Disability Happens » Insurance http://www.disabilityhappens.com And the journey to heal begins... Wed, 07 Sep 2011 16:33:40 +0000 en hourly 1 http://wordpress.org/?v=3.3.1 How & Where to report VA abuse and fraud http://www.disabilityhappens.com/how-where-to-report-va-abuse-and-fraud.html http://www.disabilityhappens.com/how-where-to-report-va-abuse-and-fraud.html#comments Mon, 24 Mar 2008 11:11:02 +0000 Richard Brassaw http://www.disabilityhappens.com/how-where-to-report-va-abuse-and-fraud.html War veterans who suffer physical and emotion illness frequently suffer financial hardships due to their inability to find suitable employment. Veterans Affairs (VA) offers substantial medical services and benefits to those who have suffered a disability.

Unfortunately, the VA disability benefits can serve as an incentive to commit fraud and abuse. Psychiatric disabilities, like Post Traumatic Stress Disorder (PTSD), is one area that has seen a substantial increase of claims. One study of veterans seeking a PTSD disability claim found that 69% of those veterans scored higher for symptoms of malingering than the control group of non compensation seeking veterans on the Minnesota Multiphasic Personality Inventory-2 (MMPI-2).

Just because someone does not appear to have a disability does it mean their claim is fraudulent. Before acting on your instincts to report fraud it is best to find out why they are receiving those benefits. If you have ever thought that someone in a handicap parking space looks healthy, but later come to learn that they are waiting for a kidney transplant, you learn not to judge by appearances. Another example is someone who often experiences seizures.

Because PTSD is not a affliction that can be measured it is difficult to determine who is a malingerer and who legitimately suffers from the disorder. There are legitimate psychological and mental impairments for collecting disability.

Before reporting a fraudulent claimant you need to understand more about their exact disability and to become familiar with the conditions/symptoms of their disability. Once you are familiar with their diagnosis and the symptoms of their disorder, then you need to consider things that are incongruent between their behavior and their diagnosis. That in-congruency is something the VA wants to know about.

You can contact the Department of Veterans Affairs’ hotline at (800) 488-8244, between 8:30 am – 4:00 pm EST, Monday through Friday–excluding Federal holidays. Write the VA hotline at: VA Inspector General Hotline (53E), P.O. Box 50410, Washington, DC 20091-0410. Or contact them by email: vaoighotline@va.gov

The types of complaints the VA hotline accepts:

  • Employee misconduct.
  • Patient abuse.
  • Serious safety violations.
  • Theft from VA beneficiaries.
  • Theft or misuse of Government property.
  • False claims by beneficiaries, claimants, patients, employees, or contractors.
  • Systemic problems with VA programs or operations.
  • Gross waste of funds or official time.

The VA hotline will want to know:

  • The particular VA facility or office involved.
  • The identity of the wrongdoer(s) and victim(s).
  • The alleged legal or policy violation(s) or other misconduct.
  • The effect of the wrongdoing, such as dollars lost, delay produced, etc.
  • The date(s) when the event(s) occurred.
  • The identity of any witness(es) to the event(s).
  • Copies of relevant documents that support the allegation.
  • Whether anyone else has already reviewed the allegation.
  • An address and telephone number of a named complainant and whether the complainant wishes confidentiality.

The VA does NOT want to know about:

]]> http://www.disabilityhappens.com/how-where-to-report-va-abuse-and-fraud.html/feed 290 Rand suggest annual prescription drug licenses for consumers http://www.disabilityhappens.com/rand-suggest-annual-prescription-drug-licenses-for-consumers.html http://www.disabilityhappens.com/rand-suggest-annual-prescription-drug-licenses-for-consumers.html#comments Sun, 02 Mar 2008 11:07:45 +0000 Richard Brassaw http://www.disabilityhappens.com/rand-suggest-annual-prescription-drug-licenses-for-consumers.html Patients with chronic health conditions often require taking medications for extended time periods and the cost burden can prevent them from taking the needed prescription drug(s).

