Claims Management: A Tale of Two Carriers

One of which, unfortunately, turns out to be undeserved:

Recently the surgeon became unable to work due to a series of severe (and acute) medical issues, and may actually need an organ transplant as a result. Needless to say, he’s out of the OR for a while, maybe permanently.

Because these plans were written so long ago, and I no longer actively represent either carrier, there are hoops through which we need to jump to bring me “back in the loop” so that the various claims folks will talk to me about the pending claim. No problem, understand completely.

So my client asks the claims rep for each carrier how to make that happen. Both basically say they just need to hear from me and they can get that ball rolling. So I emailed both and, after not hearing from either for a day, called and left voicemail.

The MassMutual rep promptly returned my call, and explained that she’d never received my email. I went and looked and, sure enough, I had mistyped it (I blame fat fingers); so re-sent it, and we’re all good. We had a lengthy conversation, much of it taken up with my concern about why they were asking for tax records (so is UCL/Ameritas). I’ll circle back to why that was even an issue in a moment, but for now I’m satisfied with the MassMutual rep’s explanation.

As for the Ameritas rep?

Well, it took a week, but she finally emailed that she’d been out of the office, and that she needed something in writing from the client to be able to speak with me about his claim.

Fair enough.

While I await that, let me explain my initial reluctance about letting my client provide tax returns:

In general, the carrier only gets to underwrite for health and finances at the time of application. After that, it’s really none of their business, and I bridled that the idea that they were going to attempt some kind of post-issue financial underwriting.

When I questioned the MassMutual rep about this, she said they needed it if and/or when he goes back to work; it wasn’t necessary to get the claim ball rolling.

And that was the mental “click” I needed to remind me that we had included a Residual Disability benefit in the plan, and that this would absolutely need the kind of income verification that a tax return could provide.

Oh, what’s a Residual Disability benefit?

Basically, it’s a partial benefit the company pays to help make up for any loss of income one may incur when going back to work after having been disabled. I usually describe it as being paid “when you’re okay but your wallet’s still disabled.” This could be due to reduced hours or fewer duties (and thus lower a lower paycheck).

So, I’m okay with th MassMutual rep’s explanation, and anticipate a similar conversation with the Ameritas/UCL claims person, as well.