Disability Insurance Specialists, LLC

Reflections on ICMG 2011

2011-02-16T09:05:00.006-05:00

As 2011 swept into action, it did not appear as though the Inter-Company Marketing Group conference (ICMG) was going to make the cut for the busy line-up that was materializing. Then, a conversation with one of our networking partners convinced me to sign up to support some initiatives we had underway. Shortly thereafter I received a call from another networking partner who had several prospective customers lined up at the conference and asked whether I could join in on those meetings as well. I must add, it was not difficult to leave three feet of snow behind and head to Miami either.

The meeting was a great success by all standards from attendance to networking opportunities. Par for the course for ICMG. The true test now is what will come of the meetings and introductions that started in sunny Florida. Now, two weeks later I can start to discern the value of this year's meeting.

First, I was able to field-test the co-marketing story that Disability Insurance Specialists shares with our respective networking partners and was further convinced of the efficacy for each value proposition. Second, our mutual relationships with existing customers and prospective clients were solidified. Third, and most importantly, the meetings at ICMG have led to action steps and several real, new opportunities have been added to the pipeline.

All in all, my assessment is an A+ for ICMG 2011. I suppose it is assured that I will be getting the early registration discount for 2012!

Inter-Company Marketing Group - Annual Meeting 2011

2011-01-25T07:55:00.005-05:00

The Inter-Company Marketing Group (ICMG) annual meeting is taking place next week from February 1 - February 4, 2011 in Miami, FL. Last year, in the midst of a stagnant economy the ICMG meeting set a record for attendance. This year they are already set to break that record. So what is it about ICMG that has such drawing power?

ICMG is different. Like most conferences, there are opportunities to attend educational seminars and informational presentations regarding current market trends, but that is not what makes ICMG special. The main goal of ICMG is to foster an environment where attendees can form mutually beneficial business alliances. Companies with products are there to find people to sell them and sales organizations are there to find products they can sell to their markets. Service organizations find companies that have gaps in their ability to support products needed in their portfolios and desire speed to market, rather than years of building or restructuring.

If the phrase "win-win scenario" wasn't coined at an ICMG meeting, then ICMG has at the very least brought it to a whole new level.

These kind of business deals and alliances take place at other conferences as well, no doubt. But usually they consist of backroom meetings and the salespeople circling around the pool of prospects just hoping to separate one from the herd. Not so at ICMG. Just like going to the market, everyone is here to buy, sell, service or in some way enhance their offerings to their clients and improve their bottom line. The organizers of ICMG have done a great job in fostering this environment and the record turnout is once again all the proof that is needed.

Hope to see you in Miami! If you are not able to attend, you can follow my updates on Twitter @DIspecialist.

I Don't Get It.

2010-12-07T08:57:00.004-05:00

The first annual TedxSimsbury is today. I'm so looking forward to attending and talked with a colleague about the event to see if he was signed up as well and he replied "I don't get it."

TED is for sure a unique experience. The concept is centered upon "ideas worth spreading" and carries with it the notion that ideas can change attitudes, lives, and ultimately the world. Its an easy concept to dismiss. But what if it were true?

Have you ever listened to Bono or Bill Gates talk about their passions for bringing solutions to the Aids or Malaria epidemics? Because of their passion, and sure - their position, countless lives have been saved. But you don't have to be famous or change the entire world at once, maybe just start with your little corner.

Look at Caley Henderson from Kidz Kare - an organization started by her and her siblings to help kids living in local homeless shelters. Kids helping kids - they are making a difference, changing lives for the better. Kidz Kare was started by Caley's idea that she could help. She saw a problem and said "someone should do something about this" and then decided - she was someone.

Yeah but, Tom - what does that have to do with my business? If you are not bringing this kind of passion to your business, then you are short-changing your company. I believe what we do at DIS makes a difference in people's lives. The entire basis of insurance upholds the "widows and orphans" kind of protection that most agree is most noble and right. I am proud to be a part of that and to be involved with a company that understands excellent service and financial success, when delivered properly, go hand in hand.

We are so busy today that we sometimes forget to stop and think. We dismiss the notion that we can make a difference. We forget to ask the question "what would I do if I knew I could not fail?" TED, and specifically TedxSimsbury is a time to remember the things that make us great, and I wouldn't miss it for anything.

DIS Presenting at the International Claims Association annual meeting in Austin, TX

2010-09-13T15:20:00.003-05:00

Disability Insurance Specialists will be represented on two panels at ICA's annual conference held this year in Austin, TX from October 3 - 6, 2010.

Tom Loftus will be joining Michael Coupland of BMI to give a presentation on Effective Interviewing of disability claimants. Tom will also be presenting on Life Waiver of Premium claims with representatives from Principal Financial and Swiss Re.

Follow Tom (@dispecialist) on Twitter from the link on the main page here for updates from the conference. For more information on the ICA, visit www.claim.org

Social Media - Ignore It At Your Own Peril (Video)

2010-05-10T12:52:00.002-05:00

I recently attended the Midwest Claims Conference in Lake Geneva, WI. During the session on Social Media presented by Kevin D'Aprile (@kdaprile on Twitter) he showed an interesting and informative video I thought our readers might enjoy. See the video here: Social Media

Details, Details...Effective Interviewing for Disability Claims

2010-03-16T10:41:00.011-05:00

Good claims decisions demand a complete understanding of all of the facts of a case. Small details, which may seem insignificant on their own, may play a big role when combined with all of the facts related to a claim. Accordingly, it is essential for the claims professional to treat the information gathering process much like an investigator processing a crime scene; gathering details while not contaminating potential or future evidence.

We don’t know what will be important as our evaluation continues. Therefore, it is crucial to gather information while reserving judgment for later. Similarly, as the picture comes together, we may need to revisit several sources of information. For this reason, developing a measure of trust and an open line of communication serves you well. Making contact in a way that is convenient for your source keeps communication lines open.

Information sources related to a claim may be plentiful, however the vast majority of pertinent details may be obtained through three sources:
• The Claimant
• The Employer
• The Medical Provider

For the purposes of this article, we will concentrate on effectively obtaining information from these three sources.

The Claimant
The primary source for information related to the claim is the claimant. It is important to have direct contact at the earliest possible opportunity to be sure he or she understands the coverage, his or her role in the claims process, the information that is required, and the anticipated timeframe for a decision (or more importantly, the soonest a claim may be paid). Information requested from the claimant during the call should be sent in writing as a reminder, and to document the request and conversation.

Being upfront and establishing the groundwork goes a long way in building a healthy rapport. This makes future conversations more effective and generates better information because the claimant is more willing to talk to someone who listens and understands their situation.

For far too long, there has been a notion of competition between the claimant and the claim examiner. Statistically, however, the vast majority of claims are approved. The examiner should bear this in mind when speaking with the claimant and exude an attitude of working with the claimant towards reaching a favorable determination. When asked a common question such as, "Do you see any problems with the claim," it is a good approach for the claim examiner to respond that if an issue arises, the claimant will be contacted first. We find that claimants are more at ease if they know they will have an opportunity to get involved if there is a possibility of an unfavorable. This approach puts the claimant and the examiner together working as a team towards a common goal.