Researchers at the Rand Health, a division of Rand Corporation, suggest a “two-part-pricing” scheme for chronic health care patients. They base their proposal on how products outside the medical world are marketed, like Internet service, cable and satellite television, all you-can-eat buffets, and country club memberships. These are all examples of a pricing plan where consumers pay a set fee to cover a period of time with unlimited access to the service. This allows users to use as much–or little–as they need. Since 1998 prescription drug cost has risen 10%, twice the 5% rate increase experienced by all other health care costs.

Pharmaceuticals for chronic health conditions are similar to services that consumers license for a period of time (i.e. cable access) because there are few good substitutes and the license fees allow providers to reduce costs. For example a drug-licensing system might be used to pay for statin drugs (used to treat high cholesterol). Based on the current costs of the drugs researchers propose consumers pay a $195 annual license fee, which is equal to what most consumers pay out-of-pocket yearly for the drug.

What is significant is the shift from a monthly out-of-pocket payments by consumers would increase patients’ compliance for taking the drug. Currently, the annual compliance for patients using statins is estimated at 7.8 months annually. Researchers feel that with the new pricing plan that figure would increase to 9.8 months.

A compliance increase for prescribed medications among patients may result in fewer long-term health problems, which means lower overall costs to insurance providers–according to the study.

One objection of the proposed plan is that the up-front cost may discourage some patients from starting drugs, but researchers believe that could be overcome by allowing monthly payment plans.

]]> http://www.disabilityhappens.com/rand-suggest-annual-prescription-drug-licenses-for-consumers.html/feed 0 How you can unwittingly help disability insurance companies deny your claim http://www.disabilityhappens.com/how-you-can-unwittingly-help-disability-insurance-companies-deny-your-claim.html http://www.disabilityhappens.com/how-you-can-unwittingly-help-disability-insurance-companies-deny-your-claim.html#comments Wed, 17 Oct 2007 11:15:42 +0000 Richard Brassaw http://www.disabilityhappens.com/how-you-can-unwittingly-help-disability-insurance-companies-deny-your-claim.html You have probably seen surveillance footage of a fraudulent disability insurance claimant who claims to have a bad back, but is caught on camera lifting a heavy carton. What the cameras do not show is the legitimate disability claimant who is denied benefits by their insurance company.

Unless you know someone personally who has been denied disability benefits from an insurance company, you might harbor a suspicion that claim denial is generally because the insurance company suspects fraud. After all, you never hear about the insurance company committing fraud on its own clients. However, voluminous court cases will attest that insurance companies are notorious for denying disability insurance. This is especially true when the claimant makes over $50,000 a year.

The reason you seldom, if ever, hear about insurance companies committing this type of fraud is commonly for one of 3 reasons.

  1. The claimant is broke and trying to keep food in their belly and a roof over their head. Dealing with both the financial cost and physical pain of their disability leaves little time, or energy, to fight the insurance companies.
  2. Less than 6% of the people who have been denied their disability benefits will sue the insurance company. This might be due to the fact that the insurance companies have successfully lobbied many states to change their laws to favor the insurance companies.
  3. Insurance companies have been known to offer a claimant a partial settlement, along with a warning, that if the claimant does sue (and is successful) it will be years before they see any money. For example, if they have a policy worth a half-million they might be offered $50,000 to settle now or wait for whatever money the suit will bring. The insurance companies have lobbied for laws that restrict any awards to the face value of the policy. All settlement payments are given with the stipulation that a non-disclosure form be signed. That is why you never hear about this type of settlement.

A new wrinkle has surfaced in how insurance companies are taking the spotlight off of themselves for denial and have shifted it to a new group called Certified Rehabilitation Counselors (CRC).  The Commission on Rehabilitation Counselor Certification (CRCC) certifies and sets standards for rehabilitation counseling in the United States and Canada. It is an non-profit organization with over 35,000 members.

When you file a disability claim one of the first things that will be requested by the insurance company is a list of skills required to do your job. What is not explained to you is that if you can do any one of those skills, that you have listed, you can be denied disability benefits.

The analysis of what marketable skills you have is often performed by a CRC member. It is their job to report to the insurance company if you can be employed with the skill set that remains available to you. It appears that the insurance companies are applying pressure to CRC members to help them in their denial of disability claims. At least that is indicated in a recent survey of 7,660 members.

