Another Reason Why Bernie Has Resonance
Today I had a client consult me on a call he received from the police. His private disability provider reported him for insurance fraud. He had suffered a pretty horrific accident on a snowmobile that left him with some serious back and digestive track impairments. The issue was not that he had those conditions but his level of activity while trying to see if he could return to work. He lasted about a month. He couldn't. The insurance company would film him going to work and leaving. They didn't film him when he had to take breaks.
Another client came in today after PEHP denied his claim for disability benefits. He has the most compelling case I have ever seen for benefits. PEHP (Utah's Public Employee's Health Plan) has the very worst system for a fair hearing. He has severe arthritis, has had both knees, shoulders and hips replaced. He has had his ankles fused and needs back surgery. He's 48 and has worked in heavy jobs his whole life. He has the body of a 75 year old. Usually joint replacements can restore function but with severe arthritis its just a stop gap measure.
Now, I know individuals commit insurance fraud. I know sometimes people have more functionality than they think. But how many insurance company executives, insurance doctors or insurance adjusters are criminally charged for intentionally lying about a file, or intentionally losing documents to hide dishonest practices or maliciously stretching the limits of medical science to deny a claim?
Probably 0. Does it happen? Yes. Do you care? Probably not, but you should. It works both ways. Both parties should be held accountable and have an equal ability to prove their case. You will care when it happens to you and the longer the inequity lasts they more likely it will affect you or someone you love.
Loren M. Lambert, March 29, 2016 ©
Today I had a client consult me on a call he received from the police. His private disability provider reported him for insurance fraud. He had suffered a pretty horrific accident on a snowmobile that left him with some serious back and digestive track impairments. The issue was not that he had those conditions but his level of activity while trying to see if he could return to work. He lasted about a month. He couldn't. The insurance company would film him going to work and leaving. They didn't film him when he had to take breaks.
Another client came in today after PEHP denied his claim for disability benefits. He has the most compelling case I have ever seen for benefits. PEHP (Utah's Public Employee's Health Plan) has the very worst system for a fair hearing. He has severe arthritis, has had both knees, shoulders and hips replaced. He has had his ankles fused and needs back surgery. He's 48 and has worked in heavy jobs his whole life. He has the body of a 75 year old. Usually joint replacements can restore function but with severe arthritis its just a stop gap measure.
Now, I know individuals commit insurance fraud. I know sometimes people have more functionality than they think. But how many insurance company executives, insurance doctors or insurance adjusters are criminally charged for intentionally lying about a file, or intentionally losing documents to hide dishonest practices or maliciously stretching the limits of medical science to deny a claim?
Probably 0. Does it happen? Yes. Do you care? Probably not, but you should. It works both ways. Both parties should be held accountable and have an equal ability to prove their case. You will care when it happens to you and the longer the inequity lasts they more likely it will affect you or someone you love.
Loren M. Lambert, March 29, 2016 ©
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