In the end, the facts and policy provisions will yield the decision. Therefore, when we find information that appears contrary to the claim, we should dispassionately share that with the claimant, rather than taking a "Gotcha!" approach. Infrequently we do uncover fraud and proceed accordingly, but many times there are explanations you would not have considered that fully explain the outlying information. In this case, a follow up request can be sent to the claimant (or other source identified) to document why the previous information was incorrect or irrelevant. On the other hand, if the claimant does not have any new information to share and a denial is the appropriate next step, they are more likely to accept the denial without appeal at this point.

If proper rapport was established and follow up communications were made throughout the claims process, there should be no surprises for the claimant when a decision is made. In our experience of conducting audits for various claim operations, there has been a direct correlation between the level of communication and the volume of appeals encountered on a given block of claims.

The Employer
Contacting the employer is often a very different experience from contacting the claimant whose only job (aside from trying to get healthy) is working with the insurance company to get his or her claim paid. The employer contact is likely a very busy person with multiple responsibilities. In addition to this, privacy rules, state guidelines and company policies and procedures may inhibit a full response.

Accordingly, in most cases it makes sense to approach the employer in the completely opposite manner than the claimant. First, send a written request for the information you want to cover and then follow up with a call to review the pre-planned questions and gather any additional details available at that time.

Once the validity of the claim is established, the examiner should focus on seeking the earliest safe date for a return to work. The best place to start this process is with the employer. It is important to understand the policies, procedures, and overall mindset of the employer with regard to returning employees to work. Important information to know includes:
• How long will the job be held open?
• Can the position be accommodated for the claimant’s limitations/restrictions?
• Are alternate "light duty" positions available?
• How long will light duty work be provided?

With this information, the examiner can assess where the employee falls within the parameters of the real work environment. Some employers fully understand the value of returning employees to work through accommodations or alternate positions and others only see this as more work in their already overburdened schedule. Knowing which type of employer you are dealing with is important.

It helps to have some statistical information available regarding the ROI of returning disabled employees to work, but realize that changing the culture of an employer is typically a larger job than can be accomplished by one claim person working on one employee’s claim. Typically, culture consultation is best reserved for a more macro evaluation with the carrier’s (or TPA’s) account rep and the employer’s senior management either at the outset of the relationship or during annual reviews. For the claim examiner, it is better to deal with the reality of the situation at hand and attempt to achieve the best possible outcome within that set of circumstances.

The Medical Provider
As with the employer, the medical provider should be contacted in a manner deferring to their convenience. A medical office typically has a set schedule when the provider conducts patient examinations, completes chart documentation, and makes contact with insurance carriers, pharmacies or other outside sources. Accordingly, the initial contact with the physician’s office should be to make an appointment to speak with the provider. Once the appointment is set, it’s best to fax a list of questions or topics in to the provider’s attention at least 24 hours in advance of the contact. If possible, a brief call should be made to the provider’s office to request that a member of the staff verify that the fax was received and ensure the provider is aware that it is in the file for review prior to the call.

Remember that in most cases, the provider is the patient’s advocate and understands the claimant far better than we can through a paper review of the file. Accordingly, while we may have opinions about recovery, care and treatment formed from our knowledge of the file and our own medical staff’s review, it is important to remain objective and be deferential to the opinion of the treating provider. The best approach is to simply hold the provider accountable for his or her opinion and seek an explanation for how that opinion was formed. In the end, the provider will either offer more details to aide in understanding the claimed loss, or it will be clear that the opinion is just that and an objective basis was not evident. In this case, the next steps are typically to arrange an independent medical examination.

The overall process of gathering information via telephone interview involves as much time and effort in the pre-planning stage as it does for the actual interview event. This can be frustrating but the time spent is well worth it if we can achieve a meaningful result and can save a lot of added work that results from making decisions with insufficient information.

Understanding and adapting to the different concerns and perspectives of the claimant, the employer and the physician increases the possibility of an effective and successful audit.

by: Charlie Putnam & Tom Loftus

Internet as a Claims Tool

2009-09-25T14:12:00.005-05:00

The Internet is an endless source of information, some of which may have value during the course of a disability claim evaluation. It may help to think of the Internet as a giant garage full of items that have been placed there over a long period of time. Some were put there just moments ago and some are gathering dust off in a dark corner that has not seen the light of day in many years. Trying to retrieve a needed item from this garage can be a time-consuming and frustrating venture if you don’t know how or where to look and especially if you are not exactly sure what you are looking for.

In addition to the time constraints outlined above, insurance company legal departments may cringe at the thought of employees “on the web” during company time for fear of viewing or sharing inappropriate information. Nonetheless, given the inherent value we have gained from access to the Internet for the purpose of assisting claim evaluations, we are advocates of finding some agreeable avenue for this access. Also, given the fact that we have uncovered claim fraud through “social media” sites, “hate” sites and “adult” sites; there should be some resource within your company to achieve “unrestricted” access. For the purposes of this article, we are primarily covering free, public records.

With all that said, it is important to have rules and accountability around such a resource and each company will need to develop its own set of parameters. The company may want to designate just one or a small number of people or just one or a small number of computers to this activity.

One of the pitfalls of the novice “surfer” is one interesting piece of information leads to another and another but not to anything concrete or useful. It is easy to get distracted into thinking that useful information is “just around the corner.” The rule of thumb here is that after five or ten minutes, tops, you should be getting more and more specific details related to your particular subject. If that is not happening, it is time to move on.

Anyone who has heard of the Internet is also aware of the famous Google search. This is still a great place to start. We recommend the advanced search or quotes around the search input to narrow the results. We completed a recent claim audit where we found information demonstrating work-related activity for the company’s largest liability claim using a simple Google search and about five minutes of sorting through results.

For more specific examples, see the following items below:

http://www.ghin.com/lookups/index.html - A website devoted to golf handicaps. If your claimant with a back problem is playing a full round of golf several times a week, you may want to look into this further. Interestingly, dates of play are posted and it is possible to develop a pattern of dates and locations played.
http://www.bowl.com/ - Bowling Scores – Similar to the golf site above.
http://usppa.com/ - Pool/billiards website similar to above.
http://www.betterwhois.com/ - Website ownership. Does it appear that your claimant may have some business activity generated from a website? This site may assist you in verifying the owner of the site and how long it has been in use.
http://www.archive.org/index.php (a.k.a. “The Wayback Machine”) This has come in handy when a claimant took down a site while we were investigating it. This site allows you to back over the years and view snapshots of what the site looked like over different points of time.
myspace.com / twitter.com / facebook.com – Most of these social media sites have filters the user can place on them to protect their information however, due to their “social” aspect, many users do not employ the filters. Accordingly, this is information put out for public consumption. Thanks to Twitter, we now have a nation of informants. One of our claimants had a friend put up a blog post (complete with photo of our claimant) about some work activity they were performing together and then “tweet” about it. Since I was running a continual search for the claimant’s name on Twitter, I was automatically notified when it happened.
http://www.blackbookonline.info/index.html This is an aggregate of available public record databases. Good starting point, created by the author of “The Investigator’s Little Black Book 3.” Examples include verification of a valid SSN, identification of an address as a mail drop vs. residence/business, news searches (including hometown newspapers for local stories that may have impacted your claimant), etc. Most sources are free, some tell you if they have information or not and let you decide if its worth paying for.
http://www.legacy.com/NS/ - Obituaries Search

It is important to note that the vast majority of information gleaned from the internet should be seen simply as a lead to develop more information. It is helpful to think about it like an annual physical with your doctor. You go in good health but they still check for all sorts of things to “rule out” any problems that merit further evaluation.

