While the COVID-19 pandemic continues to impact everyone (and, by extension, long term disability insurance companies), disability claimants may be wondering what to expect in 2021. Will telehealth appointments instead of in-person ones be enough to keep you on claim? Will the trend of an increase in insurance carrier denials continue? What should claimants do now to preserve their rights? Below, two of Dell & Schaefer’s experienced long term disability insurance attorneys discuss what to expect from disability insurance carriers in 2021 and beyond.
GREGORY DELL: Hi, I’m attorney Gregory Dell. And I’m here today with attorney Stephen Jessup. And it’s the beginning of 2021. And we want to talk about our disability insurance benefits forecast for 2021. And Stephen, welcome back. And for this beginning of the year, and it’s been a crazy 2020, which a lot of us are happy to see go. Especially with COVID, it’s been a highly unusual year.
And I think that 2021, with the vaccine starting to come out and people becoming– accepting the norm of how to work in COVID, whereas in 2020, we were all adjusting and didn’t know what to do. The disability companies included were in disarray. March, April, May, June, the disability companies themselves didn’t know how to– how were they going to manage all these claims? How were they going to manage existing claims, new claims? They had their own problems.
And I think all of the claims examiners are working remotely for the most part anyhow. We’ve seen disability insurance, large disability insurance company offices, even Unum we know, they’ve shut down offices. And most of the people we talk to are working at home. So let’s put out there from our experience of what we’re seeing, what we’ve been seeing towards the end of 2020 and now in the beginning, as to what we think is going to happen in 2021, what claimants should expect with their claims.
And what’s the first thing that comes to mind for you as to what you think we’re going to see here in ’21?
We expect an increased number of benefit denials – for many reasons.
STEPHEN JESSUP: I think we’re going to see a larger level of denials. And not just compared to 2020 which, regardless, once the insurance companies kind of streamlined what they were going to be doing, it was a busy year in denials. They just weren’t– there was no like goodwill and everything’s going to– we’re going to get to this together type thing. It was, we are still evaluating. We’re still looking.
Yes, we’ll give you the benefit of the doubt if you can’t get into your doctor. Yes, we will accept telemedicine appointments without as much scrutiny, things like that. But there were still a lot of denials. 2021, I think there’s going to be a lot of denials, not because 2020 was slow. But I think, when we look at it as a picture, everything has changed in a lot of ways. I think there’s going to be a lot more– early on already this year, what, we’re filming this, it’s January 13th.
IME requests have been rolling in. Hey, we had your file reviewed by these medical doctors. Would you like to respond for your client type thing? So I do expect that there’s going to be a stepping up in denials. And even just, it was publicly announced I think just a couple of weeks ago about the New York Life and Cigna. So they’ll be taking over. And you’re going to get a whole new fresh set of eyes, of people looking on things.
So I do expect that there’s going to be a heck of a lot more scrutiny. And the insurance companies, if nothing else, if– people always say you can rely on death and taxes. You can rely on an insurance company, you know, fighting a claim if they have any inroad to do it.
GREGORY DELL: Yeah, so I’m already seeing, just in the beginning of the year, a lot of IME requests. And my opinion as to why we’re seeing that is that now, I believe, these disability claims examiners, which are the people who evaluate the claims, are having more accountability for their actions. I think that the disability companies in themselves restructured over the last nine months. And now they’re having these protocols in place as to being more dialed in in how they’re going to review the claims.
And they don’t necessarily, disability companies, they would get around and have these roundtables, where they’d go upstairs and talk to another doctor, or talk to the claims examiner next door, or talk to their supervisor who was– you know, they’d all roundtable and talk about these claims. Now it’s basically like they put some protocols in place and said, do this, this, and that on a particular claim. And especially if it’s over a certain dollar amount, you need to get an exam.
And so one of the things they’re asking for is what they call independent medical exams. But what are those really? And why are the disability companies able to request these?
More insurance carriers are requesting compulsory medical exams.
STEPHEN JESSUP: It’s more– it’s a compulsory medical exam. The policies will say that they have a right to send you to it. And you have to go. People complain about it. But at the end of the day, if you don’t go, they can terminate your benefits. So they use these as ways, A, to put eyes on you. B, obviously when there’s an IME request, there has to be concerns about, are they looking to deny your claim?
Because more often than not, they’ll just send your file out to doctors to do a review of those medical records and render opinions there. So the IME is a stronger tool. And then if you fast forward, if we extrapolate out towards potential litigation, filing a lawsuit, where generally speaking an insurance company has to ultimately show they had a reasonable basis to deny your claim. And we have body of case law that says, well, having it reviewed by doctors is reasonable basis to deny, relying on those.
Well, having an IME is like the gold standard. As an attorney, if you see in a denial that there’s IMEs done, you already know that the battle in court is going to be potentially that much harder. So it sets them up for future success in quite a bit. So the IMEs and even with the client I spoke to the beginning of this week, we got the notice.