The CRCC survey queried members about their perceptions of ethical dilemmas and implications for code of ethics revisions. At the top of the list, members were most concerned about being pressured by their employer, followed by confidentiality and exceptions to confidentiality. When members were asked about what concerns they foresee in the future they responded that their concerns for the future are the same as they are today–employer pressures and issues regarding confidentiality.

Some interpret the CRCC survey as further proof that the insurance companies are creating a firewall to burn their claimants. The insurance companies have taken the spotlight off themselves and shifted the attention to the certified rehabilitation counselors. A site that is pursuing this line of activity is The TSA Scam.

]]> http://www.disabilityhappens.com/how-you-can-unwittingly-help-disability-insurance-companies-deny-your-claim.html/feed 4 “bad faith” – the documentary http://www.disabilityhappens.com/bad-faith-the-documentary.html http://www.disabilityhappens.com/bad-faith-the-documentary.html#comments Thu, 27 Sep 2007 12:23:39 +0000 Richard Brassaw http://www.disabilityhappens.com/bad-faith-the-documentary.html Long-Term Disability (LTD) seems like a good idea. After all, 1 out of 3 U.S. workers will require some form of supplemental disability income during their lifetime. Since most workers can only survive 3 months out of work, it makes LTD insurance sound better all the time. At least that is what the insurance companies want you to believe.

The documentary, “bad faith” tells the story of people who had paid for their LTD insurance for years, but found that when they became disabled, the insurance company would pay for a year or two only before denying their claim. These are people with serious health problems and not the kind of subjective problems that you sometimes hear about when a fraudulent claimant is caught in the act. These are objective medical issues that show up on x-rays. Things that cannot be faked.

According to a former insurance claims investigator, the insurance companies work under the premise that 90% of all claims are fraudulent.  In reality, it is approximately 10% of claims which are fraudulent.  A former litigator, who himself filed a LTD claim, says that it doesn’t matter to the insurance company whether the claim is legitimate or not.  The insurance companies know that it is a numbers game and when claims are denied, there are a certain number of people who will just give up–and that adds to their bottom line.

Part of the insurance game, in denying claims, is to hire minimally educated, aggressive, and fiercely loyal claims adjustors. It is part of the process because they know if they continually deny, the claimant will become more financially desperate and settle for far less than they are entitled.

It really doesn’t matter what your doctors say or what MRIs, or XRAYS, or surgical reports reveal. The only thing that is important to the claims adjuster is keeping his or her job and that means saving the company money. Translation: deny, deny, and deny.

The director of “bad faith,” Barbara Donahue,  feels strongly about the subject of how insurance companies deny legitimate LTD claims, and to show her commitment she has distributed a copy of “bad faith” to every Governor and state Attorney General in the U.S..

During October, Donahue will be visiting Washington to distribute a copy of “bad faith” to every Senator and Representative. One of her goals is to have the McCarran-Ferguson Act repealed. It was a law Congress passed in 1945 that prohibited the Federal government from overseeing insurance policies. Yes, you read that right–the Federal government is not allowed to have a say in the regulations of insurance policies.

You may want to contact your state Senators and Representatives in Washington about the McCarran-Ferguson Act and let them know you want it appealed.

If you are one of the countless individuals who had LTD and were denied benefits, after an injury, please take a moment to share your story. It is important that you are heard because you are not alone. Hopefully, with a collective voice Washington will repeal the McCarran-Ferguson Act and stop the insurance companies’ abusive acts.

]]> http://www.disabilityhappens.com/bad-faith-the-documentary.html/feed 0 PTSD symptoms sometimes appears months and years later http://www.disabilityhappens.com/ptsd-symptoms-sometimes-appears-months-and-years-later.html http://www.disabilityhappens.com/ptsd-symptoms-sometimes-appears-months-and-years-later.html#comments Tue, 04 Sep 2007 09:32:06 +0000 Richard Brassaw http://www.disabilityhappens.com/ptsd-symptoms-sometimes-appears-months-and-years-later.html The International Herald Tribune, has an article on how post-traumatic-stress-disorder (PTSD) sometimes manifest years and decades after a traumatic event. For example, some World War II and Korean War veterans did not show symptoms of PTSD for 30-years.

