Look Who’s Lurking Around Your Facebook Page: Your Insurance Company!

The detailed information many people reveal about themselves on popular social networking sites such as Facebook, Twitter, and MySpace has caught the attention of the insurance companies. Insureds with disability claims should be alert to their insurance company potentially using this investigation/surveillance tool and should think twice before posting photos and information about their daily lives that could be misconstrued and used against them. Marilyn Lewis has written an interesting article on Insure.com about the future of insurance companies investigating their insureds online not only in order to determine rates for home, auto and life insurance, but to conduct surveillance on insureds with claims.

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Disability Claims in Today’s Economy

Filing a private disability insurance claim in this economy can be daunting. Insurers now have more incentive than ever to deny payment of “high-end” claims, like those filed by medical, dental or other professionals. However, a few guidelines can help you protect your benefits in these difficult times.

1. Understand Why Insurance Companies Feel Pressure to Deny Claims

Disability claims filed by physicians, dentists, and other professionals can be expensive for insurance companies to accept. The troubled economy and the rising number of disability claims filed by professionals have led to financial hardship for the disability industry. This strain on resources creates an incentive for insurers to deny these expensive claims. Thus, many insurers closely scrutinize the terms of professionals’ policies in order to find ways to deny benefits, as the long-term financial benefit to the insurance company is significant.

2. Know Some Basic Policy Terms

An “own-occupation” policy provides compensation following a disability that prevents the insured from performing the particular duties of his or her occupation. If an insured professional does not have an “own-occupation” policy but an “any occupation” policy, he or she must be disabled from performing the duties of any occupation for which he or she is reasonably qualified in order to receive benefits. Some policies are a hybrid, providing own-occupation benefits for a limited period of time, then converting coverage to the “any occupation” standard.

3. Contact an Attorney Well Before You File Your Claim

Those who are considering filing a claim for disability insurance benefits should meet with an attorney experienced in the area well-before submitting a claim for payment. Each disability policy has different, complex language that insurance companies may manipulate to circumscribe and restrict coverage. Insureds should make a coordinated effort with the assistance of a lawyer to determine whether their particular claim is covered and, if so, how that claim is best presented to ensure payment.

4. Select the Right Firm to Represent You

Look for a firm that can help from the beginning of the process by analyzing complex applications and policies and identifying potential coverage issues. The best firms have particular skill in documenting claims, completing claim forms and communicating with treating physicians. Once the claims process begins, a firm should be able to protect clients against unreasonable delays and abuse by the insurer. You should also seek a firm that provides knowledgeable advice and practical guidance on how to best handle an Independent Medical Examination or other testing that may be required by an insurance carrier.

Though filing a disability insurance claim in a recession can be overwhelming, the challenges involved are not insurmountable. By following the guidelines above and enlisting the help of a qualified attorney, you can protect your future in any economy.

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AAJ Names Ten Worst Insurers

The American Association for Justice (AAJ) recently released the report The Ten Worst Insurance Companies in America. The AAJ reached its conclusions after a comprehensive investigation of insurers’ legal and financial filings.

Read the entire report here: https://www.justice.org/ten-worst-insurance-companies-america.

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Federal Court Affidavit of Former Unum Employee

A sworn affidavit by a former UnumProvident employee in a 2004 case in the United States District Court for the District of Maine (Case No. 2:2004cv-00001) provides interesting insight into some of the tactics used by Unum.   Daniel Donatelli’s affidavit appears below.

UNITED STATES DISTRICT COURT
DISTRICT OF MAINE

Daniel Donatelli, Plaintiff vs. UNUMPROVIDENT CORP., Defendant
Civil No. 04-1-P-S

AFFIDAVIT OF DANIEL DONATELLI

NOW COMES Daniel Donatelli and hereby states as follows under oath:

  1. My name is Daniel Donatelli. I am 18 years of age or older and believe in the obligation of an oath. The facts stated below in this affidavit are based on my personal knowledge.
  2. I was hired by Unum as a Disability Benefit Specialist to process long term disability claims. Disability Benefit Specialists at Unum had authority to make decisions on claims.
  3. After Unum’s merger with Provident, I became a customer care specialist and later was transferred to the Cardiac Psych Unit. Customer Care Specialists at UnumProvident did not have authority to make decisions on claims including approval, denial, and settlement. Our role became primarily processing and not managing.
  4. I did not begin working in the Cancer Unit until after February 25, 2002.
  5. While working in the cancer unit, Dennis Hersom told me that I would not survive a performance management program regardless of any improvement that I made with my work performance. Therefore, I resigned.
  6. While working in the Cardiac Unit and the Cancer Unit, I had some ethical and moral concerns regarding claims not being paid properly due to the pressure to meet quotas for closing claims.
  7. While I was at Unum, Unum provided insurance policies for employee sponsored plans, union or employee organization sponsored plans, employer sponsored plans, church plans, government plans, and many individual disability policy contracts.
  8. There was at least one individual Customer Care Specialist in my Cardiac Psych Unit, as well as an individual in my Cancer Unit, that was responsible for handling claims under individual disability insurance policies issued by Unum.
  9. I understood that all of these policies were subject to the same claims handling process and procedures. When I expressed concern about how the claims were handled, I was expressing concern for all claims and not just those on my caseload.
  10. I personally handled processed claims under church plans (for example, priests) and government/school plans (for example, teachers).
  11. Advance pay and closure was a way of closing claims based on a hypothetical ramp up of hours that was established by a customer care specialist or a vocational rehabilitation consultant. It was also based on an opinion from a UnumProvident doctor who made a determination of what the claimant was capable of doing. I believe that the advance pay and closure procedure is illegal because it could result in a claimant being subjected to higher scrutiny by UnumProvident if the claimant reopened his or her claim for benefits after a period of advancement has lapsed. Because the claimant had no right of appeal, and the claimant was not notified in advance, the claimant would be subject to higher scrutiny thereby misleading the client into agreeing to take an advance pay and close. Continue reading “Federal Court Affidavit of Former Unum Employee”
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Disability Insurance and the Doctor:
Will You Be Able to Collect?

Attorney Ed Comitz’s article,“Disability Insurance and the Doctor:  Will You Be Able to Collect?”, was published in the May/June 2003 issue of AzMed, the publication of the Arizona Medical Association.

The article focuses on own-occupation policies marketed to physicians, the disability insurance claim process, key policy definitions, the hurdles experienced by disabled physicians (including mental health limitations/exclusions), reasons claims are denied, Arizona insurance law (including elements of bad faith and punitive damages for wrongful claim denials).

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Paper Trail Surveillance:
How Disability Insurance Companies Investigate You
Without Ever Leaving a Computer

We have written about video, photograph and social media surveillance in the past, but have yet to address another kind of “surveillance” that disability insurance companies use when a claim is filed: detailed record searches.  When a policyholder files a claim for disability insurance benefits, one of the first things that claims personnel do is conduct a series of detailed record searches and record requests for all kinds of information on the claimant, including:

  1. Corporate and business filings;
  2. Civil court filings;
  3. Criminal background check;
  4. General internet search results;
  5. Workers compensation claims;
  6. Professional licenses;
  7. Real estate purchase and sale records;
  8. Medical records;
  9. Credit reports; and
  10. Pharmacy records.

The disability insurance claim process can be daunting, especially when insurers are delving into your personal and professional records.  It is always best to have a disability insurance lawyer working to protect your privacy and your rights under the policy.

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