When Your Disability Insurance Carrier Isn’t a Disability Specialist - What You Need to Know

Welcome to Season 5, Episode 29 of Winning Isn't Easy. In this episode, we'll dive into the complicated topic of "When Your Disability Insurance Carrier Isn’t a Disability Specialist - What You Need to Know."

Most people buy disability insurance trusting the name on the policy. If a major insurer sells it, surely they know how to handle disability claims - right? Not always. For many big-name carriers, disability insurance is just a sideline to their main business of life, auto, property, or investment products. That lack of focus can cost you. Without specialized staff or resources, these companies often outsource reviews to third-party administrators or “independent” doctors who never meet you. The result? A system built to protect the insurer’s bottom line, not your future. In this episode of Winning Isn’t Easy, disability law expert Nancy L. Cavey exposes how three carriers - Ameritas, Chubb, and Voya - handle disability claims. You’ll hear how their processes differ from disability-focused insurers, the games they play to delay or deny benefits, and what you can do to protect yourself. If you have a policy from one of these companies - or any insurer where disability isn’t a priority - this episode will give you the tools to fight back. Winning isn’t easy, but with the right strategy, it’s possible.

In this episode, we'll cover the following topics:

One - Ameritas: Lack of Internal Resources and the Peer Review Trap

Two - Chubb: Big-Name Insurer, Small Disability Footprint

Three - Voya, ReliaStar, and the DRMS / Fullscope RMS Problem

Whether you're a claimant, or simply seeking valuable insights into the disability claims landscape, this episode provides essential guidance to help you succeed in your journey. Don't miss it.


Listen to Our Sister Podcast:

We have a sister podcast - Winning Isn't Easy: Navigating Your Social Security Disability Claim. Give it a listen: https://wiessdpodcast.buzzsprout.com/


Resources Mentioned in This Episode:

LINK TO ROBBED OF YOUR PEACE OF MIND: https://mailchi.mp/caveylaw/ltd-robbed-of-your-piece-of-mind

LINK TO THE DISABILITY INSURANCE CLAIM SURVIVAL GUIDE FOR PROFESSIONALS: https://mailchi.mp/caveylaw/professionals-guide-to-ltd-benefits

FREE CONSULT LINK: https://caveylaw.com/contact-us/


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Need help with your Long-Term Disability or ERISA claim? Have questions? Please feel welcome to reach out to use for a FREE consultation. Just mention you listened to our podcast.

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Please remember that the content shared is for informational purposes only, and should not replace personalized legal advice or guidance from qualified professionals. 

Transcript

Nancy Cavey [00:00:00]:
 Foreign hey, I'm Nancy K. The national ERISA and individual disability attorney. Welcome to Winning Isn't Easy. Before we get started, I've got to give you a legal disclaimer. This podcast is not legal advice. The Florida Bar association says I have to say this. Now that I've said it, nothing will ever prevent me from giving you an easy to understand overview of the disability insurance world, the games that disability carriers and plans play, and what you need to know to get the disability benefits you deserve. If you've bought a disability insurance policy from a big name insurance company, you might assume they're experts in disability coverage.
 
 Nancy Cavey [00:00:45]:
 After all, that's what the policy promises to protect your income if illness or injury prevents you from working. But here's the reality. Many companies that sell disability insurance don't specialize in handling a disability claim. Disability policies or plans might be just a small fraction of their overall business, buried under life insurance, auto insurance, property coverage or investment products. That means that they often lack the internal resources, experienced staff and fair evaluation process that disability focused insurance companies or plans have. They lean heavily on outsourcing these cases. They send your claim to third party administrators who have never met you. These third party administrators are in the business of keeping the insurance company and plan happy, not you.
 
 Nancy Cavey [00:01:34]:
 And today I'm going to dive into three carriers that fit this mold. Emeritas, Chubb and Voya, all of which offer disability insurance policies but not as their primary business. And we're going to cover how they operate, the games they play, and what you can do to protect yourself. But remember, this is also applicable to other disability carriers who are also starting to outsource their work to third party vendors like Brown and Brown and other organizations. So this is spreading, if you will, even in the disability insurance world. So let's get going. I'm going to talk about Ameritas and their lack of internal resources and their peer review. Trap 2.
 