As the Center for Disease Control (CDC) states PTSD can be very difficult to diagnose, which may be part of the reason why symptoms are sometimes undetected and able to brew over time.

What is at stake is that the VA is not prepared to handle delayed symptomatic cases of PTSD. The VA is currently overwhelmed with the PTSD cases of PTSD of veterans that served in Iraq, Afghanistan, Gulf War, and Vietnam. If additional doctors are not hired to assist the expected increase of the delayed symptomatic cases of PTSD a lot of veterans will suffer broken homes, lost jobs, substance abuse, and homelessness.

]]> http://www.disabilityhappens.com/ptsd-symptoms-sometimes-appears-months-and-years-later.html/feed 0 Military denies benefits based on genetics http://www.disabilityhappens.com/military-denies-benefits-based-on-genetics.html http://www.disabilityhappens.com/military-denies-benefits-based-on-genetics.html#comments Wed, 22 Aug 2007 09:59:07 +0000 Richard Brassaw http://www.disabilityhappens.com/military-denies-benefits-based-on-genetics.html Karen Kaplan’s August 18, Los Angeles Times article, U.S. military practices genetic discrimination in denying benefits, tells how the U.S. Military denies disability benefits to both active and veteran military personnel.

The problem began in 1999, when the Office of Management and Budget (OMB) decided that soldiers with a genetic predisposition for a disease will be denied benefits for that disease until they have served for a minimum of 8-years. The reasoning proffered is to discourage individuals with a probability of developing a congenital and/or hereditary condition from joining the services in order to receive medical and disability benefits when (and if) the disease develops.

Although someone might have a predisposition for an illness it is not always caused by genetic factors. For example, there is a genetic mutation carried in about 5% of Caucasians for developing blood clots, but individuals outside that genetic group can also develop blood clots in their legs (thrombophlebitis) after sitting for long periods. That is the main reason physicians recommend that you get up and stretch during long plane flights.

The situation has become so treacherous that some Army physicians recommend that soldiers refuse any and all genetic tests. In case the soldier thinks that he can by-pass the system by having a genetic test done through a civilian physician, they could easily find themselves in serious trouble. Turns out that a private genetic test violates military code and they could be court-martialed.

]]> http://www.disabilityhappens.com/military-denies-benefits-based-on-genetics.html/feed 0 Forgotten veterans of ward 71 http://www.disabilityhappens.com/forgotten-veterans-of-ward-71.html http://www.disabilityhappens.com/forgotten-veterans-of-ward-71.html#comments Thu, 09 Aug 2007 09:05:00 +0000 Richard Brassaw http://www.disabilityhappens.com/forgotten-veterans-of-ward-71.html On the 7th floor of the Walter Reed Hospital is Ward 71, the oncology unit. When politicians come to visit wounded Iraq soldiers, they go to the 3rd floor where they can get publicity shots with amputee soldiers. “No one even knows we’re on the oncology ward,” says Sergeant Valentin.

This past July, Iraq’s environment minister claimed that 140,000 new cancer cases are clustered in 350 known bombing locations, where depleted uranium (DU) weapons were used. Many Iraq veterans who have developed cancer suspect that the DU areas, the result of the “Shock and Awe” bombings, are directly related to their developing cancer. Others suggest that possibly Saddam Hussein’s chemical weapons were more advanced than previously thought. Some wonder if the smoke from the burning oil wells may have contributed to their cancer. What they do know is that, in most cases, it is a rare form of cancer.

What is particularly troubling to veterans fighting cancer is that if they had lost a limb they would qualify for Traumatic Service-Members Group Life Insurance injury benefits. Unfortunately, cancer is considered a disease and not a war wound so they do not qualify for the disability benefits as if they had suffered a ‘traditional’ war wound.

Since the beginning of the era of the modern war veterans have developed non-traditional battle disabilities. Vietnam War veterans suffered long-term effects from a defoliant that is now referred to as the “Agent Orange Syndrome”. The Persian Gulf conflict caused a rise in immune disorders and cancers that have been given the broad label, “Gulf War Syndrome”. What these latest bouts of cancer, that returning Iraq soldiers suffer, will become known as is anyone’s guess.

