By Anthony Cruz
To increase the likelihood of success, agents should have an understanding of disability market trends to help overcome possible objections in selling disability insurance. This is now especially true because the internet provides potential clients with easy access to information regarding disability insurers claims handling practices and financial stability.
In addition, the recent highly publicized proliferation of bad-faith lawsuits against disability insurers, many of which have resulted in large punitive damage awards, will undoubtedly raise client concerns over whether the insurer will actually pay claims. In this regard, agents should know about the new claim handling practices mandated by the recent multi-state Regulatory Settlement Agreement.
Trends in the disability market
In the 1970s and 80s, insurers tried to outdo each other to win market share, resulting in benefit-rich policies that were underpriced, poorly underwritten, and non-cancelable, with premiums that could never be increased. While many carriers won the battle for market share, they lost the war on claims.
Faced with staggering losses, many carriers have fled the disability market, while others have merged and consolidated to become stronger and more efficient. The survivors have learned from their aggressive selling mistakes they no longer offer non cancelable, occupation specific disability policies with lifetime benefits. Many current companies have modified the own OCC definition or limited it to a maximum of two years or five years. In addition, carriers have capped the monthly benefits and included 24 month mental/nervous limitations.
Todays insurers also seem to have a kinder and gentler approach to claims than they did 10 years ago. The trash and bash mentality of the 1990s is gone. As carriers have turned the profitability corner making money on their disability products they have become more reasonable about claims and more willing to acknowledge that not everyone is a fraud or a fake. With the inking of UnumProvidents multi-state Regulatory Settlement Agreement, and the more enhanced California Settlement Agreement, this trend is likely to continue.
Multi-state regulatory settlement agreement
In November 2004, UnumProvident and its subsidiaries including UNUM, Paul Revere and Provident entered into a Regulatory Settlement Agreement (RSA) with 48 state insurance regulators. The RSA came upon the conclusion of a multi-state market conduct examination led by Maine, Massachusetts and Tennessee relating to nationwide disability claims handling practices.
Primary components of the RSA include enhancements to UnumProvidents claims handling procedures, a reassessment of certain previously denied or closed claims and additional corporate and board governance to support the oversight of the reassessment process and general claims handling practices.
A principal feature of the RSA is the Claim Reassessment Process, in which UnumProvident agreed to reopen and reconsider individual and group long term disability claims that were previously denied or closed since January 1, 1997. Clearly, UnumProvident has turned the claim corner by agreeing to take a fresh look at these cases, which could potentially number in excess of 215,000 claims. If UnumProvident determines that a claimant is disabled, the insured can expect to receive back disability benefits, interest and the possibility of fees for the attorney, and the insured will return to claim paying status.
As a result of the RSA, UnumProvident agreed to enhance its claim procedures and add new good faith claim objectives including:
Giving significant weight to an award of social security disability benefits, whether received before or after the denial
Giving weight to both objective and subjective evidence of impairment, along with appropriate consideration of the treating doctors opinion
Evaluating co-morbid claims collectively by looking at all the medical conditions contributing to the disability, including side affects of medications
Selecting unbiased, financially disinterested, fully-trained and skilled medical examiners for all IMEs
Requiring all in-house doctors be skilled, trained and have all of the insureds medical information in hand before making impairment findings
Claim personnel must undergo rigorous training on the new claim objectives to ensure best claim practices with vigilant monitoring and oversight
Almost a year after signing the multi-state settlement agreement, UnumProvident reached a similar, yet more expansive agreement with the California Department of Insurance (CDI).
California settlement agreement
In October 2005, the CDI and UnumProvident and its subsidiaries reached a settlement of Californias ongoing market conduct examination relating to disability claims handling practices. Similar to the RSA, provisions of which are incorporated by reference, principal features of the California Settlement Agreement (CSA) include enhancements to UnumProvidents claims handling procedures and a reassessment of certain previously denied or closed claims.
In addition, UnumProvident agreed to change certain claim practices and policy provisions specific to California, including:
A new definition of total disability, own occupation total disability is the inability to perform with reasonable continuity the substantial and material acts necessary to pursue the insureds usual occupation in the usual and customary way. Any occupation total disability is the inability to engage with reasonable continuity in another occupation in which the insured could reasonably be expected to perform satisfactorily in light of age, education, training, experience, station in life, physical and mental capacity.
Discontinue using discretionary authority, elimination of policy language delegating discretionary authority to the insurance company to determine eligibility for benefits and to interpret policy language, thereby eliminating the deferential abuse of discretion standard of review.
Limiting offsets, The company will now only offset for Social Security disability income actually received by a claimant (not estimated or due).
Pre existing conditions, The company will no longer exclude conditions contributed to or by the pre existing condition. The condition must have actually existed or been diagnosed prior to the effective date of coverage.
Mental and nervous conditions, the new limitation applies after the termination of any physiological-based disability.
Self reported conditions, discontinue the use of the self reported condition limitation.
Rehabilitation provisions will be voluntary (not mandatory).
The CSA not only benefits previously denied policyholders, but raises the legal bar so other carriers doing business in California are held to a higher good faith standard and that is good for consumers. With the industry leader stepping up to correct the problems of the past and agreeing to consumer friendly claim changes nationally, the rest of the disability carriers would be wise to follow. Anytime an industry leader commits to bright line, good faith standards, the consumer comes out on top.
An agents understanding of disability market trends and new claim handling practices is necessary to overcome client concerns regarding the purchase of disability insurance. Armed with such knowledge, agents can be confident that they are selling a product that will be there to provide peace of mind and security when the insured, your client needs it the most.
About The Author
Anthony Cruz has been marketing for his clients for over ten years through his media contacts. Visit http://www.darraslaw.com/ for additional information.