"I have retired early because I have multiple sclerosis (MS) and I can no longer work.After my retirement, my health insurance is refused a serious medication and my disability insurance said that I am no longer invalid I told myself .... my insurance company.
Former hospital CEO William Blaine (Minnesota State)
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During the 1980s and 1990s, disability insurance companies actively selled and sold their policies on occupational and occupational obstacles to physicians and other medical professionals. Marketing efforts were targeted at medical professionals. Because we have already decided that it is unlikely that work will not stop because of physical restrictions and severe restrictions.
In addition to guaranteeing a specific occupation, most of the disability insurance policies of the 1990s were irrevocable and insurance premiums could not be raised. Due to industry competition, some insurance companies dramatically lowered and reduced the compliance standards for this business block. A certain very advantageous "bell and whistle" was included in these policies. Many of them can be used without doctor's long application, give detailed medical history,
• Coverage by occupation
• Mental health exception or no limit
• Benefits up to the age of 65, not lifetime benefits
• Living expenses increase
• Benefits not offset from other income sources
• There is no limit on the maximum amount of coverage and the relaxed limit
The disability insurance company planned to pay premiums from these insurance premiums and obtain substantial revenue based on the high interest rate in the early 1990s. Companies predicted that high interest rates will continue, but in fact it plummeted. This was consistent with the emergence of managed care and brought about a drastic decrease in the income of many medical professionals. Many healthcare workers frustrated and refused to continue working beyond their physical limits. Instead, I elected to request a disability benefit for a policy equal to or better than the revised salary. As a result, the "self-employed" policy has turned into a "bad block" that costs hundreds of millions of dollars to the industry.
Due to this lack of profitability, the insurance industry has focused on managing insurance claims. Insurance companies began to thoroughly investigate the terms of insurance contracts and the majority of insurance claims. An article about UnumProvident, the largest disability insurance company in the United States, was posted on the NBC 's data line and CBS 60 minutes. The 60-minute segment was entitled "Was the insurance company deceiving disabled people?" In this episode, one employee of UnumProvident told Ed Bradley that a bonus was awarded to a manager who closed a particularly large claim. According to Mr. Gina Hartley, another employee who was a complaint handler, her department has set monthly interest saving goals and had to get hurt by stopping the complaint . Mr Hartley said that the pressure to reach these goals often resulted in the termination of a legitimate assertion.
As a result of media attention, UnumProvident became the main target of repeated inspection by the insurance supervisory authority, Multistate Market Conduct Examination Report was created. The report identified four major concerns for UnumProvident's insurance.
• Excessive dependence on internal health care workers
• Unfair construction of physician or IME report
I failed the overall evaluation of the complainant's condition
• Inappropriate placement of burden on the petitioner to justify eligible eligibility
Ultimately, UnumProvident signed a regulatory settlement agreement with all 50 state insurance members and agreed to investigate all claims promptly, fairly and objectively. Media interest has declined greatly, but the "bad business block" in the industry is still a serious and outstanding responsibility. Correspondingly, healthcare workers who adopt high-value policies are difficult to collect benefits despite lip service paid for industrial reform practices.
Insurance companies will continue to monitor video of the activities, field interviews and survey without notice so that management of high-value loans is a billion dollar business and there is no end to damages. Interview of the doctor's doctor without notice; vocational rehabilitation examination; medical evaluation at the company. "Independent" health checkup. Medical "intervention" and medical micro-management; audit of financial audit insurance claims. Reassessment of the response of the application form. Preliminary litigation and investigation of board complaint. Survey of the environment surrounding practice sales. We aim to increase the profits of each company.
Healthcare workers need to continue accustoming to their own policy and billing process and continue to pay premiums to liberalized policies that may have been purchased in the past. The provision of obstacles varies greatly depending on the language used, and insurance coverage may be limited and limited by eligible words and phrases that insurers interpret according to their own interests. We have to review each policy of insurance individually and judge whether specific insurance claims are covered or not. A disabled insurance company can protect its own profit with financial, professional and caution. Health care professionals need to be more vigilant in order to protect themselves.
Disclaimer
The information in this article has been prepared for informational purposes only, and no legal advice has been given. Those reading this article should not act based on the information contained therein without seeking professional advice from lawyers. Authors and publishers are not responsible for any damage caused by mistakes, inaccuracies or omissions described in this publication.
*: Edward O. Comitz, Esq.
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