disability benefits that it approved before the company experienced this dramatic drop in profits.

Company: The Hartford Financial Services Group, Inc.

Location: Hartford, Connecticut.

Associated Entities:  Hartford Fire Insurance Company; Hartford Life, Inc.; Hartford Accident and Indemnity Company; Hartford Casualty Insurance Company; Hartford Life and Accident Insurance Company; Hartford Life and Annuity Insurance Company; Hartford Life Insurance Company; Property and Casualty Insurance Company of Hartford.

Assets: $245 billion in 2014.

Notable Policy Features:  Hartford offers policies that define total disability as being unable to perform one of your prior substantial and material duties.  If your policy contains such a definition, it will be much easier for you to demonstrate that you are totally disabled.  In contrast, if your policy does not define total disability in this manner, you may have to prove that you cannot perform any of your prior substantial and material duties in order to receive total disability benefits.

Claims Management Approach:  Hartford only offers group disability policies (as opposed to individual disability policies).  This means that if you have a Hartford policy, it will probably be governed by ERISA.  For many reasons, it will likely be harder for you to obtain your disability benefits if your policy is governed by ERISA.

For example, normally, if you become disabled and you have an individual disability policy, you can collect your disability benefits without filing for Social Security.  However, if you have a Hartford group policy, your policy may require you to apply for Social Security benefits before you can receive your disability benefits.  Hartford requires its policyholders to apply for Social Security because, under ERISA, any Social Security benefits the policyholder receives automatically offset the amount of disability benefits Hartford must pay the policyholder.

Read more about how ERISA claims are treated differently than non-ERISA claims.

These profiles are based on our opinions and experience. Additional source(s): Hartford’s 2014 Annual Report; “The Hartford Fact Sheet (2013),” and “The Hartford Fact Sheet (2014),” available at www.thehartford.com.


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Disability Insurer Profiles: Guardian

In the last few posts, we’ve looked at a few of the most common disability insurance companies for doctors.  See our profiles of MassMutual, MetLife, and Northwestern Mutual.  Guardian is another disability insurer that specifically markets its policies to physicians and dentists.

Guardian has been around for over 150 years and is one of the largest individual disability income insurance providers in the United States. Guardian’s business model emphasizes the need for continuous growth, and Guardian reports that it has paid out dividends to its owners every year since 1868. To reach its goal of uninterrupted growth and live up to its owners’ expectations that it will pay out dividends each year, Guardian must not only maintain its past levels of profitability, but also come up with new ways to be more profitable. Obviously, from Guardians’ perspective, denying high paying claims submitted by physicians and dentists is an attractive method of increasing its profits.

Company: The Guardian Life Insurance Company of America.

Location: New York, New York.

Associated Entities: The Guardian Insurance & Annuity Company, Inc.; Berkshire Life Insurance Company of America; Guardian Investor Services, LLC; Park Avenue Securities LLC; RS Investment Management Co. LLC; Reed Group, Ltd.

Assets: $84.1 billion in 2013.

Notable Policy Features:  Guardian policies oftentimes attach a “Residual Disability Rider” to their policies. This rider could impact you in significant ways if you are partially disabled and considering part-time work. For instance, the residual disability rider to your policy might contain the following provisions:

Income. Income means your gross earned income, less business expenses, but before any other deductions. It includes salaries, wages, fees, commissions, bonuses, business profits or other payments for your personal services.”

“Prior Income. Prior income means your average monthly income for the tax year with the highest earning in the three years just prior to the date on which you became disabled.”

“Current Income. Current income means all income which you receive on a cash basis in each month while you are residually disabled.”

“Loss of Income. Loss of income means the difference between your prior income and your current income.”

“Residual Indemnity. Residual indemnity  =  (loss of income/prior income)  x  monthly indemnity.”

“Termination of Residual Indemnity. Residual indemnity will stop when the first of the following events occurs:

  • you become totally disabled; or
  • the benefit period ends; or
  • your loss of income is less than 20% of prior income . . . .”