DMEC 2009

2009-07-21T11:09:00.007-05:00

The organizers of the 2009 Disability Management Employer Coalition conference in Portland, OR have done a fantastic job. The conference is chock full of excellent speakers and the attendee base is loaded with experts in the field of absence management. On a side note, the Twitter crowd is small but powerful here with folks like Andrea Olson (@pacifdisability), Kim Greive (@CAHRKim), Carol Harnett (@carolharnett), Steve Cyboran (@SCyboran), and Tamara Greenleaf (@mdguidelines). Follow them all if you are so inclined.

The official start of the conference commenced with an amazing speaker, Kirk Bauer who is the founder of the Wounded Warrior Project and more recently, Disabled Sports USA. Kirk is a veteran who sustained a service-related injury resulting in an above-the-knee amputation. As a fiercely competitive guy, he found himself sidelined for the first time in life. However, rather than succumb to the notions of what he was unable to do, Kirk focused on what might still be possible for him to do. As a result, he found a pathway to recovery and created the road map for other wounded veterans and more recently, any disabled person, to find rehabilitation through sports activity.

"If I can do this, I can do anything" became the motto of Disabled Sports USA. DSUSA has over 20 different sporting activities and 75 teaching events across the country where disabled individuals can participate, free of charge (that's right...free!). DSUSA has found that by engaging in physical activities that may have seemed out of reach, disabled individuals are achieving success in all other areas of their life. For example, a recent study conducted by DSUSA and Harris Interactive revealed that individuals participating in DSUSA were twice as likely to return to work than the general population (68% vs. 33%).

The lesson here?...If you are not currently referring your disabled employees/claimants to DSUSA, you should start immediately. Kirk took what could have been a very negative turn in his life and decided to see it as an opportunity to recognize what his abilities were instead, and discovered some pretty amazing things.

DMEC 2009 - Annual Conference, Portland, OR

2009-07-15T11:50:00.004-05:00

Will you be at the Disability Management Employer Coalition conference July 19th - 22nd in Portland, OR? As the only non-profit devoted to integrated disability and absence management, the Disability Management Employer Coalition (DMEC) will provide you with tools to save your company money and keep valuable employees at work.

I hope to see you there. Either way, you can follow the conference right here with daily updates from the show! We will be posting information on the material presented and providing insight on who is making news - as it unfolds.

With a line-up of expert panelists scheduled and nearly 500 attendees already registered, it is bound to be a gold mine of information on industry best practices for maximizing employee productivity in a healthy, safe and effective manner. Registrations are still be accepted on site at the "early bird" discount rate in order to allow as many of us as possible to join in while budgets are tight. Nonetheless, if you can't be there in person, participate by adding your comments here and don't forget to follow me on Twitter @DIspecialist.

More to come....

DMEC - Boston Chapter Meeting - "EXTREME PRODUCTIVITY"

2009-06-11T11:50:00.014-05:00

DMEC's Boston Chapter hosted a terrific meeting on June 10th, 2009 at the Liberty Mutual Training Center in Weston, MA. The panel of speakers was led by Carol Harnett, who was joined by Tracie Foster, Dr. Edward Crouch and Dan Arkins.

This presentation was based upon the White Paper produced by the 2008 DMEC (Disability Management Employer Coalition) Think Tank. This is the second White Paper produced by DMEC and follows their successful "Workplace Warrior" project which dealt with best practices in the case of employees involved in military service.

The speakers discussed the perils of "extreme productivity" and the misconception that more work hours necessarily equals more productivity. The publication suggests that stress (caused by overwork) is a driver of reduced profitability, increased healthcare costs and reduced productivity. Clearly, this is not the result desired by an employer. But how do we fix the problem? Well, the presenters did not dare to suggest that they had all of the answers (although they seemed to have a lot of them), but rather stated that they were attempting to start the discussion which they hoped would continue into each employer's workplace.

As a basis for the discussion, the panel reviewed several real case studies of companies, both big and small, who had volunteered to participate in the Think Tank study. Some of the solutions were simple, as in the case of H-E-B Grocery who simply created a message from top management that encouraged employees to take advantage of existing benefits. The culture had become one where it was not expected that you would use all of your vacation days or take any personal time. Senior management was able to create a culture shift to a more healthy level of productivity and claims that they have improved their employee retention by at least 10%.

Plans adopted by other employers focused on increasing communication, such as the "daily huddle." The huddle is a brief, daily meeting designed to encourage communication between employees and typically with their manager. Tracie Foster explained that she decided to try this out with her own group and found it very successful. In Tracie's case, she and her staff have a 10 minute meeting every morning and each member speaks for 90 seconds, covering current roadblocks/hurdles, what other departments they are working with, and how they are benefiting the company. The idea here is the that employees feel engaged and also gain a fresh focus on how they impact the company. A more comprehensive communication model created by USAA was also outlined. USAA's "Personal Best" online tool helps guide employees by asking them to enter information about their own status and then provides them with the cadre of benefits offered by the company that can assist them. The tool also provides coaching resources to assist managers in dealing with their employees.

Lastly, the Think Tank explored the neuroscience of stress. Dr. Crouch outlined the medical reality that increased stress accelerates the loss of neurons in the brain and creates the downward spiral that leads to an actual reduction in productivity. Dr. Crouch talked about the healthy habits used to counter the effects of stress, such as exercise, which decreases depression and actually builds neurons, leading to "healthy, high productivity."

The "bottom line" conclusions were narrowed down to:
- The importance of the manager in modeling and encouraging adherence to corporate practices as well as fostering a healthy work environment
- Communication: Not just "what" is communicated but also "how" it is done can be crucial to employee satisfaction
- Resiliency: There will be ups and downs in employee stress levels, but giving them the tools to enable them to get back on their feet as soon as possible, is crucial.

If you don't think employee satisfaction is very important, just look at Sears' statistics. They found that for every 5% increase in employee satisfaction, their sales increased 1.5% and bottom line profit rose .5%. Apparently happy employees sell lots of appliances.

It was an interesting presentation and for more details, I encourage you to download the full White Paper.

Hope to see you at the DMEC Annual Conference in Portland, OR from July 19-22nd!