 Nancy Cavey [00:02:18]:
 I'm going to talk about Chubb, the big name insurer, the small disability footprint and Voya, Reliantar and DRMS and RMS and the problems that we're seeing with that particular organization. Got it. Let's take a break and we'll come back.
 
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 Nancy Cavey [00:03:08]:
 Ameritas and their lack of internal resources and the peer review trap that you need to know about. Now, Emeritas offers individual disability policies to professionals and they're often customized to your occupation and your financial needs. You might have one yourself, an own occupation. Individual disability policy is designed to pay you benefits if you can't perform the material and substantial duties of your occupation due to sickness or injury, and on paper is strong protection. But here's the catch. Disability insurance is not Emeritas main business. The lack of specialization shows in their claims handling. So how do they handle claims? Well, instead of evaluating their claims in house with their own claims staff, they outsource your medical records and attending physician statements to external vendors.
 
 Nancy Cavey [00:03:56]:
 And often it's a medical peer review company. These companies are not hired to give a fair review of your medical records. They are hired to help the disability carrier, in this case Emeritas, find a reason to deny your claim or terminate benefits. Now, many of these companies are run by former medical directors for large disability carriers who now are making easy money providing reports that favor insurance companies. How do they do that? Will they cherry pick your medical records to find things that would support a claim denial or termination? They ignore the treating physician's opinion. They look for objective evidence requirements in your medical records when there's no objective evidence requirement in the policy. So they're ignoring the terms of the policy, looking to take apart the medical records on the basis that there isn't objective evidence of the diagnosis or there isn't objective evidence that establishes severity, intensity and the nature of your symptoms, such that you have restrictions and limitations that would prevent you from doing your own or any occupation. What are the typical peer review questions that Emeritas asks when they're doing this handoff to the peer review company? Well, they ask, is this diagnosis supported by objective medical evidence? Is the disability supported by objective medical evidence? What restrictions and limitations does the policyholder have? Can the policyholder do at least sedentary work? Can the policyholder work full time, possibly with accommodation, regardless of whether the policy or plan requires that? Is the policyholder or plan beneficiary receiving appropriate treatment? Now, the peer review person who never met you and may not even be a specialist is going to get on the phone with your doctor and they're going to push them to agree that you can work in some capacity.
 
 Nancy Cavey [00:05:43]:
 I call these doctors liar for hires and they often lay the groundwork for the denial. And I will tell you, there's conferences that go back and forth between the adjuster, if you will, and their peer review company. The peer review Doctor trying to massage any report that the peer review doctor has prepared to get it to say what it needs to say to justify a claim denial or termination. What should you do if Emeritas denies your claim? Most Emeritas disability policies are individual disability policies, and that's fantastic. You can sue in state court without appealing. You can depose Emeritas as adjusters and medical reviewers and you can have a case decided by a jury. But before you jump into that arena, I think that filing a strategic appeal before filing suit is a smarter move. And this is what I do.
 
 Nancy Cavey [00:06:37]:
 We put together an appeal that rebuts the denial. And if they're questioning your functional capacity, we get functional capacity evaluations or CPET exams. We get independent medical evaluations to rebut the opinions. And we want to build a paper trail for a bad faith claim, depending, of course, on what state you live in. I want to lay traps in this appeal for the disability carrier. Now, does this cause delay? Of course it does. But I think it's better to prepare a comprehensive evidence heavy appeal than rush into court unprepared. There are times when these appeals are successful and benefits get reinstated in Emeritas claims and there are times when it doesn't.
 
 Nancy Cavey [00:07:21]:
 And that's where we move on to the litigation stage. And part of that is attacking that liar for hire peer review provider or the company that that liar for hire peer review company works for and the relationship between Ameritas and that particular liar for hire peer review company or physician. There are lots of things that can be done in the litigation stage to attack this relationship. Got it? Let's take a foreign. Let's talk about Chubb. Big name insurer, small disability footprint. Chubb's motto is protecting the present and building a better future. They're one of the largest property and casualty insurers in the world.
 
