Lawsuits Claim Insurers Are Choking Social Security With Unnecessary Disability Applications

Two whistleblower lawsuits have been filed recently against insurers, faulting them for requiring unnecessary and repeated disability applications with Social Security before they’ll pay out any benefits. One person says her disability insurer, the Unum Group—which was only paying her $50 a month for a temporary injury she was almost certain to recover from—called her 10 times to ask her about her Social Security disability application. The woman told the New York Times “she did not need or want money from Social Security, and did not think she was entitled to it. Her doctors had told her she would recover, and Social Security is limited to people whose disabilities are total and permanent.”

Even if you are rejected by Social Security, you can apply for benefits again and again, which is what both lawsuits claim insurers are taking advantage of to avoid paying benefits. The suits cite the federal False Claims Act and contend “that the insurers were knowingly committing fraud.”

The insurers have claimed this is just business as usual and it’s their policy to require everyone to apply—a Cigna spokesperson disingenuously says, “Our goal is to ensure that each member receives all of the benefits to which he or she is entitled.” But a former Gigna employee who’s now a plaintiff in one of the suits says insurers abuse the practice by routing everyone to Social Security even when it’s obvious they’ll never qualify.

Forcing people who are injured to apply for Social Security before paying their claims appears to bolster insurers’ profits in several ways. If claimants refuse to apply, the insurers can simply stop paying their benefits, said Dawn Barrett, an employee of the Cigna Corporation, who grew frustrated sending people to Social Security and who is now a plaintiff in one of the lawsuits. More typically, she said, people apply for Social Security when an insurer tells them to. That allows the insurer to reduce its claim reserves, money that is kept in conservative investments for benefit payments. And in the insurance industry, smaller reserves mean bigger profits.

Check out the article for another story of a woman who has been forced to apply for disability three times in order to keep receiving her insurance benefits, even though it’s self-evident her injury isn’t permanent or life-threatening. According to a former Social Security administration, each time she has to re-apply for disability, it costs the administration an average of $1,180.

“Insurers Faulted as Overloading Social Security” [New York Times]

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  1. YoHenYo says:

    I work at a customer service desk at Stop and Shop. A woman came in to pick up money, from her baby’s daddy, and was stating to one of her ghetto friends how she was “disabled” and was fine but was enjoying not working.

    I wanted to slap her in the face for draining the system. It makes me sick when people take advantage of government programs designed to help people who are in genuine need.

  2. DrGirlfriend says:

    Insurance companies will hold up your claim for any reason they can think of, including ones they make up. For example, they will receive a bill from your provider, then decide that they simply cannot pay until they find out if you are covered by any other insurance. They have no basis for thinking that you might be, they just, ya know, want to know. So they send you a letter, and that’s it. They don’t pursue it aggressively, they just suspend all payments on your claims until you call them back to say, no, I don’t have any other insurance. Lots of times no one has any clue this has happened until the provider gets a denial letter.

    In other Cigna news, they just bought out another insurance company called Great West. As of 4/1/08 Cigna is administering their claims.

  3. ecwis says:

    @YoHenYo: Social Security Disability Insurance is notorious for abuse, one of the many problems with the current Social Security system…

  4. snoop-blog says:

    @YoHenYo: i can’t stand how they give it to you for being too obese. how retarded is that?

  5. bohemian says:

    There is currently a 2-4 year lag for people with qualified disabilities. That means people that really can not work and have permanent disabilities are being denied the benefit they earned through working for 2-4 years.

    Social Security has been pat rejecting huge volumes of claims without even really looking at them in recent years because they are so overwhelmed right now. So now finding out part of that overload of the system that is dragging out the process for years is because of private insurance companies is a bit much.

    This isn’t the first time Unum has been in trouble with the feds. Instead of shutting them down years ago they slapped their hands and put them on monitoring for a set number of years.

  6. bohemian says:

    From the article
    “The flood of referrals, however, is making it hard for Social Security to respond to people who are truly disabled, said Kenneth D. Nibali, the former top administrator of the Social Security disability program.

    “Anybody who is forced to come into this system, and who doesn’t need to be there, is affecting someone else,” said Mr. Nibali, who retired in 2002 and is serving as an expert witness for the plaintiffs. “They’re holding up cases for the people who have been waiting for months and years, who in many cases are much worse off.””

    Excuse me I need to go scream now. What a waste of govt. money.

  7. @snoop-blog: hahaa…obviously, seeing as there is a genetic component to weight gain, people are totally helpless and there is no way not to get obese.

  8. ConsumptionJunkie says:

    SSI is NOT for people whose injuries are “total and permanent.” It is for people whose disabilities are expected to last for more than one year.

