Another story of a disability claimant

Story detailed here.

CFSAC summarizes the various testimonies that it heard

CFSAC summarizes the testimonies and stories that it heard from patients.
Typical issues that patient face are:
"

1. Deny, Deny, Deny -- Not paying claims, regardless of merit, no matter what proof is provided. It forces the claimant to action when they are too ill to launch an appeal, especially one deliberately undefined.
2. Delay, Delay, Delay -- Holding off payment of claims, partial claims, or legally directed settlements is another strategic tactic
3. Drop, Drop, Drop -- Terminate claims arbitrarily, which forces patients to seek expensive legal counsel and medical documentation for appeal.
4. NOT providing the RULES or governing 'Plan Document', or at least not the appropriate ‘version.’ ERISA levels fines of $100 per day to insurers that delay in providing this basic document, but advocates say that $100 per day is not a sufficient deterrent. They recommend large automatic fines for not complying, and fines should be directed to the claimant (separate from and regardless of the success of the claim).
5. The ‘standard of proof’ is deliberately obfuscated. “Not delineating upfront what DOES constitute proof of disability allows for more abuse of PWC claimants, ‘spin’ placed on facts, and creates an easily manipulatible ‘moving target’, to render claim success impossible.”
6. Habitually ignoring pertinent, objective medical evidence.
7. Paupering the claimant -- (This is a major and frequent complaint of patients and advocacy groups) The LTD Carriers’ MO is to pauper PWC so they don't have the resources to obtain a proper medical diagnosis or medical care. Being impoverished by not receiving LTD, many claimants have to choose between paying for legal representation or paying for medication and medical care.
   
   Paupering the PWC also thwarts retaining legal counsel. Very few lawyers are willing to take on contingency a case where the compensation is minimal yet the effort and time will be made deliberately intensive by the carrier’s vast and well oiled legal machine.
8. Delaying a lawsuit filing can further pauper the claimant. “In one case, even when lawsuit was won by claimant, Carrier appealed, successfully delaying payment.”"

More details here

A patient's story on dealing with ERISA disability issues - testimony before CFSAC

Marly Silverman presents her experience as a part of her testimony before CFSAC .  This is a typical story experienced by various patients.
"The regulations of ERISA are excessive and extremely bureaucratic. They are part of an “administrative process” that uses language or legalese, which is often contradictory and counter-productive to the well being of the claimant, i.e. the individual who is sick or injured.  This administrative process is long, and tiring. One must exhaust all of the steps in the administrative process, before one is allowed to file a suit against the employer/insurance company. By the time one is actually able to do this, personal savings are gone, and a financial crisis of long-term proportion sets in"


It is high time we work together to alter ERISA to create  a win win situation for all sides.

Legislators and government employees are exempt from ERISA

Interesting to know that Legislators and government employees are exempt from the 'protection' offered by ERISA. This way they don't get to know what the private sector workers go through in an unfortunate case of disability. More info here

Insurance agent themselves vouchsafe for own occupation disability policy

On this site managed by an insurance agent, it is mentioned that "My personal belief is that one cannot go wrong when they buy a Non-Cancellable, own-occupation disability insurance policy."
We agree. A private, non cancellable, own occupation disability insurance policy is probably the best (and if you put things in perspective - the only way) to have a shot at having reliable coverage. Group insurance policies are dangerous because they provide the employees with a false sense of security. In some ways, if the employee knows that she does not have a disability policy, she will think twice before making major financial decisions. However, with the 'security' of the ERISA policy, she may tend towards making risky decision based on her hope that the policy will cover her if she is disabled. That leads to a very unfortunate and complex situation in the event of disability (loss of home, kids pulled out from college, no money for medical treatment etc etc). We see this routinely with disability claimants denied disability.

ABC news coverage of Cigna

After exposing Hartford denial of claims based on twisted logic, ABC details the story of disability insurance claimants from Cigna
"They did agree to a non-recorded phone call with their chief medical officer and gave us a written statement which said Cigna pays 90 percent of their claims and that a majority of their clients are satisfied."

We wonder how can one verify this claim. Are these STD or LTD claims or both? What percentage of them is ERISA and what percentage private?

"Cigna wouldn't talk to us about Kristoff's case, but the insurance trade group, America's Health Insurance Plans, said cases like hers were the exception, not the rule."

If so, then why is the insurance industry not willing to come forward and disclose the statistics of their rate of denial (particularly for group insurance policies ) on paper to their potential customers. Surely, that is a very important way that a customer can evaluate if spending her money on disability insurance is worth it.

Disability claim verdicts against Hartford

Info here