Tough case. Wouldn’t any insurance company benefit from denying claims? If she is still disabled, then how could they pull her off the roll? If she’s not, then why wouldn’t they pull her off?
I think the problem is that many insurance companies have employees working in their claims departments who are uneducated regrading the role of the insurance company as fiduciary of the disability policy.
Without an understanding of the fiduciary role, the claim department employees render decisions that could lead to a claimant feeling forced to sue in order to obtain benefits.
It’s a shame.
What kind of definition of disability would Met have that would allow them to deny benefits as the client “had improved” yet the client would still qualify for Social Security.
The issue most likely is own occupation vs. any occupation. While she may not be able to do certain types of work related to her previous job, Met Life probably determined that thier was sedentary type jobs she could perform. Each disability claim stands on its own merits.
Whether they decide and pay or not. This article does not give enough detail. There are a lot of people out there working the system and getting benefits they do not deserve which costs all of us. In this case not enough details are given why she was denied further payments. We would all like to be paid not to work but somebody has to. I think her doctor should be the one who decides if she can work, not her insurance company. However, doctors can easily be bought so there needs to be a review process through a panel of other doctors to when necessary over rule the primary.
Hey, I’m all for that! Been going to my doctor for twenty years, lives in the same neighborhood, kids went to school with mine….I would trust him to certify that I was disabled (joking, of course).
The facts that are cited (probably not all of them, of course) don’t look too good for the insurer. Maybe this case could have been resolved far short of raising this issue.
It is common that SS benefits are awarded as the SS standard of disability is often much lower than the standard of proof and defintion required by private insurers.
I agree that is probably the definition change from her own occupation to any occupation which she is qualified to perform – this can mean a sedentary job such as secretary work even if she was disabled from doing patient lifting, for example.
Most claim people are educated and are genuinely concerned about doing the right thing – Met’s denial rate has been consistently below industry average.
Yeah, right. The doctors should decide – then the battle moves to “which doctors” or “whose doctors”?
There is a cottage industry of doctors that do nothing but testify for “injured parties”. They don’t have to practice medicine; they just write reports and bill hefty fees which are gladly paid by plaintiff lawyers…
JMHO
Just to clarify: my comment from earlier (re: fiduciary duty) was more of a general oberservation on the issue of discretion, versus regarding a specific company or specific claim situation.
I’m so much more at ease now that the Bush Administration has weighed in with their opinion.
By the simpleton standard, doesn’t everyone have a conflict of interest in denying their own money to others who want it? I guess this is the standard the feds use to raise me taxes, we’ll sure I don’t want to pay more, but I can’t make that decision, as I have a conflict of interest in wanting to keep my money for me, as that betters my condition? Maybe we should just let the government decide…anytime I see any administration weighing in with an ‘opinion’ I grab my wallet.
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Tough case. Wouldn’t any insurance company benefit from denying claims? If she is still disabled, then how could they pull her off the roll? If she’s not, then why wouldn’t they pull her off?
I think the problem is that many insurance companies have employees working in their claims departments who are uneducated regrading the role of the insurance company as fiduciary of the disability policy.
Without an understanding of the fiduciary role, the claim department employees render decisions that could lead to a claimant feeling forced to sue in order to obtain benefits.
It’s a shame.
What kind of definition of disability would Met have that would allow them to deny benefits as the client “had improved” yet the client would still qualify for Social Security.
The issue most likely is own occupation vs. any occupation. While she may not be able to do certain types of work related to her previous job, Met Life probably determined that thier was sedentary type jobs she could perform. Each disability claim stands on its own merits.
Whether they decide and pay or not. This article does not give enough detail. There are a lot of people out there working the system and getting benefits they do not deserve which costs all of us. In this case not enough details are given why she was denied further payments. We would all like to be paid not to work but somebody has to. I think her doctor should be the one who decides if she can work, not her insurance company. However, doctors can easily be bought so there needs to be a review process through a panel of other doctors to when necessary over rule the primary.
Hey, I’m all for that! Been going to my doctor for twenty years, lives in the same neighborhood, kids went to school with mine….I would trust him to certify that I was disabled (joking, of course).
The facts that are cited (probably not all of them, of course) don’t look too good for the insurer. Maybe this case could have been resolved far short of raising this issue.
It is common that SS benefits are awarded as the SS standard of disability is often much lower than the standard of proof and defintion required by private insurers.
I agree that is probably the definition change from her own occupation to any occupation which she is qualified to perform – this can mean a sedentary job such as secretary work even if she was disabled from doing patient lifting, for example.
Most claim people are educated and are genuinely concerned about doing the right thing – Met’s denial rate has been consistently below industry average.
Yeah, right. The doctors should decide – then the battle moves to “which doctors” or “whose doctors”?
There is a cottage industry of doctors that do nothing but testify for “injured parties”. They don’t have to practice medicine; they just write reports and bill hefty fees which are gladly paid by plaintiff lawyers…
JMHO
I absolutely agree.
Just to clarify: my comment from earlier (re: fiduciary duty) was more of a general oberservation on the issue of discretion, versus regarding a specific company or specific claim situation.
Thank you.
I’m so much more at ease now that the Bush Administration has weighed in with their opinion.
By the simpleton standard, doesn’t everyone have a conflict of interest in denying their own money to others who want it? I guess this is the standard the feds use to raise me taxes, we’ll sure I don’t want to pay more, but I can’t make that decision, as I have a conflict of interest in wanting to keep my money for me, as that betters my condition? Maybe we should just let the government decide…anytime I see any administration weighing in with an ‘opinion’ I grab my wallet.
Would love to know what injury was suffered…