Unum, the nation’s leading disability insurance carrier for the past 34 years, has built a unique approach to claims handling to ensure that every claim decision is treated with equal thoroughness, fairness and objectivity. The emphasis is on the three Ps – people, processes and protection.

“A claim decision, particularly on long-term disability, is analogous to a major medical event,” says Diane Garofalo, Unum’s senior vice president of disability benefits. “Oftentimes, people’s livelihoods are at stake.”

Producers may assume there isn’t any distinction in long-term disability claim processes from one carrier to the next, and that people who file claims experience essentially the same kind of decision-making. But Unum’s focus on people, process and protection means the carrier is able to gather appropriate information to more effectively manage each claim.

Unum’s 2009 claims-related complaint ratio is the lowest among the carrier’s primary competitors, and well below the industry average, according to data from the National Association of Insurance Commissioners.

And over the past five years, Unum has reduced its disability claim caseloads to among the lowest in the industry so the company’s disability benefit specialists can focus on building relationships and a sense of trust with each person whose claim they manage.

“When you’re talking about what distinguishes the ways disability carriers handle claims, it’s not about the words in the insurance contract; it’s about how the provider follows through,” Garofalo says. “Just because another disability carrier has the same words in their contract doesn’t mean you’re buying the same thing. It’s all in the execution.”

Connecting with customers

Processes are at the heart of claims handling, but processes are only as good as the people behind them. Every disability benefit specialist Unum hires is required to take two months of classroom training, and then has a formal mentor relationship with an experienced claims specialist for at least a year, along with ongoing incumbent training.

Specialists also receive training to help them have more supportive interactions with customers, as well as gather more accurate and comprehensive information. And an open-file review process ensures disability benefit specialists are judged on the quality of their work – not on decisions to accept or deny claims.

A claims-management team of clinicians, nurses, vocational consultants, Social Security Disability Income experts, lawyers and accountants supports Unum’s claims specialists to cover all aspects of a claim, including the contractual, vocational and medical areas.

In addition, front-line managers at Unum have only six claim specialists reporting to them so that they can be responsible for their team’s professional development and quality of claims handling. They’re also involved in the management of a block of claims, with on average more than 10 years of hands-on claims management experience.

Independent industry research from JHA in 2009 found that Unum exceeds the industry average in 20 of 24 claims handling performance categories. And 98% of Unum customers said they are likely to recommend the carrier to others, according to a fall 2009 employer survey conducted by Harris Interactive.

Second opinions

Another major distinguishing feature of Unum’s approach is the second opinion medical process, Garofalo reports. Two physicians are required to review the facts of the claim when it appears that an employee’s medical diagnosis does not restrict their ability to work. One other physician is required to review a medically based claim decision that is appealed. In 2009, just 1% of all Unum disability claims closed were appealed.

In addition to having the benefit of multiple opinions through each step of the decision-making process, people who file claims with Unum have the right to request an independent medical exam conducted by a doctor who’s not affiliated with the company if there is disagreement on a claims decision.

Each month, an internal audit function that operates independent of the benefits organization reviews 10% to 12% of decisions in which claims have been closed. These results, along with complaints and litigation, are reported on a quarterly basis to Unum’s Regulatory Compliance Committee established by the Board of Directors.

There’s also an external, anonymous ethics hotline that company staffers can call if they’re ever uncomfortable with the decisions they’re being asked to make.

“One of the biggest challenges in the disability business,” Garofalo observes, “is the fact that in the end you need to make a reasoned decision about whether someone is disabled or not. We realize how much work needs to be put into processes and controls in order to assure that hundreds of people are making consistent decisions.”

“It is important to get it right all the time.”

To learn more about benefits products and services from Unum, contact your local Unum field office.

http://www.unum.com