 Nancy Cavey [00:08:08]:
 I actually have my homeowner's insurance and my automobile insurance and my excess coverage through Chubb, and they have been fantastic. I couldn't ask for a better carrier. However, disability coverage is just a small fraction of their business. And what they do offer is this. They offer group disability policies to employers, which are ERISA governed. They do offer individual disability policies to professionals such as doctors, dentists, chiropractors. And that's going to be state law governed. Now you might ask, well, why is IDI coverage better with Chubb? And Chubb is one of the companies that I do tend to recommend together with Northwestern Mutual.
 
 Nancy Cavey [00:08:49]:
 And if you can afford it, you want to choose your own occupation or Subspecialty own occupation policy. This ensures that you can get paid if you can't do the specific duties of your current occupation, even if you can work in another occupation. So for example, a surgeon who can't operate but can teach in medical school could still collect their full benefits. One of the things that I always tell people when they're looking at individual disability policies is look, you potentially want to have a residual disability provision payment which will allow you to work, but if you work in your own occupation at reduced hours or productivity, you're protected in terms of financial loss. And of course you still have the total disability claim. However, I want you to understand that they also have an outsourcing issue. Because disability is such a small part of their business, they outsource the claims handling to companies like Lincoln national or other plan administrators. And the problem can be a lack of direct oversight, delayed responses and inconsistent communication denials driven by that third party cost control motives.
 
 Nancy Cavey [00:09:51]:
 I think that outsourcing creates confusion for policyholders. You may think you're dealing directly with Chubb, who I love to deal with, but the actual decision makers are at a different company with different priorities. And I think that that's a disconnect that leads me to recommend other disability individual disability carriers once the prospect person understands that while Chubb is good for property and casualty, it may not be so good for disability claims. What are their tactics to look out for? Well, it's requesting repeated attending physician statement forms to update your status and then using them to find inconsistencies, ordering unnecessary IMEs by doctors. They select a payment conducting surveillance to capture a few minutes of physical activity and misrepresent it as proof that you can work full time. Now, what you should do if Chubb denies your claim is this. If you have an IDI claim, remember you can sue in state court for your benefits for extra contractual damages, punitive damages, potentially bad faith damages depending on where you live, costs and attorney's fees. While an appeal isn't required, I am still an advocate of appeals because I want to provide detailed medical documentation, vocational documentation and factual rebuttal because it can lead to reinstatement of the benefits without having to file suit.
 
 Nancy Cavey [00:11:15]:
 If you're in a situation where Chubb is the insurer for your employer, it is most likely going to be covered under ERISA unless you work for a church related employer or work for a municipality or a state organization. So a governmental organization, you're going to only have 180 days to appeal and that appeals is the trial of your case. In that particular situation, you need to get a lawyer as quickly as possible because that appeal is the trial of your case and if you blow it and save your evidence for the better day, there is no better day because that evidence won't come in. What happens if Chubb accepts the claim? Acceptance isn't the end of the claim. They're going to continually to review your case, monitor social media, may even conduct surveillance. They may also have you undergo not so independent medical evaluations. I think having an attorney review the attending physician statement forms, your activity of daily living forms and correspondence can help prevent surprise terminations and ensure that your reporting is not only consistent but current. Got it.
 
 Nancy Cavey [00:12:21]:
 Let's take a break.
 
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 Nancy Cavey [00:13:12]:
 Welcome back to Winning Isn't Easy. Let's talk about voya, reliaStar and DRMS. I'm not seeing a lot of these cases these days from these disability carriers, but let's talk about them anyway because you might have a policy or be a plan beneficiary with these folks. Voia is primarily a health wealth and investment company, but they sell disability coverage largely through employer sponsored benefits. Thanks to acquisitions like Reliastar and Aetna Financial Services, they're in the world of erisa and on their website they tout short and long term disability insurance plans that match your organization's culture and goals. And in reality, that's not the case. They often come with cost saving features that hurt you because there might be limited coverage for certain conditions like migraines or fibromyalgia. There might be offsets for other income like Social Security Disability.
 
