The Problem

• The skills and methodologies necessary to evaluate disability are fundamentally different than the skills and methodologies needed to assess death claims.
• Responsibility for Life Premium Waiver and Waiver of Specified Amount Rider claims management typically resides with the Life insurance claim department.
  • Each premium waiver claim must be evaluated based upon the claimant’s unique medical impairment in terms of how it impacts the claimant’s ability to perform his/her occupation.
  • Disability is rarely static.
• Life insurance claim departments are usually not equipped with the specialized experience and clinical, investigative and occupational resources necessary to accurately adjudicate disability benefit eligibility and anticipate the potential recovery and return-to-work of disabled claimants.
• Changes in the policy definition of disability are often ignored or improperly applied.
• Premium Waiver and Waiver of Specified Amount Rider Claims are long duration benefits (To Age 65 or Lifetime) and can have large reserve liabilities.

DMS’ Enhanced Disability Management Program for Life Premium Waiver

Objectives:

• Improve the accuracy of life premium waiver benefit eligibility determinations
• Provide timely, clear and proactive communication throughout the claim process
• Maintain cost efficiency

Services:

• Enhance claimant and attending physician forms to facilitate the collection of better information
• Efficient utilization of expert medical and vocational resources
• Timely re-evaluation of benefit eligibility when definition of disability changes
• Timely re-evaluation of non-static claims

DMS’ Life Premium Waiver Pilot Program