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 MassMutual, MetLife, Northwestern Mutual, Guardian, 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 disability insurance 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 disability 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 disability 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 disability insurance policy.
These profiles are based on our opinions and experience. Additional source(s): Great-West Financial’s 2013 Annual Report; www.greatwest.com.
Changes in DSM-5 Could Affect Some Disability Insurance Claims
More than a decade after work began on updating and revising the Diagnostic and Statistical Manual of Mental Disorders, DSM-5 replaced DSM-IV-TR in May 2013. While some of the changes in diagnostic criteria for disabilities such as intellectual developmental and specific learning disorders or the addition of new diagnoses in DSM-5 for disorders such as hoarding and gender dysphoria are unlikely to affect the private disability insurance claim of a doctor or dentist, the changes in the criteria for diagnosing post-traumatic stress disorder or substance-related and addictive disorders and the addition of the diagnoses of social (pragmatic) communication disorder and mild neurocognitive disorder have potential implications in the context of private disability insurance claims. Additionally, the elimination of the Global Assessment of Functioning (GAF) scale, widely used by insurance companies in determining the medical necessity of treatment, is likely to have an effect on some disability insurance claim determinations.
Some of the changes in DSM-5 are outlined below.
Social (Pragmatic) Communication Disorder: This new diagnosis, which cannot be diagnosed unless autism spectrum disorder has been ruled out, is described by the American Psychiatric Association as pertaining to individuals “who have significant problems using verbal and nonverbal communications for social purposes, leading to impairments in their ability to effectively communicate, participate socially, maintain social relationships, or otherwise perform academically or occupationally. . . Symptoms must be present in early childhood even if they are not recognized until later. . .”
Substance-Related and Addictive Disorders: The categories of substance abuse and substance dependence have been combined, and the criteria for a diagnosis have been strengthened. Where DSM-IV required only one symptom for a diagnosis of substance abuse, DSM-5 requires 2-3 symptoms from a list of 11 potential symptoms. Drug craving has been added to the list of symptoms and “problems with law enforcement” has been eliminated due to cultural differences in law enforcement internationally.
Post-Traumatic Stress Disorder: There are a couple of significant changes in the diagnostic criteria for post-traumatic stress disorder (PTSD). The requirement of DSM-IV that the person personally experience or witness the traumatic event has been eliminated and DSM-5 allows for a PTSD diagnosis when the person has learned that the traumatic event occurred to a close family member or friend, or experiences first-hand repeated or extreme exposure to aversive details of the traumatic event (from sources other than media, photos, television or movies, unless work-related). Additionally, the requirement that the person experience “fear, helplessness or horror at the time of the traumatic event” has been deleted.
The criteria has also been changed to require “actual or threatened death, serious injury, or sexual violence.” The previous manual also allowed for “a threat to the physical integrity of self or others” but did not specify sexual violence.
Mild Neurocognitive Disorder: The American Psychiatric Association describes this new disorder in DSM-5 as “an opportunity for early detection and treatment of cognitive decline before patients’ deficits become more pronounced and progress to major neurocognitive disorder (dementia) or other debilitating conditions.” The APA goes on to characterize the disorder as:
Mild neurocognitive disorder goes beyond normal issues of aging. It describes a level of cognitive decline that requires compensatory strategies and accommodations to help maintain independence and perform activities of daily living. To be diagnosed with this disorder, there must be changes that impact cognitive functioning. These symptoms are usually observed by the individual, a close relative or other knowledgeable informant, such as a friend, colleague, or clinician, or they are detected through objective testing.
Global Assessment of Functioning (GAF) Scale: The GAF scale of 1-100, which was a single global assessment combining separate assessments of symptom severity, danger to self or others, and ability to care for oneself and function socially, has been eliminated from DSM-5. In the place of assigning a GAF number, separate assessments of severity and disability are recommended. The World Health Organization Disability Assessment Schedule (WHODAS 2.0) was determined to be the best current measure of disability for routine clinical use by the DSM-5 Disability Study Group.
The changes in DSM-5 are, of course, far more complex and detailed than what we have outlined above, but if you are suffering from a mental disorder and thinking of filing a private disability insurance claim, we recommend that you coordinate with not only your psychiatrist but an attorney before filing your claim with your insurer.
More information related to DSM-5 is available at this link.