And one of the big things I always like to do, is this a doctor that has a practice? Are they practitioners, or do they actually treat patients? Or do you find them only on– you know, the things is, I’ve done 10,000 IMEs in the past X amount of time. Well, that’s going to be problematic. So the IME is a tool that’s used to look to deny claims and strengthen legal arguments.
But as we’ve seen, it can be very much a double-edged sword and can solidify claims for the insured. So preparation of those is always big. But this uptick in IMEs compared to, even when we look at 2019, 2018, when things were, quote, unquote normal, it is pretty kind of– it is surprising this early on how many we’re seeing.
GREGORY DELL: And what are your thoughts about, in 2021, the requirements for in-person medical treatment versus telehealth? And is telehealth going to be the new trend of the way more patient appointments with the doctor are taking place?
Telehealth appointments just aren’t the same; seek physical examinations whenever you can.
STEPHEN JESSUP: I think, yes, to an extent. You know, I think telemedicine, A, I mean if the insurance companies are working from home and doing everything remotely, why can’t you see your doctor remotely? And I also think the medical profession has also seen a new way to treat patients. Now obviously, certain conditions are going to require you have to go in. You have to be examined, things like that.
But I do think that there’s– there was in 2020 definitely much more an acceptance of it. And I think you will see that an acceptance of telemedicine appointments. Because a lot of hospital systems, especially clients that I have who rely on the VA, telemedicine is the only way they’re getting appointments. So I think there will be. But at some point, I think the insurance companies are even going to start to back away from that as much.
They’ve done a lot of things, you know, even when it comes to appealing decisions based on you’ll have extra time due to there being a national emergency, due to the COVID pandemic. But the goodwill and the easing of restrictions, I think, at some point will kind of fall back a bit. I think for clients who’ve been on claim for a while, who have well-established claims, I think telemedicine appointments will be accepted a little more. Because you already have a huge body of medical evidence.
But a lot of the newer claims, I think that they will be met with more scrutiny. So people looking to file this year, those telemedicine appointments may be met with a heck of a lot more scrutiny than in years past.
GREGORY DELL: I think also in ’21 the people who are on claim now need to be concerned that there’s going to be a higher level of scrutiny. And my reason for that is that I think that the claims reps that are handling the claims are going to not have a couple of things. Number one, I don’t think they’re going to have as many claims to handle as they did in the past, because I don’t think you’re going to see as many filings in ’21 as we did in ’19 and pre-’20.
And the reason for that is that COVID has changed the way that work is performed in a lot of office settings. And a lot of the difficulties for people working in an office was the fact that they basically had no flexibility. They had– if they had a sedentary job, they had to sit at their desk the whole day. And you basically have to be able to sit for at least six hours a day, arguably eight in order to do a job, obviously take a break, go to lunch.
But you can’t lay down. You can’t stretch every three minutes. You can’t throw your feet up all the time. You’ve got to maintain yourself in a professional work environment. Now, a lot of these people have had the opportunity to work at home. And most claimants don’t want to file. Because when you file for long-term disability, you’re giving up at least 40% of your income. And that’s assuming that you’re proportionately insured, meaning that you have enough disability coverage.
So most people don’t want to file for disability insurance. Because you’re going to make a lot less money than you’re making now. So a lot of people have been able to accommodate themselves and basically work from home. Because now they feel like if they need to sleep for an hour, nobody may know. If they want to throw their feet up, they can do that. If they want to run around in circles the whole time, if they want to take five breaks an hour, they can do that.
As long as they’re getting their work done, the employers are likely going to be satisfied and not know what they’re doing. And therefore, the person can keep their job. Now, obviously, they’re still going to have to perform. They’re going to have employee reviews. And we’ll see the scrutiny start to come down on these people working at home. But in 2021, people who are on claim are going to get more scrutiny. Because the claims examiners are going to have more time to review claims.
So you really need to be aware of that. So what do the people do that are on claim already? One of the things you mentioned was telehealth, at a minimum. They need to be proactive in their medical treatment and not necessarily just sitting at home saying– or not going to the doctor because saying, it’s COVID. I can’t get to the doctor. So that might mean once a month, once every two months calling your doctor, checking in, telling them how you’re feeling, and getting that document.
Because like we always say, the claim’s only as good as it is on paper. And if it’s not in the medical records, then disability carriers what they’re doing now is they’re saying, look, you haven’t seen your doctor in eight months. Let’s have a doctor look at you. And there’s the IME. And if you’re on claim, you don’t want that IME. So message is continue to be proactive, reach out to the doctor, either go to the doctor or call your doctors and get those appointments and do your follow-ups.
What do you see happening, I mean, it’s such an interesting dynamic. Vaccines are coming out. COVID is worse than it’s ever been right now. Yet, a lot of people all over, regardless of your political views, are acting in many ways like as if COVID doesn’t exist. And they’re going about their business, you know, going out places and doing things. Do you think we’re going to see a ramp up in video surveillance now?