Disability Insurance Awareness Month

2009-04-30T19:30:00.007-05:00

May is Disability Insurance Awareness Month.

Why is this important to you? If you don't plan on becoming disabled, it is not important at all. However, if you are one of the almost 13% of working age Americans who will report a disability this year*, it is extremely important. The problem is, there is no way of knowing which category you fall into.

Disability Insurance protects your ability to earn an income and support yourself and your loved ones. I have met first hand with hundreds of disability benefit recipients who have told me many different stories that all end with the same line; "I would have lost everything without these benefits."

It is a tremendous blessing to have had the opportunity to meet with these fine individuals. They are a testament to both determination and will, as many worked for years with serious limitations before being forced to stop as their disability progressed. In addition, their foresight in taking the steps to protect their families from devastating financial loss is a great lesson in truly caring for those who rely on you.

Disability insurance gives you the peace of mind of knowing that while you recover, your thoughtful planning will protect you and your loved ones in your time of need. Don't just hope things will work out. Take a moment and plan. It makes all the difference.

* Bjelland, M.J., Erickson, W. A., Lee, C. G. (2008, November 8). Disability Statistics from the American Community Survey (ACS). Ithaca, NY: Cornell University Rehabilitation Research and Training Center on Disability Demographics and Statistics (StatsRRTC). Retrieved April 30, 2009 from www.disabilitystatistics.org

EASTERN CLAIMS CONFERENCE 2009

2009-03-06T16:37:00.005-05:00

KEYNOTE SPEAKER - Dr. Sheila Murray Bethel

Dr. Sheila Murray Bethel provided a dynamite appearance at this year's Eastern Claims Conference in New York City on March 2, 2009. She spoke just one day prior to releasing her latest book: A New Breed Of Leader
(8 Qualities That Matter Most In The Real World,
What Works What Doesn’t & Why)
By: Sheila Murray Bethel, PhD.

Here are some highlights as outlined by the author:

The winds of change are blowing across the globe. They demand a new feeling of purpose, new actions, and yet-unseen solutions. People everywhere hunger for a new breed of authentic men and women who are physically strong, mentally quick, politically limber, emotionally stable, intellectually superior and unselfish consensus builders.
Truly great leaders of the 21st century will possess a strategic sense, an inherent understanding of how the framework of their thinking and the tides of time fit together and how their powers should be applied to achieve a larger purpose.
It is time to view the tried and true concepts of leadership through a new filter and then update them. By combining the best leadership qualities of the past with a set of new descriptors, measures and actions, we will begin to change the huge disconnect that exists between our daily lives and our leaders in business, government, and other institutions.

The 21st Century Leadership Puzzle

There are eight qualities in the New Breed Leadership Puzzle. The value of each piece lies in the tools it gives you to shape your personal leadership strength and to reinforce your ability to serve others.

Competence Matters…Building Purpose
Competence is doing the right thing, the right way, at the right time and it tops your list of leadership qualities that matter most. When you know what you are doing, have the experience and knowledge to take risks and make wise decisions, have a deep sense of purpose and a healthy dose of charisma, you can lead people through beneficial actions into positive results. living in a constant state of innovation where your competence is continually nurtured, moves your dream into reality. When you recognize that competence begets competence and that knowledge shared is knowledge multiplied, you’re saying, in effect, to your followers, “We can learn and grow together.” You build a sense of connectedness and a community of growth. When vision and purpose are backed by competence, you can move mountains.

Accountability Matters…Fostering Trust
Very little in the realm of leadership is more important than the trust that accountability generates. Leading is primarily about the relationship between the leader and the led, and trust is at its core. It’s the contract you make with your followers by holding yourself to account and then following up with strong ethical actions. Your leadership deepens when followers know you’re reliable and that you are a person on whom they can depend
Accountability is about doing what’s right even when no one is looking. It is the backbone of any successful entity and continually speaks to the integrity and ethics of your organization and you as a leader. Whether you’re leading at home, in the community or at work, even one example of accountability can set others on the right road.

Openness Matters…Generating Integrity
Openness involves candor and frankness. Its most important byproduct, integrity, is at the heart of earning the right to be called a leader. Integrity reveals your true intentions and greatly affects your followers and your entire organization because it reflects on everyone who is associated with you. Transparent actions and policies are the currency by which you garner the loyalty, commitment and willingness of your followers. When your words and actions match, credibility cannot help but follow, and then you earn trust. Being an open leader enables you to lift everyone and everything to a better place because of the integrity it generates. It is vital for leaders at all levels, in all sectors, across the globe to embrace a level of openness that transforms ideas and processes, visions and strategies.

Language Matters...Connecting Relationships

The power to communicate is the key to forging productive relationships. Your words inspire or discourage, hurt or help, divide or connect, cause fear or give hope. String them together artistically and sensitively, and they become a brilliant instrument by which you connect with your followers
The impact of your skillful use of language cannot be exaggerated. You never know whom you will touch with your words or how you will influence their lives. Be assured that when you speak in aspirational language, you lift minds and hearts. When you speak in clear, honest language, human bridges are built. When you use your verbal expertise to reinforce the organization’s goals, values, ideas, and ideals in the minds and spirit of your followers, your communication becomes an art form. You serve your followers best when your mission is articulated by both what you say and what you do. Words really matter.

Values Matter…Forging Community

Your principles are like a fixed beacon giving direction and purpose to the other seven qualities that matter most to a New Breed Leader. “Values” is a subtle, intangible and elusive quality with different meanings for different people under different circumstances. You have values that give you a moral compass. Most companies and organizations have a set of values that represent them to their constituents. Even our communities have certain values that make them different from a nearby town or city. Because of the enormous daily changes and challenges it is a worthy and honorable process to closely examine these values that influence you and your “communities.” The authenticity you establish from a renewed set of principles gives you the creditability to guide others as they navigate the sometimes-daunting issues of our new century.

Perspective Matters…Establishing Balance
Now is time to fill your leadership toolbox with as much intellectual, emotional and physical perspective as you can gather for your journey to the new horizons of the future. Most importantly, when you have the counterpoint of past and present to help you transition into the future; you are ready to be a New Breed leader. Your fresh clear perspective and the balance it generates—yields a sense of promise, a sense of a better life, and a sense of progress that builds community and connectedness. As you learn from past failure, you are less likely to make the same mistake again. When you gain insight from past success, you can preserve your strengths and build on them. A real world, true-to-life perspective gives you the staying power to handle the crush of daily events.

Power Matters…Mastering Influence
Power is the prime mover of people and events. You can’t lead effectively without it. Great leaders do not shrink from power, nor do they seek it unnecessarily. They know that having clout often intimidates others, so they use their power judiciously. They “pull rank” only in emergencies. It is about influencing others to follow you, even when they don’t know where you are headed. Those who make the greatest contribution will use power wisely. They understand that the highest and best use of power is to direct others and help them achieve their full potential.
Of all the examples you set as a leader, the wise use of humble power has the most long term impact. If the basis of your desire for power is one of service, then your leadership acquires an aura of dignity and your influence is increased a thousand fold.