  9. howie_in_az says:

    @YoHenYo: Do what I do and make that person qualify for benefits. I find a quick blow to the knees with a handy wrench or something similar usually results in Social Security benefits.

    You have the added benefit of stimulating the economy: said person will have to go to the hospital and see a specialist, and that specialist will go out and buy something based on their salary.

    It’s really a win-win situation for all parties involved.

  10. snoop-blog says:

    @new and troubling questions: i’m sick of people blaming everything on genetics. science sux! besides i don’t believe it to be a hardcore fact. if they could physically show me the “gene” that they inherited that makes them fat, then why don’t they just start the ssi off right off the bat? is it because there’s a chance it might not effect them?

  11. ChuckECheese says:

    @snoop-blog: “if they could physically show me the “gene” that they inherited…”

    Should be easy to find–it would be a big gene, right? My withdrawal from psych began when people began blaming (so-called) psychological problems on genes. I say we return to humours and devils.

  12. nequam says:

    @snoop-blog: In other words …

    Don’t be blamin’ fat genes for your fat jeans!

  13. @snoop-blog: It’s true…there are genetic predispositions, yes, but it isn’t exactly one’s “fate” to be obese, so to speak. This, somehow, confuses the crap out of people (and for others, it’s a really awesome excuse…”my genes made me do it”)

  14. nequam says:

    @new and troubling questions: Exactly … genes are not Calvinist.

    Assuming there are fat genes, then (1) not every person with the gene gets fat; (2) not every person who is fat has the gene. If you are fat and have the gene, there may be a correlation.

  15. TechnoDestructo says:

    I really, seriously, non-jokingly, honestly believe that things like this should be capital crimes.

  16. mizmoose says:

    The disability insurance companies are a joke. I still have the letter from {a different carrier that my former employer used} that rejected my *appeal* for denial of claim because “you already had a hip replacement in 1997″. My illness had nothing to do with my hips, and as far as I know, both of my hips are original model.

  17. ced91071 says:

    @YoHenYo: wow, your reeks of ??????????

  18. glater says:

    I know at least one hospital locally that does something similar – I’m uninsured and was life-threateningly ill, and ended up in hospital. The financial aide department asked me how I would be paying; I was told they had a financial aide program after telling them I was uninsured… However, this program demanded that I apply for Medi-Cal (California Medicaid). I explained to them over and over, and even showed them on the documents that THEY handed me, that I did not qualify – i.e. I’m clearly over 18, under 65, not disabled, a pregnant female nor a “qualified resident alien” or similar as listed on the front page of the big glossy 8.5×11 brochures that they kept handing me. I’m just a poor white natural citizen male with a crappy job, and acutely ill. I finally agreed to apply, was denied after several months of beaurocratic waiting and threatening letters (wasting everybody’s time and energy), and they eventually wrote me off for a large sum of money. Go figure.

  19. NoWin says:

    @glater: …your experience “is” their financial aide program. (I’ve seen it done that way before with my area hospitals)

  20. johnva says:

    @nequam: In some cases, genes ARE “Calvinist”. If you’ve got a genetic disease, then you may well be fated to get that, regardless of what you do. I’ve got one, and I absolutely would have gotten it regardless of lifestyle.

    That being said, I do not believe getting fat is a genetic disease that people are fated to get (though I guess that’s possible in some small number of cases). I do believe that some people are genetically predisposed to get fatter than others given the exact same lifestyle and eating habits. But that just means they need to work harder than other people at avoiding obesity. Life’s not fair.

  21. AustinTXProgrammer says:

    @ConsumptionJunkie: SSI Has very strict income guidelines and comes secondary to any other income, unlike Social Security Disability which is an “entitlement” without any income guidelines (it pays based on qualified earnings).

    Insurance companies won’t benefit from having customers file for SSI.

  22. jw6828 says:

    I work for the SSA Office of Disability Hearings and Appeals.

    In addition to insurance companies causing part of our backlog, many people who are obese apply because they are too fat to work. Many who have breathing problems apply because they can’t breath but they continue to smoke cigarettes. Drug addiction of some cause them to apply. Many are in prison for different reasons and want the SSA to pay them. I believe this country is in need of some changes. Why do drug addictions, obese, and smoking problems that are caused by the ignorant or stupid people qualify for benefits? Others who are really in need of help after working and paying into the system for years, trying to take care of themselves must wait up to 16 – 24 months just for the hearing with a Judge. The legal system needs a make over. We have too many rules and too many Judges who look at the rules in different ways. I say, make a law that says, if you provide disability insurance, you CAN NOT get SSA help and they must pay as they promised when you signed up!

  23. Mr. Gunn says:

    new and troubling questions: If only science could uncover the genes involved in detecting sarcasm, right?