When read together, these provisions essentially mean that if you are partially disabled and working in another occupation, Guardian includes the additional income earned in that occupation when determining your current monthly income. This is important because you could lose your residual disability benefits if, after adding in your additional income, your loss of income amounts to less than 20% of your prior income. If you have this residual rider in your policy, you should be aware that accepting part time work could jeopardize your ability to collect residual disability benefits.

Read more about residual disability benefits.

Claims Management Approach: Like many of the other insurance companies we have profiled, Guardian frequently conducts in-home field interviews, in an effort to catch you off guard and observe you in a state of activity that may not accurately reflect the severity of your condition. In-home field interviews also allow Guardian to collect personal information, such as your daily routine, hobbies and interests, names of friends and family, and work hours, so that its private investigators can more easily conduct surveillance of you.

If your claim involves a psychological disability, Guardian will likely require you to submit proof that you are being treated by a PhD level therapist, even if you have been working with a non-PhD level therapist for a significant period of time. Consequently, if you have a Guardian policy and are in need of therapy, you might want to consider consulting with a PhD level therapist from the start.

A final tactic frequently used by Guardian is the peer-to-peer call, which consists of Guardian directly contacting your treatment providers over the phone without your consent. This tactic is similar to the in-home field interview in the sense that it is an attempt to catch your treating physicians off-guard by ambushing them with detailed questions about your disability. Since these discussions take place over the phone, your treating physicians will likely not have an opportunity to provide well thought out, thorough answers, and there will likely be little, if any, documentation of the call. Although this tactic is alarming, it is easily countered. As we explained in a previous post, peer-to-peer calls can be preempted in most cases if you have your attorney notify the insurance company that all communications with your treatment providers must be coordinated through your attorney’s office.

These profiles are based on our opinions and experience. Additional source(s): Guardian’s 2013 Annual Report; Guardian Fact Sheet 2013; guardianlife.com.


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Ed Comitz Selected as one of Arizona’s Top 100 Lawyers by Az Business Magazine

 

Top 100 Lawyers - Az BusinessTop 100 Lawyers - EOC

Attorney Ed Comitz, the head of the healthcare and disability insurance practice at Comitz | Beethe, was chosen by Az Business as one of the Top 100 Lawyers in Arizona. Attorneys throughout the state were nominated by their firms and their peers.  From that pool of over 1,000 attorneys, the editorial team and industry experts narrowed down the list to the 100 top lawyers in the state based upon their professional success, impact on the firm, impact on the community and impact on the legal profession.

 


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Disability Insurer Profiles: Northwestern Mutual

In this series, we’re taking a look at some of the most popular disability insurance companies for doctors.  See our profiles of MassMutual and MetLife.  Northwestern Mutual is another disability insurer that specifically markets its policies to physicians and dentists.

In 2014, the  company insured 476,000 people through 727,000 individual disability policies. Northwestern Mutual prides itself on paying more dividends that its competitors.  In order to do that, of  course, it must maintain consistently high profit levels.

Company: Northwestern Mutual Life Insurance Company.

Location: Milwaukee, Wisconsin.

Associated Entities: Northwestern Long Term Care Insurance Co., Northwestern Mutual Investment Services, LLC, Northwestern Mutual Wealth Management Co., The Frank Russell Co.

Assets: $217.1 billion in 2014.

Notable Policy Features:  Northwestern Mutual sells policies with an “own occupation” definition of total disability.  However, these policies are often only truly “own occupation” for a limited amount of time, after which they become any occupation policies (only providing benefits if you are unable to work in any job) or “no work” own occupation policies (only providing benefits if you are unable to perform your job duties and are not working in another job).

For instance, a Northwestern Mutual policy might include the following definition:

Total Disability. Until the end of the Initial Period [defined elsewhere as 60 months of benefits], the Insured is totally disabled when is unable to perform the principal duties of his occupation.  After the Initial Period [i.e., 60 months], the Insured is totally disabled when he is unable to perform the principal duties of his occupation and is not gainfully employed in any occupation.

In order to make sure a Northwestern Mutual disability insurance policy keeps the own occupation definition for as long as you hold the policy, you may need to purchase an additional benefit rider.

Read more about Northwestern Mutual’s interpretation of its own occupation policies.