Humility Matters…Inspiring Authenticity
Humility, like leadership itself, it is earned, not claimed. The most humble and effective leaders do not even think about taking steps to be humble. They just “are.” Humility is a state of “being.” Humility comes from deep within you. It’s how you feel about your self, how you value others. It’s an attitude, philosophy and a belief system that says, “The way for me to be the best leader possible is to be the best servant to my followers.” Authentic leaders know that humility is not weakness and arrogance is not strength. When a leader is humble, it is usually because he or she scores high on emotional intelligence. Such leaders are comfortable with themselves, without a need to constantly talk about themselves or brag about what they have, what they do or who they know.

Transcendent Challenges of 21st-Century Leadership

It is a time of transcendence, a time of limitless possibilities. No generation of leaders, at every level of society and across the globe, has had such an opportunity to solve our greatest problems and bring all peoples together to work and live in a safe and harmonious planet. You can stand up and be counted as one who will do his or her part and knowing that in combination with millions of other leaders, you’ll leave deep footprints forming a global path to a better world for all the generations that follow.
#
(1,414 words.)
© 2009 Dr. Sheila Murray Bethel

Based on the new book, “A New Breed Of Leader, 8 Qualities That Matter Most in the Real World…What Works, What doesn’t and Why,” (Berkley, March 2009), by Sheila Murray Bethel, PhD. Best Selling Author, Global Leadership Expert and Award winning Speaker, www.anewbreedofleader, 800-548-8001

Eastern Claims Conference 2009

2009-02-16T19:16:00.003-05:00

Pay valid claims more efficiently and detect fraudluent claims sooner. These are just a few of the topics covered this year, and every year at the Eastern Claims Conference - the premier conference for the life, disability and medical claims industry.

Another terrific line up of speakers is slated for this year's Eastern Claims Conferece ("ECC") scheduled for March 1st - 3rd in bustling NYC! Top special investigative unit leaders, legal specialists, and industry experts will be speaking on the industry's latest trends and hottest topics. STOLI/IOLI, ERISA updates, Deposition prep, and a "Brass Tacks" Disability Round Table discussion group are just a few of the vital sessions you do not want to miss!

The ECC has established itself as the premier destination for nationwide and international claims professionals to gather and get the latest updates on industry devlopments while networking with their peers and the top vendors serving the life, disability and medical claims business. While some are "cutting back," the ECC has gone all out to secure top industry experts and leading professionals to share their knowlegde and experience during these difficult times. Don't miss your chance to learn from the best in the city that never sleeps!

For more information, go to www.easternclaimsconference.com.

ICMG 2009 - How To Run A Successful Conference In A Tough Economy

2009-02-09T13:41:00.005-05:00

How do you have a successful conference during a time when almost everything else is trending downward? Two words; Value & Improvisation.

The Inter-Company Marketing Group has long been a unique venue for networking with other industry professionals and forging strategic alliances. Companies participate in ICMG because they have seen the solid track record of ROI for their time and money. In a day of tightening budgets, companies are looking to spend their marketing dollar only where they have the best chance of return. ICMG is well-known for the value they bring to their members.

It was for this reason that it was so surprising to find ICMG was working with marketing consultants from The van Aartrijk Group LLC to better understand what their members wanted and how to best provide it. Whether as a part of that strategy or in addition to it, ICMG also added a group on LinkedIn and enhanced the annual meeting by building it into a networking community. So rather than simply trust what had worked in the past, ICMG instead chose to build on that reputation and deliver an even better product for the future. Improvisation at its finest!

Brave New Workshop, led by Caleb McEwen provided comic relief while communicating the point that improvisation is paramount in today's business world. BNW covered the "8 Secrets of Innovation:"
* Accept all ideas (you don't have to adopt them all...just accept them for consideration)
* Defer judgement
* Share focus/accept all sytles
* Make a declaration (say what you think!)
* Create a "status-less" environment (everyone's ideas matter)
* Create a reward system that recognizes innovation (praise over critique)
* "Yes" first (accept and then add to ideas)
* Perceive change as fuel

If we allow the problems of our times to weight us down, we will be sure to sink. However, if we take hold of the rising tide of change, we can ride the wave of success. Well, if ICMG is any example of the results achieved by seizing the power of change and capitalizing on improvisation - count me in!

Inter-Company Marketing Group meets LinkedIn!

2009-01-14T17:23:00.008-05:00

What happens when the most dynamic insurance industry conference meets the leading business networking website? For starters, you get 34 new members in the first week. Not too shabby. Further proof that ICMG attendees understand the benefits of networking.

When Audrey Wittenburg added the ICMG as a group on LinkedIn she started with a question about how existing members are already using the online networking site. This shows the open-mindedness that makes ICMG members successful at creating strategic alliances that add value to their companies. Audrey recognized that LinkedIn is working to connect business professionals in meaningful ways in an online setting. Knowing the existing success of ICMG in making such connections in a conference setting, she recognized the natural alliance.

This alliance will be helpful to ICMG members both prior to and following the show in maximizing their planning and follow up with fellow members. Similarly, alliances forged at this year's ICMG conference will undoubtedly bring success in 2009 for the respective members and their companies. Whether you are a carrier seeking distribution or a distributor seeking products, if you have been to the ICMG before, you probably have a success story to share.

Additionally, service providers such as Disability Insurance Specialists provide the support for the development of new products or any related services that may not be present within the carrier, reinsurer or distribution source. For example, this year we will be co-marketing a new product along with our alliance partner, Vision Financial - Short Term Care Insurance built for the Worksite market.

To be the first to seize this opportunity or simply to tap into the wealth of other products and services provided by Disability Insurance Specialists, we would appreciate the opportunity to talk with you further. C'mon by booth #3 in the exhibit hall or drop a card behind the handsome photos of Tom Loftus, Bill Bossi or Tad Verney on the connection board and we'll be sure to track you down.

See you in sunny Florida!

Supreme Court Rules on Insurer's Conflict of Interest

2008-07-14T09:38:00.001-05:00

MetLife (Metropolitan Life Ins. Co.) and Long Term Disability Plan for Associates of
Sears, Roebuck and Company v. Wanda Glenn. US Supreme Court opinion - 6/19/08.

Background:

Glenn was a long-time employee and manager of Sears women's department. She was covered by Sear's ERISA-governed LTD plan, insured by MetLife. The plan documents invested MetLife with discretionary authority. In 2000, Glenn took a medical leave based on cardiac problems (cardiomyopathy and ventricular dysfunction) and submitted a disability claim. MetLife approved the claim (under the own-occ definition), and advised Glenn to seek social security disability income benefits (“SSDI”), which would then be deducted, dollar-for-dollar, from her MetLife benefits. MetLife referred Glenn to an SSDI attorney to represent her, and provided that attorney with medical records from MetLife’s claim file.