The number of Iraq veterans that have developed cancer is publicly unknown. The Veterans Administration refuses to provide the number of Iraq soldiers who have developed cancer and what type of cancers are involved.

]]> http://www.disabilityhappens.com/forgotten-veterans-of-ward-71.html/feed 1 What is new in Veterans disability benefits? http://www.disabilityhappens.com/what-is-new-in-veterans-disability-benefits.html http://www.disabilityhappens.com/what-is-new-in-veterans-disability-benefits.html#comments Sun, 29 Jul 2007 05:34:20 +0000 Richard Brassaw http://www.disabilityhappens.com/what-new-in-veterans-disability-benefits.html The U.S. Government Accountability Office (GAO) provides the most recent reports and testimonies related to military and veteran’s health care and disability benefits issued since March 2003. Currently there are 28 items listed related to veterans disability benefits.

]]> http://www.disabilityhappens.com/what-is-new-in-veterans-disability-benefits.html/feed 0 Bad faith insurance companies http://www.disabilityhappens.com/bad-faith-insurance-companies.html http://www.disabilityhappens.com/bad-faith-insurance-companies.html#comments Thu, 26 Jul 2007 06:53:28 +0000 Richard Brassaw http://www.disabilityhappens.com/bad-faith-insurance-companies.html Fight Bad-faith Insurance Companies (FBIC) is an excellent site on getting the low-down on your insurance company. In previous posts it has been mentioned that there are no Federal or State laws that specifically regulate insurance policies. Sure, there are rules and regulations on how insurance companies conduct business, but when it comes to how policies should be written or enforced there are NO LAWS.

The worst insurance policy to have is a long-term disability (LTD) policy that falls under the guidelines of Employee Retirement Income Security Act (ERISA). If you make a claim on an ERISA covered LTD policy and have been denied benefits, you will be unlikely to find an attorney to pursue the matter. The major obstacles to finding an attorney to handle your lawsuit are that you must sue in Federal court, you are unable to collect attorney fees if you do prevail, and punitive damages cannot be awarded.

You will not have much luck with your state’s Department of Insurance (DOI) either. Of all the state DOI’s, California is probably the most effective one, and even it is powerless when it comes to a LTD policy covered by ERISA. In fact, no state regulates ERISA insurance policies. The state DOI’s only regulate how the insurance company conducts business in the state—not the policy itself.

What surprises most people is that no state will sue an insurance company on behalf of a policy holder. A state DOI will levy fines against an insurance company for fraud and criminal behavior, but even those fines are relatively rare.

]]> http://www.disabilityhappens.com/bad-faith-insurance-companies.html/feed 2 Veterans file class action against Department of Veterans Affairs http://www.disabilityhappens.com/veterans-file-class-action-against-department-of-veterans-affairs.html http://www.disabilityhappens.com/veterans-file-class-action-against-department-of-veterans-affairs.html#comments Wed, 25 Jul 2007 00:13:36 +0000 Richard Brassaw http://www.disabilityhappens.com/veterans-file-class-action-against-department-of-veterans-affairs.html Veterans Adminstration (VA) Secretary Jim Nicholson has been accused by injured Iraq war veterans of denying them benefits. The class action suit was filed on behalf of hundreds of thousands of veterans. Attorneys filing the class action said that the objective is not monetary. What they want is for the VA to provide the mental and physical disability benefits and treatments the veterans are already entitled to receive.

The complaint in part reads: “Unless systemic and drastic measures are instituted immediately, the costs to these [Iraq] veterans, their families, and our nation will be incalculable, including broken families, a new generation of unemployed and homeless veterans, increase in drug abuse and alcoholism, and crushing burdens on the health care delivery system.”

Earlier this month the 9th Circuit Federal Court in San Francisco issued a strong rebuke directed at the VA. The VA was ordered to provide retroactive benefits to Vietnam War veterans who were exposed to Agent Orange and contracted a form of leukemia.

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