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Florida's Civil Remedy Notice of Insurer Violations (
November 20, 2020

Florida's Civil Remedy Notice of Insurer Violations ("CRN"): What is It and What Should an Insurer Know About It?

As an insurer (or general counsel for an insurer), you may have received a demand from a Florida attorney representing one of your insureds.  In that letter, the attorney has likely accused you of a “parade of horribles,” with accusations spanning your failure to attempt in good faith to settle a claim, unfair claim settlement practices, failure to implement standards for proper investigation of claims, denial of claims without conducting reasonable investigation, and many more misdeeds.  These accusations are often accompanied by colorful (in my experience, usually inaccurate) allegations.  Finally, in the letter, the Florida attorney has notified you that a “Civil Remedy Notice” (or “CRN” for short) has been filed. 

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New Life & Annuity Committee Survey: Original Death Certificates Required
October 28, 2020

New Life & Annuity Committee Survey: Original Death Certificates Required

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

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Covid-19 is Wreaking Havoc on the Future Solvency of Social Security
October 6, 2020

Covid-19 is Wreaking Havoc on the Future Solvency of Social Security

Covid-19 has already greatly impacted Social Security with high unemployment rates.  There were nearly 13 million fewer people working in July 2020 than in February.  This is 13 million fewer people and their employers paying into Social Security, resulting in a net of more funds being drawn from the trust fund in 2020 than actuarially predicted.

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Customer Service – What if IT Was YOU?
September 30, 2020

Customer Service – What if IT Was YOU?

As we become and remain more remote, it is critical that we “step up” our levels of service with our customers.  In-person service is being replaced with emails, phone calls, instant chat lines and more web-based video meetings.

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Riding the Wave of COVID-19 Claims
September 30, 2020

Riding the Wave of COVID-19 Claims

Since the pandemic started, many carriers have seen a drastic reduction in health claims submissions.  Many are wondering if there will be a tsunami of claims once the operations begin to reopen or a steady increase of receipts. We do expect to see an uptick in Non-Covid-19 claims once the restrictions on elected procedures have been removed.  However, there are only so many surgeries and visits that can be scheduled at facilities and physician offices.

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LAW COMMITTEE 2020 BLACK LETTER LAW REPORT
September 30, 2020

LAW COMMITTEE 2020 BLACK LETTER LAW REPORT

Insurer’s Right to Rescind Beyond the Two-Year Contestability Period Based Upon Misrepresentation, Fraud or Other Grounds

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AD&D Insurer's Decision Burns Brightly in The Ninth Circuit
September 23, 2020

AD&D Insurer's Decision Burns Brightly in The Ninth Circuit

Should an ERISA plan participant, who allegedly stepped on a glass resulting in a below-the-knee amputation seven years later, be entitled to accidental dismemberment benefits even if his longstanding diabetes substantially contributed to that loss?

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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?

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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