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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\u2019s experienced long term disability insurance attorneys discuss what to expect from disability insurance carriers in 2021 and beyond.<\/span><\/p>\n GREGORY DELL<\/strong>: Hi, I\u2019m attorney Gregory Dell. And I\u2019m here today with attorney Stephen Jessup. And it\u2019s 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\u2019s been a crazy 2020, which a lot of us are happy to see go. Especially with COVID, it\u2019s been a highly unusual year.<\/p>\n And I think that 2021, with the vaccine starting to come out and people becoming\u2013 accepting the norm of how to work in COVID, whereas in 2020, we were all adjusting and didn\u2019t know what to do. The disability companies included were in disarray. March, April, May, June, the disability companies themselves didn\u2019t know how to\u2013 how were they going to manage all these claims? How were they going to manage existing claims, new claims? They had their own problems.<\/p>\n And I think all of the claims examiners are working remotely for the most part anyhow. We\u2019ve seen disability insurance, large disability insurance company offices, even Unum we know, they\u2019ve shut down offices. And most of the people we talk to are working at home. So let\u2019s put out there from our experience of what we\u2019re seeing, what we\u2019ve 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.<\/p>\n And what\u2019s the first thing that comes to mind for you as to what you think we\u2019re going to see here in \u201921?<\/p>\n STEPHEN JESSUP<\/strong>: I think we\u2019re 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\u2019t\u2013 there was no like goodwill and everything\u2019s going to\u2013 we\u2019re going to get to this together type thing. It was, we are still evaluating. We\u2019re still looking.<\/p>\n Yes, we\u2019ll give you the benefit of the doubt if you can\u2019t 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\u2019s 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\u2019s going to be a lot more\u2013 early on already this year, what, we\u2019re filming this, it\u2019s January 13th.<\/p>\n 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\u2019s 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\u2019ll be taking over. And you\u2019re going to get a whole new fresh set of eyes, of people looking on things.<\/p>\n So I do expect that there\u2019s going to be a heck of a lot more scrutiny. And the insurance companies, if nothing else, if\u2013 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.<\/p>\n GREGORY DELL<\/strong>: Yeah, so I\u2019m already seeing, just in the beginning of the year, a lot of IME requests. And my opinion as to why we\u2019re 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\u2019re having these protocols in place as to being more dialed in in how they\u2019re going to review the claims.<\/p>\n And they don\u2019t necessarily, disability companies, they would get around and have these roundtables, where they\u2019d go upstairs and talk to another doctor, or talk to the claims examiner next door, or talk to their supervisor who was\u2013 you know, they\u2019d all roundtable and talk about these claims. Now it\u2019s basically like they put some protocols in place and said, do this, this, and that on a particular claim. And especially if it\u2019s over a certain dollar amount, you need to get an exam.<\/p>\n And so one of the things they\u2019re asking for is what they call independent medical exams. But what are those really? And why are the disability companies able to request these?<\/p>\n STEPHEN JESSUP<\/strong>: It\u2019s more\u2013 it\u2019s 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\u2019t go, they can terminate your benefits. So they use these as ways, A, to put eyes on you. B, obviously when there\u2019s an IME request, there has to be concerns about, are they looking to deny your claim?<\/p>\n Because more often than not, they\u2019ll 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.<\/p>\n Well, having an IME is like the gold standard. As an attorney, if you see in a denial that there\u2019s 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.<\/p>\n 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\u2013 you know, the things is, I\u2019ve done 10,000 IMEs in the past X amount of time. Well, that\u2019s going to be problematic. So the IME is a tool that\u2019s used to look to deny claims and strengthen legal arguments.<\/p>\n But as we\u2019ve 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\u2013 it is surprising this early on how many we\u2019re seeing.<\/p>\n GREGORY DELL<\/strong>: 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?<\/p>\n STEPHEN JESSUP<\/strong>: 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\u2019t 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.<\/p>\n But I do think that there\u2019s\u2013 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\u2019re 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.<\/p>\n They\u2019ve done a lot of things, you know, even when it comes to appealing decisions based on you\u2019ll 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\u2019ve 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.<\/p>\n 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.<\/p>\n GREGORY DELL<\/strong>: I think also in \u201921 the people who are on claim now need to be concerned that there\u2019s 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\u2019t think they\u2019re going to have as many claims to handle as they did in the past, because I don\u2019t think you\u2019re going to see as many filings in \u201921 as we did in \u201919 and pre-\u201920.<\/p>\n 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\u2013 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.<\/p>\n But you can\u2019t lay down. You can\u2019t stretch every three minutes. You can\u2019t throw your feet up all the time. You\u2019ve 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\u2019t want to file. Because when you file for long-term disability, you\u2019re giving up at least 40% of your income. And that\u2019s assuming that you\u2019re proportionately insured, meaning that you have enough disability coverage.