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Seeing a drastic reduction in claims submissions since the pandemic started?   Do you envision an influx of claims once the pandemic subsides?
September 23, 2020

Seeing a drastic reduction in claims submissions since the pandemic started? Do you envision an influx of claims once the pandemic subsides?

Seeing a drastic reduction in claims submissions since the pandemic started?   Do you envision an influx of claims once the pandemic subsides?

Blurb: Clearly, some people who planned on going to the doctors/hospital didn’t during the pandemic and may not go afterwards so there is the potential of a reduction in claims volumes. On the other hand, more people may go to confirm any cough or shortness of breath and we see an influx.

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Building a
September 23, 2020

Building a "Destination" Claim Department

While process and procedure help to differentiate claims organizations, a department’s talent is how companies deliver on their sales promise. A diverse and talented claims staff makes for good customer service, risk management, and continuous improvement. Though each carrier may have unique concerns, all can agree that providing service, balancing risk, and continuing to improve are the necessary ingredients for a successful claim organization.

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Investigations during Covid-19..., Current Observations
September 23, 2020

Investigations during Covid-19..., Current Observations

COVID-19 sucker punched our world.  Our relationships, mental strength, and businesses goals have all been challenged. Although it seems like a time to be somber, perpetrators of fraud and exaggeration continue to run their schemes, while insurers and employers endure to protect their assets.

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Social Security in the Age of Covid-19
September 23, 2020

Social Security in the Age of Covid-19

Like many businesses in the United States and around the world, effective March 17th, the Social Security Administration closed to the public its 1230 field offices around the country and its 165 sites where Administrative Law Judges’ hearings are held. They were then faced with the daunting task of getting roughly 60,000 employees set up to work from home.  This included not only field office and payment center employees, but also Disability Determination Services (State employees who make the medical decision for Social Security disability applicants at the initial and reconsideration levels), and the hearing office employees.  

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Dean A. Connor President & CEO, Sun Life will be the Opening Keynote Speaker
August 24, 2020

Dean A. Connor President & CEO, Sun Life will be the Opening Keynote Speaker

As the world grapples with the unprecedented and different challenges posed by COVID-19, Sun Life is focused on the people whose lives have been impacted by the virus. In this session, Sun Life's President and CEO will share their response to the pandemic, including how they adjusted course to better serve their clients and take care of their employees.

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New Life & Annuity Committee Survey: Foreign Wire Transfers
August 24, 2020

New Life & Annuity Committee Survey: Foreign Wire Transfers

New surveys from the Life & Annuity Committee are now available online.

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Q&A: Test Your Knowledge
August 18, 2020

Q&A: Test Your Knowledge

Questions ranging from the medical aspects of claims to the life and health insurance law.

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COVID-19 Implications; Covered Risk or Risk of Disability
August 11, 2020

COVID-19 Implications; Covered Risk or Risk of Disability

With the onset of the COVID-19 Pandemic, the Life, Health & Disability industry has seen claims for disability benefits due to the risk of contracting COVID-19 if an insured returns to or continues to work.

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Registration Open for the 2020 ICA
August 11, 2020

Registration Open for the 2020 ICA "VIRTUAL" Annual Education Conference!

The ICA Annual Education Conference is well known among insurance claim professionals from around the globe as the leading educational conference in the life and health claims industry.

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New Life & Annuity Committee Survey: COVID Changes and RTO Plans
June 18, 2020

New Life & Annuity Committee Survey: COVID Changes and RTO Plans

Committee Members Share COVID-19 Challenges in New Survey.

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Disability Claims Based on C-19 Exposure/Quarantine
June 1, 2020

Disability Claims Based on C-19 Exposure/Quarantine

Following the arrival of the novel Corona Virus (C-19) on U.S. shores, state, county and municipal authorities across the country have imposed various forms of stay-at-home orders, mandatory business closures and quarantines.   These restrictions prevent certain people from working, especially those known to be carriers of the virus (though symptom free), those who have recently travelled from known “hot spots” and those who have otherwise been in close proximity to the virus.  Are such people – who are otherwise perfectly capable of doing their jobs but for the fact that they cannot leave their homes, hotels or other quarters – entitled to disability benefits?  Depending upon the specific terms of the disability policy at issue, the answer may be “no.” 

