Part 3: How NOT to Work with a Long Term Care Benefit Analyst

canstockphoto11493017I would bet that many claim professionals will applaud after they read the following, if only in secret. Insurance companies mostly are wise about customer service, but I have heard each of the following statements too many times from insureds, family, and agents. As I am no longer employed in the insurance business, I can now say what I think.

Turning down claims did not make me happy, but I took pride in doing the best job I could for both my insureds and my employer. While very sympathetic to the circumstances involved when people become ill, I have experienced extreme rudeness, been cursed at, called terrible names, and hung up on in conjunction with the following statements. Of course, anybody who deals with the public has experienced all of that at one time or another. My responses are what I wish I could have said, but didn’t, at least not so bluntly. Please do not say these things during the course of your claim.

I have been paying on this policy for X number of years and now it’s time for you to pay.
Yes, you may have paid for the policy for many years without reaping any direct benefit. That’s what insurance means. It’s no different than your auto or homeowner insurance. It just costs more because LTC claims cost more. It does differ in that you chose to purchase LTC insurance and were not forced to do so as with auto and homeowner. The good news is that you haven’t been sick enough to claim until now. Lucky people will never be so sick or injured that a claim is necessary.

You will be happy you bought the policy if you have to claim for an extended period of time. I also heard many people say how grateful they were that the policy was in place to help them or their parents. We all know how horribly expensive care can be. An insured on claim permanently could recoup all their premiums paid and much more.

My mother/father would never have bought a policy that: Had such a long waiting period; had such a low daily benefit; fill in the blank.

How could you say that? You weren’t there and too much of the time, you didn’t even know your parent had an LTC policy. The benefits your parents ended up with are usually the result of what they could afford at the time, or how much they were willing to pay. It’s about cost.

You insurance companies just want to cheat me/my parent so you won’t have to pay our claim.
There are so many ways this is a wrong statement. Insurance companies are officially regulated and subject to audits by 50 different state governments. They are also under federal scrutiny particularly where Medicare is involved and tax qualified versus non-tax qualified policies. Unofficially, they are watched by news organizations, lawmakers, and citizens.

Everybody likes to pick on insurance companies, and sometimes there is good reason. But they are not in the business of denying claims. They are in business of collecting enough premiums to cover claim expenses and, hopefully, make some profit. That being said, mistakes do happen and they should be addressed.

You are purposely delaying making a decision on my claim.

Or, my favorite, you’ve had my paperwork for several hours now, where is my decision. I’m sorry to say this, but you are not the only one submitting a claim. An insurance company wants you to feel like you are. They think that’s good customer service. When a BA is on the telephone for half an hour, or more, listening to you complain about insurance companies, and whatever else is on your mind, that’s half an hour of an eight-hour day, or more, when they can’t work on anybody’s claim. When you must call, please clearly state what you need. The BA should respond in kind.

It is not to anybody’s benefit to delay a claim decision. State insurance commissioners and auditors don’t like it and BAs don’t want to hear from disgruntled people all of the time. It makes them less effective in their work and BAs are inclined to want to help people.

All that being said, I have to confess that helping people through a difficult time in their lives was the most rewarding part of my job.

I’m going to call my lawyer or write the State Insurance Commissioner.
These words are usually said when somebody doesn’t like a claim decision or they think it’s taking too long. They do not strike fear in a BA’s heart, change a decision, or magically produce information that may be missing. If you really do feel that you have been wronged, just do what you think is necessary and don’t threaten people. It will never produce the desired results.

I cannot stress the word communicate enough. Problems often occur because of a misunderstanding on the part of the claimant, the BA, or the caregiver. Please have a civil conversation to try to find a resolution before you do or say anything unpleasant.

Remember that just because you don’t like a decision doesn’t mean that it is wrong. A policy is specific about how benefits can be accessed. Please understand that the purpose of this series is to assist you through the long term care claim process.


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