Claims Management Approach: Some of the claims strategies that Northwestern Mutual is known to use include conducting in-home field interviews on top of third-party surveillance, hiring its own medical consultants to review claimants’ records and opine on whether or not they are disabled, and demanding that claimants (especially those with mental conditions) undergo “independent” medical examinations (IMEs) with providers of Northwestern Mutual’s choosing.

 

These profiles are based on our opinions and experience. Additional source(s): Northwestern Mutual’s 2013 Annual Report; Northwestern Mutual Fact Sheet 2014; Forbes.com.


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Disability Insurer Profiles: MetLife

Today we’re profiling another popular insurer that issues private disability policies to dentists and physicians: MetLife.

Company: Metropolitan Life Insurance Company, a.k.a. MetLife.

Location: New York, NY.

Associated Entities: MetLife, Inc. (parent company), General American Life Insurance Company, New England Life Insurance Company.

Assets: MetLife, Inc. held over $885 billion in assets as of May 2014, according to Forbes.

Notable Policy Features:  One thing to watch out for in MetLife policies is a limitation on benefits for mental disorders and/or substance use disorder.  Under the Limited Monthly Disorders and/or Substance Use Disorders provision of some MetLife policies, policyholders are only entitled to a total of 24 months of benefits for any mental or substance abuse disorder, such as depression, panic disorder, post-traumatic stress disorder (PTSD), bipolar disorder, and alcohol abuse or dependency.  The 24 month limitation is cumulative.  So, for example, if you have depression that disables you for 23 months, then start suffering from disabling alcohol dependency later in your life, you would only have one month of benefits still available to you.

Claims Management Approach: In its 2013 Annual Report, MetLife, Inc. reported that “unfavorable morbidity experience in our individual income disability business resulted in a $6 million decrease in operating earnings.”  In other words, in 2013, more private disability insurance policyholders experienced disabling illnesses or injuries than in years before, and that hurt MetLife’s profits.  In these situations, where an insurer is facing increased liability for benefit payments, we often see that insurer put additional resources towards managing claims.  In this way, the insurer can spend extra time and effort looking for ways to deny or terminate claims, with the goal of limiting its liability.

In our experience, one way that MetLife attempts to dispose of claims as quickly as possible is by ordering surveillance early on in the claim.  While some companies will wait until they have received more information before starting surveillance, MetLife has started following and videotaping claimants within weeks of the claim being filed.

With respect to its medical investigation, we have found that MetLife often follows a similar strategy to MassMutual’s.  The insurer will often attempt to have its own medical personnel schedule “peer-to-peer” telephone consultations with claimants’ treating physicians, with the aim of catching the treating physician off guard and persuading them into saying their patient isn’t disabled.  However, we have found that, in certain circumstances, MetLife can be amenable to submitting medical questions to the treating doctor in writing instead.  That way, the treating doctor can more carefully consider the issues, without feeling pressured or put on the spot.

 

These profiles are based on our opinions and experience. Additional source(s): MetLife’s 2013 Annual Report; Forbes.com


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Disability Insurer Profiles: MassMutual

We have written about Unum, arguably the most notorious disability insurance company, in great detail.  However, we realize that many physicians and dentists may not know very much about other disability insurance companies, including those whose policies they own.  In the next few posts, we’ll profile some of the most common doctors’ disability insurers.

Company: Massachusetts Mutual Life Insurance Company, a.k.a. MassMutual.

Location: Springfield, Massachusetts.

Associated Entities: Mass Mutual Financial Group (parent  company), C.M. Life Insurance Company, MML Bay State Life Insurance Company.

Assets: Over $195 billion in 2013.

Notable Policy Features:  As part of its product offerings, MassMutual sells own-occupation disability insurance policies to physicians and dentists.  One notable aspect of some MassMutual policies we’ve seen recently is an especially restrictive definition of “Total Disability,” which we sometimes refer to as a “no work” own-occupation definition.  Under the “no work” own-occupation definition, an insured is Totally Disabled if he or she is unable to perform the material and substantial duties of his or her own occupation and not working in any occupation.  Unlike traditional own-occupation policies that allow a physician or dentist to collect total disability benefits and return to work in a different occupation, this one will not pay total disability benefits if the policyholder is doing any type of gainful work.