 Nancy Cavey [00:14:07]:
 There might be discretionary clauses that make it hard to overturn a claims denial. So these are things that sound good, if you will. The idea that this is a big company, but when you pull back the curtain and start looking at the product that they're selling to the employer, there are problems. So let me give you an example. This is the case of Silva v. Boya. It's a 4th Circuit case and it upheld a denial because it was a discretionary clause in the policy. And these clauses are basically used as a golden handcuff on a judge to prevent them from substituting their own independent judgment for that of the carrier.
 
 Nancy Cavey [00:14:45]:
 And disability carriers know that. And they play the game that needs to be played to successfully argue to the court that they did not abuse their discretion in denying or terminating benefits. Why would an employer plan with Voya be even more risky? What I have found in representing CEOs, CFOs, Union Stewards is they just don't really understand the coverage that's being offered. They think that they're offering solid protection to their employees, but they never really look at the policy or plan language. And that policy or plan language will often contain limitations that can reduce benefits to just two years. Or they have very narrow definitions of disability. Or they might have offsets that reduce the amount of benefits. Or there might be other limitations that you will see in these too late that will limit coverage.
 
 Nancy Cavey [00:15:43]:
 There's also the issue of claims handling. Voya has outsourced claims management ID rms, now known as Full Scope rms, and it markets itself as a turnkey disability risk management program. In plain English, they're not in the business of paying claims, they're in the business of denying claims. So what do they do? They demand objective evidence when the policy or plan doesn't require it. They misclassify occupations to argue that the person can return to work. They cherry pick records to support the denial. They play that we need more information game. They will drag out the process to frustrate you into giving up, going away, or ultimately forcing you into litigation, which is not necessarily where you want to be.
 
 Nancy Cavey [00:16:30]:
 So how can you protect yourself? Well, if you're an employer and you're looking to buy these kinds of benefits, employee benefit packages for your employees. Congratulations. You're well intentioned. But you need to review the Voya benefit package before you decide that this is going to be offered to your employees. And if you're an employee where Voya is being touted as the disability coverage for you that your employer is offering, I think you need to take a look at that whole benefit package, not just kind of this summary of what they're going to offer. But read the policy or the plan and understand what's the definition of occupation? What's the definition of disability? What is my burden of proof? Do I have to have objective evidence? Is there limitations such as a mental nervous limitation? Is there a subjective medical condition limitation that limits benefits for conditions like fibromyalgia or migraines or soft tissue conditions to just two years? And you want to, of course, look for that discretionary clause. It might be that this isn't the best thing for you and that you want to get disability coverage someplace else. Obviously, you want to.
 
 Nancy Cavey [00:17:45]:
 If you're filing a claim, keep copies of all the claim forms, correspondence and medical evidence that you submit. And again, this should be done, in my view, once you've hired a disability attorney to help you understand what this Voya policy or plan has to say. Again, what's the definition of disability? What is it that you have to prove? What's the strength of your medical records? What needs to be done to get this claim filed so that it would be accepted? If your claim is being denied or terminated, what are your appeal rights? What does that claim file say or not say? What are the proof things that need to be developed timely in an appeal to preserve your rights to your benefits? Because remember, in an ERISA case, you'll only have 180 days in which to file an appeal, and that appeal is the trial of your case. You can't wait for a later day to put in better evidence or more evidence. The judge is only going to look at what was in that names file at the time the appeal process ended. So there's a lot of thinking and strategy and evidence development that goes into these types of cases. Got it. Well, thank you for tuning in this week for our episode of Winning Isn't Easy.
 
 Nancy Cavey [00:19:01]:
 If you found this episode helpful, please take a moment like our page, leave a review, share it with your family and friends, and don't forget to subscribe to this podcast so you'll be notified whenever a new episode drops. Join us next week for another insightful episode of Winning Isn't Easy. Thanks for listening.