The SSA determined that Glenn was disabled and awarded her SSDI benefits. The SSA’s determination was based in part on information not provided by MetLife and in part on the absence of certain MetLife documentation which was not submitted to SSA. (Glenn never submitted to SSA a MetLife APS and PCA stating she could perform sedentary work.) After deducting her attorney’s fees, MetLife recouped from Glenn the balance of the retroactive benefit award, applying it to the resulting overpayment, and reduced Glenn’s monthly benefit by “almost 100%” of her monthly SSDI benefit. Shortly thereafter (at the 2-year test change), MetLife decided Glenn did not meet the policy’s any-occ definition of totally disabled (stating that her condition had improved to the point where she could perform sedentary work) and terminated her benefits. Glenn appealed, presenting to MetLife some (but not all) of the documentation which she previously submitted to the SSA which was not part of MetLife’s file. Specifically, she never presented to MetLife a letter by the APS physician stating she could not work full-time and could not work under any type of stress. MetLife maintained their termination on appeal.

Glenn filed suit in the US District Court and lost, the Court deferring to MetLife’s discretionary authority. Glenn appealed, and the 6th Circuit Court of Appeals reversed, stating that MetLife operated under a conflict on interest and citing various acts supporting that conclusion.

MetLife appealed to the U.S. Supreme Court, which rendered its decision on 6/19/08. Justice Breyer delivered the majority opinion of the Court; Justices Stevens, Souter, Ginsburg, and Alito concurred. Chief Justice Roberts filed an opinion concurring in part and concurring on the judgment, but dissenting relative to how a court should assess a conflict of interest. Justice Kennedy filed an opinion concurring in part and dissenting in part relative to how a court should assess a conflict of interest. He also would have remanded to the 6th Circuit for additional findings.) Justice Scalia filed a dissenting opinion in which Justice Thomas concurred, criticizing how the majority opinion eroded the deference that is to be accorded to an ERISA fiduciary with discretion. He also would have remanded to the 6th Circuit for additional findings.)

Questions Presented to the Supreme Court:

1. Does an insurer who has both discretionary authority to make claim decisions and also funds the plan benefits automatically operate under a conflict of interest?

2. If so, how should that conflict of interest be assessed on judicial review of an adverse claim determination?

Summary:

The Court unanimously agreed that MetLife was operating under a conflict of interest, as its claim determinations had a direct impact on its net income. However, the majority opinion failed to clarify exactly how a theoretical conflict of interest should be factored in to an assessment of whether the conflicted claim administrator abused its discretion. In that respect, federal District (trial) Courts and Circuit Courts of Appeals are somewhat free to continue pursuing divergent standards of review, including the advice contained in the dissenting opinions.

The Existence of a Conflict of Interest:

The Court reiterated that the standard for review of a claim determination made by a claim administrator with discretionary authority is to determine whether the claim administrator abused its discretion. It then stated that the existence of a conflict of interest was just one factor to be considered in making that determination, but in and of itself, does not automatically mean that that the claim administrator necessarily abused its discretion in arriving at a financially self-serving adverse claim determination. The Court then unanimously found that MetLife (or any claim administrator with discretionary authority who is also financially responsible for the payment of claims) necessarily operates under a conflict of interest.

Evaluating a Conflict of Interest:

In reviewing the 6th Circuit’s decision, the Court noted that other factors were considered in arriving at that determination.

The Court of Appeals ultimately set aside MetLife’s denial of benefits in light of a combination of several circumstances: (1) the conflict of interest; (2) MetLife’s failure to reconcile its own conclusion that Glenn could work in other jobs with the Social Security Administration’s conclusion that she could not; (3) MetLife’s focus upon one treating physician report suggesting that Glenn could work in other jobs at the expense of other, more detailed treating physician reports indicating that she could not; (4) MetLife’s failure to provide all of the treating physician reports to its own hired experts; and (5) MetLife’s failure to take account of evidence indicating that stress aggravated Glenn’s condition.

The Court declined to develop a “bright-line” rule for evaluating conflicts of interest and other factors, stating:

Benefits decisions arise in too many contexts, concern too many circumstances, and can relate in too many different ways to conflicts—which themselves vary in kind and in degree of seriousness—for us to come up with a one-size-fits-all procedural system that is likely to promote fair and accurate review.

However, the Court did note several ways that a conflicted claim administrator could reduce, or even eliminate, conflict of interest as a relevant factor.

It should prove less important (perhaps to the vanishing point) where the administrator has taken active steps to reduce potential bias and to promote accuracy, for example, by walling off claims administrators from those interested in firm finances, or by imposing management checks that penalize inaccurate decisionmaking irrespective of whom the inaccuracy benefits.

Chief Justice Roberts, while agreeing with the result, disagreed with how a conflict of interest should be factored in. Specifically, he stated that the existence of a conflict of interest should have no weight, and should not add weight to other factors, unless the claim administrator acted improperly because of that conflict of interest.

The majority’s approach would allow the bare existence of a conflict to enhance the significance of other factors already considered by reviewing courts, even if the conflict is not shown to have played any role in the denial of benefits. The end result is to increase the level of scrutiny in every case in which there is a conflict—that is, in many if not most ERISA cases - thereby undermining the deference owed to plan administrators when the plan vests discretion in them. I would instead consider the conflict of interest on review only where there is evidence that the benefits denial was motivated or affected by the administrator’s conflict. No such evidence was presented in this case. I would nonetheless affirm the judgment of the Sixth Circuit, because that court was justified in finding an abuse of discretion on the facts of this case—conflict or not.

He went on to cite specific examples where the evidence showed that the claim administrator’s conflict motivated an improper determination:

It may, for example, appear on the face of the plan [citation omitted] (offering hypothetical example of a plan that gives “a bonus for administrators who denied benefits to every 10th beneficiary”); it may be shown by evidence of other improper incentives, see [citation omitted] (insurer provided incentives and bonuses to claims reviewers for “claims savings”); or it may be shown by a pattern or practice of unreasonably denying meritorious claims, see [citation omitted] finding a “pattern of erroneous and arbitrary benefits denials, bad faith contract misinterpretations, and other unscrupulous tactics”). The mere existence of a conflict, however, is not justification for heightening the level of scrutiny, either on its own or by enhancing the significance of other factors.

Justice Kennedy agreed with the majority’s analysis, but disagreed with the result. Rather than confirming the 6th Circuit’s decision (reversing MetLife’s determination), he stated the case should have been remanded to the 6th Circuit to determine whether MetLife had taken any of the suggested steps to insulate its claim department from the insurer’s financial considerations, thus extinguishing the conflict of interest as a factor in assessing whether or not MetLife abused its discretion.

But as far as one can tell, the Court of Appeals made no effort to assess whether MetLife employed structural safeguards to avoid conflicts of interest, safeguards the Court says can cause the importance of a conflict to vanish. … By reaching out to decide the merits of this case without remanding, the Court disadvantages MetLife solely for its failure to anticipate the instructions in today’s opinion.

