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

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.

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.

Committee Members Share COVID-19 Challenges in New Survey.

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.” 

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

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

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……

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?

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.

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.

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.

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

Pandemic and Significant Insurance Decisions in Massachusetts

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

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

A new survey from the Life & Annuity Committee is now available online.

A new survey from the Life & Annuity Committee is now available online.

Generally, a non-resident defendant may remove a case filed in state court if the plaintiff could have originally filed the same case in federal court.  Removal of a lawsuit based upon state law claims, such as a dispute regarding benefits under an insurance policy not governed by ERISA,  requires diversity jurisdiction.  The United States Code vests the federal district courts with diversity jurisdiction over all civil actions where the amount in controversy exceeds $75,000 and the action arises between citizens of different states.  The United States Code further provides that a resident defendant may not remove an action if it is a citizen of the State in which such action is brought.  Diversity jurisdiction, therefore, requires complete diversity; every plaintiff must be diverse from every defendant and no defendant may be a citizen of the state where the action is brought.  Accordingly, a plaintiffs’ attorney determined to avoid federal court could falsely accuse a resident bystander, innocent of any wrongdoing, to prevent complete diversity. This is a practice known as fraudulent joinder.

Three new survey from the Life & Annuity Committee are now available online.  Topics include children’s term riders, staffing, and privacy policies.