<\/p>\n So most people don\u2019t want to file for disability insurance. Because you\u2019re going to make a lot less money than you\u2019re 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.<\/p>\n As long as they\u2019re getting their work done, the employers are likely going to be satisfied and not know what they\u2019re doing. And therefore, the person can keep their job. Now, obviously, they\u2019re still going to have to perform. They\u2019re going to have employee reviews. And we\u2019ll 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.<\/p>\n 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\u2013 or not going to the doctor because saying, it\u2019s COVID. I can\u2019t get to the doctor. So that might mean once a month, once every two months calling your doctor, checking in, telling them how you\u2019re feeling, and getting that document.<\/p>\n Because like we always say, the claim\u2019s only as good as it is on paper. And if it\u2019s not in the medical records, then disability carriers what they\u2019re doing now is they\u2019re saying, look, you haven\u2019t seen your doctor in eight months. Let\u2019s have a doctor look at you. And there\u2019s the IME. And if you\u2019re on claim, you don\u2019t 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.<\/p>\n What do you see happening, I mean, it\u2019s such an interesting dynamic. Vaccines are coming out. COVID is worse than it\u2019s 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\u2019t exist. And they\u2019re going about their business, you know, going out places and doing things. Do you think we\u2019re going to see a ramp up in video surveillance now?<\/p>\n STEPHEN JESSUP<\/strong>: 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\u2013 and they\u2019ve been working from home, and they make a filing now, I think that\u2019s something that could be used more so.<\/p>\n I would expect, yeah, I mean even driving into work, it\u2019s not quite the South Florida traffic I\u2019m used to. But it\u2019s 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.<\/p>\n GREGORY DELL<\/strong>: And then the last area about you mentioned more denials. But insurance\u2013 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\u2013 businesses were hit hard in 2020 so a lot of coverage was dropped.<\/p>\n And these disability insurance companies are in business to make money. And now they have less revenue coming in, yet picked up\u2013 they still have the liability. So they\u2019re going to put higher scrutiny, because they can\u2019t 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\u2019ve seen a lot of consolidation in the last couple of years.<\/p>\n And now we\u2019re starting to see where, for example, New York Life\u2019s going to take over for Cigna claims. And you know, Liberty Mutual and Lincoln Financial, a lot\u2013 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\u2019s new companies that are involved in managing?<\/p>\n STEPHEN JESSUP<\/strong>: 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\u2019re starting to see, finally, like a mixture of the review process of the two. And you know, it\u2019s one of those things that where are the numbers to prove it. But in my opinion, too, because I\u2019ve just seen it with people contacting me, they\u2019re like, oh, Hartford denied my case. Hartford denied my case.<\/p>\n Turns out, it was an old Aetna policy. So it\u2019s 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\u2019t before. And now Hartford\u2019s reviewing an Aetna case the way Hartford reviews a Hartford case, not the way Aetna did. So you are seeing that.<\/p>\n And they\u2019re trying to figure out where they can. Yes, they spent a lot of money to acquire this. And there\u2019s a lot of money to be made. But at the end of the day, it\u2019s a numbers game for them. And when you\u2019re working with an area of the law that\u2019s very favorable to you as the insurance industry, you will look to cut cases where you can, without a doubt.<\/p>\n GREGORY DELL<\/strong>: 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.<\/p>\n STEPHEN JESSUP<\/strong>: Things will be done differently.<\/p>\n GREGORY DELL<\/strong>: The protocols, the structures is different. And we know the protocols and the methodologies of each and every disability company.<\/p>\n STEPHEN JESSUP<\/strong>: And you know, it\u2019s also one of those things. When there are more companies, there\u2019s more competition in the marketplace to try to get the business of the employers. Now with less companies, there\u2019s 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\u2019t have to worry about maybe this company that\u2019s buying your product leaving you for another insurance carrier.<\/p>\n GREGORY DELL<\/strong>: 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\u2019re applying for benefits, you\u2019re on claim, or you\u2019ve 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\u2019re available and ready to help you.<\/p>\n 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\u2019s going on.<\/p>\n As you can see, when there\u2019s 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.<\/p>\n The bottom line is this \u2014 the events of 2020 mean that long term disability claimants can expect more scrutiny at every level of the claim process in 2021. It\u2019s 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\u2019t go into this process unarmed; no matter where you are in the claims review process, give us a call to schedule your FREE consultation<\/a> today.<\/p>\n You can learn more about disability insurance on our website: What is disability insurance? What type of disability income policy should you buy?<\/a><\/p>\nWe expect an increased number of benefit denials \u2013 for many reasons.<\/h2>\n
More insurance carriers are requesting compulsory medical exams.<\/h2>\n
Telehealth appointments just aren\u2019t the same; seek physical examinations whenever you can.<\/h2>\n
Video surveillance dropped off in 2020, but is poised to come back in 2021.<\/h2>\n
Many disability carriers have merged, which can mean a full review of long term disability benefit claims.<\/h2>\n