In their dissenting opinion, Justices Scalia and Thomas reviewed the history of ERISA relative to treating a claim administrator in the same way as a trustee.

… our cases make clear that it is to be governed by the law of trusts. Under that law, a fiduciary with a conflict does not abuse its discretion unless the conflict actually and improperly motivates the decision. There is no evidence of that here. …

The Restatement [of Trusts] does indeed list in Comment d certain circumstances (including conflict of interest) that “may be relevant” to deciding whether a trustee has abused his discretion. … In trust law, a court reviewing a trustee’s decision would substitute its own de novo judgment for a trustee’s only if it found either that the trustee had no discretion in making the decision, [citation omitted], or that the trustee had discretion but abused it, [citation omitted.] Otherwise, the court would defer to the trustee. … A trustee abuses his discretion by acting dishonestly when, for example, he accepts bribes. [citation omitted] A trustee abuses his discretion by failing to use his judgment, when he acts “without knowledge of or inquiry into the relevant circumstances and merely as a result of his arbitrary decision or whim.” [citation omitted] A trustee abuses his discretion by acting unreasonably when his decision is substantively unreasonable either with regard to his exercise of a discretionary power or with regard to his assessment of whether the preconditions to that exercise have been met. [citation omitted] And—most important for this case—a trustee abuses his discretion by acting on an improper motive when he acts “from a motive other than to further the purposes of the trust.” … The four abuses of discretion are clearly separate and distinct.

Relative to the deference to be accorded a claim administrator with discretion, Scalia stated:

A trustee without a conflict could take either of two reasonable courses of action, but a trustee with a conflict, facing the same two choices, would be compelled to take the course that avoids the appearance of self-dealing. He would have to do that even if he thought the other one would better serve the beneficiary’s interest, lest his determination be set aside as unreasonable. … A trustee’s conflict of interest is relevant (and only relevant) for determining whether he abused his discretion by acting with an improper motive. It does not itself prove that he did so, …

Reasonable is reasonable. A reasonable decision is one over which reasonable minds seeking the “best” or “right”
answer could disagree. It is a course that a trustee acting in the best interest of the beneficiary might have chosen. Gradating reasonableness, and making it a “factor” in the improper-motive determination, would have the precise effect of eliminating the discretion that the settlor has intentionally conferred upon the trustee with a conflict, for such a trustee would be foreclosed from making an otherwise reasonable decision.

I conclude that the only possible basis for finding an abuse of discretion in this case would be unreasonableness of petitioner’s determination of no disability. The principal factor suggesting that is the finding of disability by the Social Security Administration (SSA). But ERISA fiduciaries need not always reconcile their determinations with the SSA’s, nor is the SSA’s conclusion entitled to any special weight. [Citation omitted.] The SSA’s determination may have been wrong, and it was contradicted by other medical opinion.

We did not take this case to make the reasonableness determination, but rather to clarify when a conflict exists, and how it should be taken into account. I would remand to the Court of Appeals for its determination of the reasonableness of petitioner’s denial, without regard to the existence of a conflict of interest.

Impact:

The Court’s opinion will most likely result in a flurry of activity by conflicted claim administrators (employers administering their own self-funded claims and insurers administering their own insured claims) to insulate their claim departments from financial considerations in order to diminish or extinguish conflicts of interest as a factor in an abuse of discretion assessment. Some companies may look to a TPA, acting independently of any financial considerations, to provide claim services in order to resolve their conflict whereas many would likely prefer to keep their claim administration in-house. In that case, there may be more of move to add such a separation only when claims have already been denied, such as an “appeals only” service. This would allow insurers to keep claims in-house while using the TPA to create a “Chinese Wall” on those claims which present the greatest likelihood of undergoing judicial scrutiny and the ambiguous standard of review described above.

Lessons Learned:

The majority, as well as Chief Justice Roberts, viewed MetLife’s failure to investigate and address the conflicting SSA determination as a significant abuse of discretion. When denying or terminating benefits based on an any-occupation definition of disability relative to a claimant known to have been approved for SSDI, claims associates should consider including in the denial / termination letter, as an additional item to be provided on appeal, all SSDI award letters and any documentation submitted to SSDI not referenced in the denial / termination letter. This should be considered regardless of whether or not the claims administrator assisted the claimant in obtaining SSDI benefits.

6th US Circuit Court of Appeals Supports Claim Outsourcing! (Supreme Court Considers Same)

2008-05-07T13:32:00.005-05:00

The Supreme Court agreed to consider whether an insurer has a conflict of interest when they adjudicate claims on policies they sell, according to the attached story printed April 28, 2008 in the Insurance Journal.

http://www.insurancejournal.com/news/national/2008/04/28/89482.htm

"Disability insurance plans cover 28 million Americans, and insurers paid more than $7.2 billion in long-term disability claims to more than 500,000 people in 2006" say sources cited in the report. The Supreme Court is considering whether there exists a substantial financial incentive for the insurance carrier to deny claims in favor of inflated profits.

The 6th US Circuit Court of Appeals ruled in the case Glenn v. MetLife that the insurance carrier must reinstate benefits because they "acted under a conflict of interest," unjustly terminating Glenn's benefits. Solicitor General Paul Clement of the Bush administration offered his opinion that companies like Met who make more money when they deny a claim present a classic case of conflict of interest.

Some argue that costly legal battles associated with unjust denials and bad public image would inflate expenses and decrease sales, sufficient to offset any suggested "gains" which might be garnered by the suggested dubious conflict. This case is clear in individually sold plans, where awards are not altogether uncommon such as the case in Lee Ingalls v. Paul Revere. Revere terminated Ingalls claim with approximately $70,000 of liability remaining. The judgements that followed cost the carrier over $3 million. However, Group LTD claims are covered under ERISA, the Employee Retirement Income Security Act, which limits such extra-contractual damages.

MetLife has appealed the 6th Circuit's decision to the Supreme Court and all eyes will be on the ruling which is expected by July.

DIS to present at Munich Re's Customer Appreciation Conference in Charleston, SC

2008-05-07T13:18:00.002-05:00

Tom Loftus, VP Business Development will join Bert Sosnin of Munich Re for a presentation on the hidden clues found in Life and Disability claim submissions. Look for our report on the presentation and content following the conference which takes place on May 18 - 20, 2008!

DIS's Bill Bossi making connections at ICMG

2008-05-07T13:11:00.003-05:00

Bill Bossi from DIS greets an exhibit hall guest at the InterCompany Marketing Group Conference. It's no coincidence that Jay Pettapiece from Vision Financial was our neighbor in the exhibit hall. DIS and Vision co-promote our combined services through the "Worksite Benefits Alliance," providing turnkey services for products sold in the Worksite.

DIS and friends enjoy Carmine's at the Eastern Claims Conference

2008-05-07T13:02:00.000-05:00

Riders Appeal To Clients Who Just Won't Buy Traditional DI

2007-06-06T09:35:00.000-05:00

Check out this great article by Jay Drucker of AIG at National Underwriter!

New England Claim Association - Spring Meeting - Great Turnout!