Video surveillance dropped off in 2020, but is poised to come back in 2021.
STEPHEN JESSUP: Finally, I think yeah. I think all of last year we could safely say, do not expect too much that they will be doing it, especially in states and locations with more severe lockdowns. I think this year I think it will be another weapon, another tool to be used without a doubt, 100%. I think even more so in the cases like you discussed, if people do filings with– and they’ve been working from home, and they make a filing now, I think that’s something that could be used more so.
I would expect, yeah, I mean even driving into work, it’s not quite the South Florida traffic I’m used to. But it’s noticeably much increased. You know, I came to the office all of 2020. And it was like driving every day on a Sunday morning. It was wonderful. But there are a lot of people out and about. So yeah, I think video surveillance will be put back in the quiver of arrows for the insurance company to use to try to deny a claim.
GREGORY DELL: And then the last area about you mentioned more denials. But insurance– in 2020, the disability insurance companies clearly lost a lot of revenue. Because they need numbers, they need bodies, they need employees to write these group policies. And a lot of employers were downsizing in 2020 or cutting expenses because they were– businesses were hit hard in 2020 so a lot of coverage was dropped.
And these disability insurance companies are in business to make money. And now they have less revenue coming in, yet picked up– they still have the liability. So they’re going to put higher scrutiny, because they can’t afford to pay out as many claims. But the other thing that you were mentioning as well is that we saw consolidation amongst many. And we’ve seen a lot of consolidation in the last couple of years.
And now we’re starting to see where, for example, New York Life’s going to take over for Cigna claims. And you know, Liberty Mutual and Lincoln Financial, a lot– a lot of mergers but different sets of eyes. And why is that going to change the game for people who are unclaimed now that there’s new companies that are involved in managing?
Many disability carriers have merged, which can mean a full review of long term disability benefit claims.
STEPHEN JESSUP: You know, every insurance company does things differently than the next. So the way Liberty used to review claims was different than Lincoln did. But now you’re starting to see, finally, like a mixture of the review process of the two. And you know, it’s one of those things that where are the numbers to prove it. But in my opinion, too, because I’ve just seen it with people contacting me, they’re like, oh, Hartford denied my case. Hartford denied my case.
Turns out, it was an old Aetna policy. So it’s almost like the companies that have acquired are trying to move out those older books of business if they have the ability to. Or they finally give it a really good lookover that hadn’t before. And now Hartford’s reviewing an Aetna case the way Hartford reviews a Hartford case, not the way Aetna did. So you are seeing that.
And they’re trying to figure out where they can. Yes, they spent a lot of money to acquire this. And there’s a lot of money to be made. But at the end of the day, it’s a numbers game for them. And when you’re working with an area of the law that’s very favorable to you as the insurance industry, you will look to cut cases where you can, without a doubt.
GREGORY DELL: Right, and I would say the consolidation of the insurance companies and the takeovers is equivalent to a change in governmental parties. The way things are administered.
STEPHEN JESSUP: Things will be done differently.
GREGORY DELL: The protocols, the structures is different. And we know the protocols and the methodologies of each and every disability company.
STEPHEN JESSUP: And you know, it’s also one of those things. When there are more companies, there’s more competition in the marketplace to try to get the business of the employers. Now with less companies, there’s less options to go to. So the more you corner a portion of the market, you can enforce the will and way you do business more. Because you don’t have to worry about maybe this company that’s buying your product leaving you for another insurance carrier.
GREGORY DELL: Right. Well, thank you for your time. And hope 2021 works out to be a significantly better year than it was in 2020. And if you have any issues whatsoever with your long-term disability claim, whether you’re applying for benefits, you’re on claim, or you’ve been denied, feel free to contact Stephen or myself or any of our long-term disability insurance attorneys. We represent claimants all over the country. So no matter where you live, we’re available and ready to help you.
We encourage you to spend a little bit of time on our website, take a look at information specifically about your company. You can search by your medical condition or your occupation. We want you to become educated about this whole disability insurance process. And while you may already a lot about it, we want you to have the most current information so that you can stay on top of everything that’s going on.
As you can see, when there’s consolidations amongst the companies, we start to see different trends in the behaviors of the different companies. And we always share that information. We always put out these YouTube videos on a weekly basis. And you can click below to subscribe to our video, which we are thankful for you doing that. Should you need us in the future, we look forward to helping you.
The bottom line is this — the events of 2020 mean that long term disability claimants can expect more scrutiny at every level of the claim process in 2021. It’s never been more important to ensure that all aspects of your claim are covered, documented, and carefully considered. Throughout the pandemic, the long term disability insurance attorneys at Dell & Schaefer have continued to help clients secure and maintain their benefits. Don’t go into this process unarmed; no matter where you are in the claims review process, give us a call to schedule your FREE consultation today.
You can learn more about disability insurance on our website: What is disability insurance? What type of disability income policy should you buy?