This article is featured on page 26 of the September 2012 SOA Long Term Care Newsletter. Other articles in this issue include:

The Future of Genetic Testing is Now
Aspirin, Not Morphine
LTC Dashboard - Key Accessory to High-Octane Performance
Opinions and a Conversation on LTC Financing
Independent Providers: A Long-Term Care Insurance Conundrum
AGGIR, the Work of Grids
Thoughts of a Landscaper

Just under half (47%) of new critical illness insurance claims in 2011 began prior to age 55 according to the 2012 Buyer & Claimant Study conducted by the American Association for Critical Illness Insurance (AACII) and General Re Life Corporation.

Claims have become the next battleground for winning and retaining customers, and insurers are exploring new ways to apply people, process and technology to create a superior customer experience

For several years now, claims professionals have looked across at their underwriting neighbors with a tinge of envy – while they struggle on with piles of paper and processes heavily dependent on manual input, many of those lucky underwriters get to play with sophisticated workflow and imaging systems, rules engines, tele-interviewing and a growing host of facilities that the claims folk can only dream of.

New report examines how insurers can employ data from social media sites in claims and underwriting.

Personal health, life, and P&C insurers face myriad claims challenges, and many are using technology to overcome them.

It’s not the first time that insurers and consumer groups have battled it out, but the recent face-off over PPACA’s provision allowing consumers to appeal coverage denials looks to be a big one.

Despite the increase, the Council for Disability Awareness says there's little evidence the recession has broadly impacted the number of claims.

A life insurance agent wrote a $25,000 life insurance policy on a nine-month-old infant. In applying for coverage, the parents responded “No” to the following question:

Has any person proposed for insurance consulted or been seen by a physician, psychiatrist or medically licensed practitioner in the last five years, or has any such person ever been declined for life insurance or offered a policy with an extra premium charge?

Three months into the policy, the infant passed away. Upon investigation of the claim, the insurer discovered that the child had been confirmed as having a terminal condition within days of the application being submitted for coverage. The parents had been advised of the probability of their child’s condition on February 22, and received test results confirming the diagnosis on March 3. They then applied for life insurance on the child on March 8. When the claim was tendered later that year, the life insurer denied the claim due to the material misrepresentation on the application.

Much has been published in the mainstream media about the fact that disability income insurance claims have increased dramatically over the last several years, along with a disproportionate number of inappropriate claims denials. And the claims departments of many insurance companies have been told to “tighten-up.” Claims that would have once been routinely paid are now being denied due to industry trends, misunderstandings, lack of consumer knowledge, inability to contest, and lower returns on investment.

It's no surprise when health insurers deny a claim or pay only for a certain "reasonable" amount.

It has become a way of life. But we should expect health insurers to process our claims properly and accurately.

In reality, one in five medical claims are processed inaccurately by health insurers, according to the 2010 National Health Insurer Report Card by the American Medical Association.

Cancer and complications from pregnancy were the top causes of long term disability claims filed with Unum Group Corp. in 2009.

The popularity of the multiple CSI television shows and similar real-life (and death) cable programs have raised the public's awareness of forensic science. Insurance companies have also noticed and forensic claim investigations are becoming a normal part of the business, especially in the area of AD&D claims where it is important to determine if a death was accidental according to the terms of the policy.

It seems that everyone is interested or at least has heard of Facebook, Twitter, My Space and other social networking sites. Undoubtedly, they are becoming more and more populari and bringing the world in which we live closer together. These new networks provide an overabundance of possibilities to keep "friends" (real or virtual) informed of our daily status, our activities and even our whereabouts should we chose to do so. This level of sharing has led to the creation of an electronic evidence trail of a user's thoughts and activities including photos as created and recorded by the user. Insurance companies have caught on and have started to "surf" the web to gather information with respect to claimants as part of the claims adjudication process. Telephone interviews and video surveillance do not seem to be enough anymore.

It's a fact that disability income insurance (DI) claims have increased dramatically over the last several years, along with a disproportionate number of inappropriate denials. The claims departments of too many insurance companies have been told to "tighten-up." Claims that once would have been routinely paid are now being denied due to industry trends, contractual misunderstandings and consumer lack of knowledge and inability to contest.

Rising unemployment rates could lead to an increase in morbidity and mortality rates even for workers who keep their jobs.

Explores the difficulties in analysing and handling Child CI claims and look at how providers generally manage their risks via benefit design.

Presentation at the SOA Annual Meeting & Exhibit, October 2008.