2007-05-07T07:19:00.000-05:00

May 4, 2007 - The spring meeting of the New England Claims Association in Chelmsford, MA boasted strong attendance and a terrific speaker. While it seems that most regional associations have suffered a loss in turnout over the last couple years, NECA has managed to draw back claims associates in droves - perhaps some due to strategic location and much part in due to quality programming.

John Allen of West Falmouth Associates gave a strong presentation, outlining the tools and strategies needed to attain and keep true job satisfaction. He addressed the reasons employees stay in their jobs and the reasons they leave, creating both a pathway to individual satisfaction as well as corporate retention.

The real story here, however was attendance. Virtually a "standing room only" crowd showed up, making for a lively discussion period in the breakout sessions following the main speaker. While one or two companies dominated the attendance, there was also a good mix of other companies represented, making for diverse opinions and practices, which greatly added to the discussions.

Thanks goes out to the NECA crew who pulled this together. Here's hoping you keep moving forward in this direction. Pictured below are Sue Abbott, Kimberly Biggs, Sorana Baba, Paula Bonina, Sandy DeCoff and Jim Papi (from bottom to top, left to right). Looking forward to the June golf outing!

Keep up the good work!

TWIN CITIES LIFE & HEALTH CLAIMS CONFERENCE

2007-04-26T19:57:00.000-05:00

This was our first time attending this regional conference in Minneapolis, MN but we will certainly return next year. The conference was well attended by various local companies and vendors and offered a variety of informational sessions with experts in medical, legal and other relevant fields.

But who are these guys? None other than Tonic Sol Fa - a locally based (but nationally known) singing group (www.tonicsolfa.com). Fantastic! I've never actually attended a regional meeting of this size that had entertainment at the lunch break, but it was a great idea and certainly broke up the day. The caliber of the entertainment was amazing and spoke to the event organizers' abilities to put together a strong meeting.

The association is run by co-presidents Pamela Moore Roberts and Joe Evans of ING Reliastar and they are assisted by Treasurer Linda Paulson and Board Member Karen Nichols of Minnesota Life as well as Genae Nicole of Metropolitan Health Plan. (Pictured here are Karen, Joe and Linda, respectively).

DIS Employees Participate as Panelists at the Eastern Claims Conference - March 2007

2007-03-21T08:38:00.000-05:00

Diabilitiy Insurance Specialists was well represented at this year's Eastern Claims Conference held at the Waldorf Astoria in New York City.

Panelists included VP of Claims, Rita Holroyd, RN; Mary Anne Heleniak, RN, Jeff Champagne and Tom Loftus. Rita joined Michael Bell and Brett Preston to present the Do's and Don'ts of Deposition testimony. It was a light-hearted but informative session which they said was aimed mainly at the "novice" deponent, however the topics covered were a good reminder for anyone finding themselves under the spotlight in litigation.

Jeff joined Melissa Cowan to provide an update on recent developments in DI Litigation. Jeff and Melissa presented case studies and then asked the audience to vote on whether the outcome for the insurance carrier would be "Good, Bad or Ugly." Some of the outcomes were surprising and without question the information provided by Jeff and Melissa was a "must know" for all involved in DI Claim adjudication.

Mary Anne and Tom presented information on Voluntary Benefits sold through Worksite marketing and the trends that are emerging there. More and more carriers are getting in the game and a variety of factors affect the kind of results seen at claim time. Agent/broker training and knowledge level as well as available marketing material can have a strong impact on the caliber of clients the carrier ends up with as well as the retention levels that result from insureds understanding what they have purchased. Results at claim time have shown up to one-third of policies rescinded, one-third of claims denied and the remaining third approved.

For further details on any of these topics, feel free to leave a comment via the link below.

Recent Article Featuring DIS's own Bill Bossi - written by Tim Meyer of Meyer Disability Consulting for the February/March '07 issue of "The Source"

2007-03-20T09:11:00.000-05:00

...the STD manual rate basis is still extremely important.
Manual rates are often used to determine the relative pricing difference between benefit options. The relative price difference is then applied to actual experience (subject to underwriting judgment and discretion) to determine a proposed rate applicable for the revised plan of benefits. For example:
•A current inforce policyholder has a STD benefi t plan with
a 26-week benefi t duration, and has asked for a rate for a
plan with a 13-week benefi t duration.
•The STD manual rates show that the 13-week plan is 75
percent of the 26-week plan.
•The underwriter might adjust the actual experience under
the 26-week plan downward by 25 percent in developing
the proposed rates for the 13-week plan.
At the annual SOA meeting in Chicago this fall, Bill Bossi of Disability Insurance Specialists LLC presented the following, which indicates how sensitive STD profitability is to claim duration:
•If pricing anticipates a 65% loss ratio and a 5% profi t, and
average claim duration is 50 days, then a 1 day increase
in duration adds 2% to claim costs (equal to 1.3% of
premium).
•Additional claim cost of 1.3% of premium drops after-tax
margin to 4.15% or 83% of expected.
•A 1-day difference in expected claim duration is worth
17% on the bottom line!
This illustrates the significant impact the STD manual rate can have even for larger cases.
Block Demographic Changes/Shifts
Is the average duration of claim changing? Are incidence rates changing? Are maternity claims changing as a percentage of total claim costs? Note that the answer the above questions should also include an analysis of what was "expected". In other words, is the average duration of a claim changing, and is this expected? Are maternity
of business by plan design, SIC, etc., could result in these changes. As could a shift in demographics – higher/lower female content, changes in average age/age distribution of the block, etc. The best measure of "expected" is the manual rate basis. And if the manual rate basis has an adequate rate slope by age, adequate rates by gender, adequate rates by benefi t duration, etc., then all of the above changes could be occurring and yet the actual-to-manual claims ratio would remain constant, i.e. the changes are occurring but the resulting change in claim costs was expected.
Case Specifi c Demographic Shifts
The manual rate can play an important role in the renewal process by identifying changes in case specifi c demographics. Given no changes in the plan of benefi ts, a change in manual claim costs of a group over time indicates a change in underlying case demographics. When predicting claims for a future experience period, it may be appropriate to make a demographic adjustment to the historical claims experience
to refl ect this gradual change. The manual rate basis can serve as the tool for determining the appropriate adjustment to use.
The above are but a few examples of how the STD manual rate basis impacts the pricing and management of a STD block of business. These examples illustrate that devoting resources/time to ensure an adequate STD manual rate basis is key to a profi table, growing book of business.

Welcome!

2007-03-19T22:21:00.000-05:00

Welcome to Disability Insurance Specialists' Blog on Hot Topics and Solutions for the Industry.

Here you will be able to find tips, training tools, and links to current issues facing the Disability Insurance Industry. Whether you work in Short Term Disability, Long Term, IDI or other Morbidity based products - this is the site for you!

Read our Posts on the latest issues facing the market, or submit your own topics for input from others. Let this be your primary stop for industry issues and answers. Come back and visit often as updates are posted on a regular basis.