We’ve recently had several clients who have had utterly terrible experiences with their claims examiners. From rudeness to laziness to incompetence, it seems like some insurance companies are not only trying to save money by denying claims but also by hiring less qualified staff. Companies and claims departments (who know better!) are hiring, training, and even promoting claims examiners
who don’t return phone calls, provide wrong information, or become defensive or non-responsive when asked claim questions that deserve an answer. After complaining, some insureds are reassigned to another claims examiner who in turn answers their questions. Although this may be seen as a win, all that’s been accomplished is a game of musical chairs.
The disability insurance world is a very tight-knit community, and employees in the industry know and take care of one another. Although this is not necessarily a bad thing, it can become an issue if bad and incompetent employees are given too much leeway to hurt insureds through their conduct. Claims examiners leave one disability insurance company and quickly wind up at another company. Attitudes and environments that cause problems for insureds are widely and loudly criticized by company management but are also permitted and discretely encouraged in their claim departments to make the claims process more difficult and intimidating, which helps delay and deny claims. A prime example of these types of business practices is the story of Unum/Provident/Paul Revere. After the company reached a major settlement for their unfair business practices in 2004, some of their employees were encouraged to pursue other professional opportunities and went to work with other disability insurers, continuing the same attitudes.
Unfortunately, these patterns have gotten worse with the continuing industry consolidation trends, meaning that the same individuals keep getting recycled back into the pool. To compound the problems, some employees go out on their own to assist insurance companies as outside consultants, claiming they’re independent while still collecting their paycheck from the same disability insurance companies. This enables the insurance companies to claim they are using an “independent” or “outside” expert to analyze the claim, even though that person worked for them for years and continues to be beholden to the company.
There are even other disability claim consultants who will skirt what we would consider ethical guidelines and play both sides of a claim against each other. Some outside consultants work with an insurance company to deny a claim,
then using information to have another party reach the insured to try and help get their claim approved. While that may be acceptable as hard-nosed competitive business tactics, we think that’s despicable. These so called professionals don’t care about the well-being of the insured or the insurance companies, compounding the problem and hurting the insurance industry. For them, it’s nothing personal – it’s just business. But disability claims are utterly and completely personal to people who need and deserve their disability benefits.
These attitudes are causing some to lose track of the purpose of the disability insurance industry: to help disabled clients protect their income by paying benefits those clients deserve. Working in disability claims for decades, we know that some people will try and commit fraud. In fact, we’ve declined to work with several people who’ve come to us for help with what were pretty obvious fraudulent claims. We agree that it’s an insurance company’s right to vigorously defend against such claims, but problems arise when they overuse this guise to delay and deny valid and appropriate claims of insureds who deserve their disability benefits. It becomes a little depressing to think that claim professionals who proclaim to only want to help their clients would take advantage of disabled insureds during an incredibly vulnerable time in their lives.
This is why our experienced experts have come together to focus on helping insureds who need our help and assistance. In an industry that has become rather harsh and arbitrary, it was time for professionals to stand up for compassion and civility and lend an honest, helping hand to people in need. We think the best way to bring about reform in the disability insurance industry is to provide reasonable assessments that quickly get insureds the benefits they deserve. No insurance company should be cheated out of paying claims they don’t owe, and we don’t want to give any false hopes to insureds. During our free consultations, we’ll consider your specific claim and circumstances and give you our honest opinion. We don’t have conflicts of interest and don’t work for the insurance company that denied your claim. We take pride in doing things the right way, by helping clients who truly need our help.
If you have any stories about dealing with less-than-professional claims examiners or disability claims consultants, please leave them in the comments section below – but please do not use any names, as we’re not trying to insult or degrade others. And as always, you can contact our firm toll-free at (855) 828-4100 or visit our website for more information about our firm.
Royal Claims Advocates 