Claims Management Approach: MassMutual is a highly successful insurer.  In June 2014, it was ranked number 96 in the Fortune 500.  However, Fortune reports that MassMutual is currently experiencing a dramatic reduction in profits.  If MassMutual follows the current trends in the disability insurance industry, we believe it will increase scrutiny on disability insurance claims in order to try to regain its former profit levels.

In our experience, one of the ways MassMutual aggressively approaches claims is to hire a medical consultant to evaluate claimants’ medical records.  The consultant then tries to insert himself or herself between the claimant and the treating physician, writing or calling the treating physician and suggesting treatment methods that, in the consultant’s opinion, will get the claimant back to work as soon as possible.

 

These profiles are based on our opinions and experience. Additional source(s): MassMutual’s 2013 Annual Report; Fortune 500 2014; Bloomberg.com


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Legal Requirements for Denial Letters: What Your Insurance Company Has to Tell You When It Denies or Terminates Your Claim

stack of letters

If your claim for disability insurance benefits is denied or terminated (i.e., if the insurance company discontinues benefits they were once paying), the insurance company will send you a letter notifying you of that denial or termination.  Depending on the state you live in and the type of policy you have, the insurance company’s denial or termination letter has to include certain information.  Most doctors have individual (a.k.a. private) disability insurance policies governed by state law.  Below are some examples of denial letter requirements in several states.

Arizona: Under Arizona law, the denial letter should reference any specific policy provision, condition, or exclusion upon which the denial or termination was based.[1]  The letter should also provide a reasonable explanation why, given the facts of your claim and/or the applicable law, the insurer believes you do not qualify for benefits under the terms of your particular policy.[2]

California: In California, insurers must advise claimants of the acceptance or denial of a claim within 40 calendar days of receipt of proof of claim, unless they provide written notice of a need for additional time within that 40 days.[3]  All denials must be in writing (as opposed to simply given over the telephone), and the denial or termination letter must state reasons for the decision, including reference to specific policy provisions.[4]  Like in Arizona, denial or termination letters from California disability insurance companies should provide a reasonable explanation of the basis the insurer relied on in the insurance policy, in relation to the facts or applicable law, for the denial.[5]

Nevada: Nevada disability insurers have 30 working days after receiving properly executed proofs of loss to advise claimants of the acceptance or denial of the claim, unless the insurer advises otherwise within the 30-day period.[6]  Nevada law requires that denials be in writing, and it must include whatever specific policy provision, condition or exclusion upon which the insurer based its decision.[7]  Just like Arizona and California, Nevada law indicates that disability insurance denial letters should provide a reasonable explanation of the basis the insurer relied on in the insurance policy, in relation to the facts or applicable law, for the denial of the claim.[8]

Utah:  Utah follows the same 30-day rule as Nevada with respect to the time the insurer has to provide a claims determination.  In Utah, the insurance company must not only put the basis for the denial or termination of the claim in a letter to the claimant, it must also record that basis in its claim file.[9]  Consistent with the other states mentioned, insurers are prohibited from denying a claim on the grounds of a specific provision, condition, or exclusion in the policy unless they reference that provision, condition or exclusion in the denial letter.[10]

We always recommend contacting a disability insurance attorney if your claim is denied or terminated.  If your denial or termination letter does not include the required information, be sure to let the attorney know, as you may have additional legal rights that you need to enforce.



[1] R20-6-801(G)(1)(a).

[2] A.R.S. § 20-461(15).

[3] Cal. Code Regs. tit. 10, § 2695.7(b).

[4] Cal. Code. Regs. tit. 10 § 2695.7(b)(1).

[5] Cal. Ins. Code § 790.03(h)(13).

[6] Nev. Admin. Code ch. 686A.675(1), (3).

[7] Nev. Admin. Code ch. 686A.675(1).

[8] N.R.S. § 686A.310(1)(n).

[9] Utah Admin. Code. R590-190-10(2).

[10] Id.


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