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New Life & Annuity Committee Surveys: Same Day Processing, Rapid Pay and COVID-19 Changes, and ACH payments and Proof of Account
May 29, 2020

New Life & Annuity Committee Surveys: Same Day Processing, Rapid Pay and COVID-19 Changes, and ACH payments and Proof of Account

New surveys from the Life & Annuity Committee are now available online.

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New Life & Annuity Committee Survey: Death Claim Interest
May 11, 2020

New Life & Annuity Committee Survey: Death Claim Interest

New surveys from the Life & Annuity Committee are now available online.

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What is the Death Master File?
May 11, 2020

What is the Death Master File?

The DMF is maintained by the NTIS (National Technical Information Service) on behalf of the SSA (Social Security Administration), and according to the NTIS website, it contains over……

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If Medicare Pays, You Pay...Right?
April 22, 2020

If Medicare Pays, You Pay...Right?

There is rampant fraud and abuse in the Medicare system. It’s no secret healthcare fraud costs taxpayers conservatively $68 billion each year. The impact last year looked something like this:

  • $377B Medicare payments were made, of which:
  • $52B were fraudulent/improperly made or 13.7% of claims paid, and:
  • $2.4B of the $52B was recovered… So, where did the rest go?

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Detecting Insurance Fraud Indicators
May 1, 2020

Detecting Insurance Fraud Indicators

ICA’s Toolkit for the New Claims Professional is an exclusive member benefit providing an overview of disability, fraud and risk management, life and annuity, group health, long term care and reinsurance claims.    

Three indicators to detecting insurance fraud are as follows:

  1. Identify
  2. Resolve
  3. Refer

It can be as simple as 1. 2. 3.! Click here to access ICA’s Toolkit for the New Claims Professional and learn more about Fraud and Risk Management.

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Common Fraud Indicators for Disability Claims
April 24, 2020

Common Fraud Indicators for Disability Claims

ICA’s Toolkit for the New Claims Professional is an exclusive member benefit providing an overview of disability, fraud and risk management, life and annuity, group health, long term care and reinsurance claims. Fraud includes five main elements that are needed to prosecute insurance fraud. These five elements are: knowledge, intent, misrepresentation, materiality, and harm/loss/or damages.

Some common fraud Indicators for Disability Claims are as follows:

  • Pushy, volatile insured/claimant
  • Insured/claimant very knowledgeable of claim process and insurance terminology
  • Claim presented within days/weeks of policy inception
  • Unwitnessed injuries
  • Delayed reporting of claim (sometimes years)
  • Insured/claimant with a lengthy history of prior claims
  • Seasonal workers or occupations
  • Insured/claimant with known financial difficulties
  • Initial presentation of claim made by attorney
  • Claim forms/application appear to be forged/altered
  • Insured/claimant threatens immediate legal action or report to DOI
  • Insured/Claimant Insists on rushed claim adjudication
  • Insured/Claimant Provides vague information or not able to “remember” key details to loss
  • Incomplete claim forms
  • Insured/Claimant refuses to provide statement on loss, sign (or alters) authorization
  • Misspellings on formal, professional documents (medical records etc.)

Click here to access ICA’s Toolkit for the New Claims Professional to learn more about Disability Claims.

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Determining Tax Consequences on Life Insurance Proceeds
April 17, 2020

Determining Tax Consequences on Life Insurance Proceeds

ICA’s Toolkit for the New Claims Professional is an exclusive member benefit providing an overview of disability, fraud and risk management, life and annuity, group health, long term care and reinsurance claims. Determining Tax Consequences on Life Insurance Proceeds are subject to estate and income taxes

Click here to access ICA’s Toolkit for the New Claims Professional to learn more about Life and Annuity Claims.

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The CARES Act
April 9, 2020

The CARES Act

We have summarized the pertinent sections of The CARES Act that will impact both businesses and individuals.

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Law Committee First Quarter Newsletter
April 1, 2020

Law Committee First Quarter Newsletter

Pandemic and Significant Insurance Decisions in Massachusetts

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