Timeliness

Claim application - Claims are filed on or after the benefit begin date, as often as 30% of the time for STD claims.

Contact with the claimant - The claimant is not contacted prior to benefit begin date. Claimant contact occurred prior to benefit begin date only 14% of the time. Claimant was contacted regarding test change prior to the test change only 22% of the time. In a recent 100 LTD claim example, 62% of the cases had no telephone contact prior to the initial approval of the claim.

Decisions - Approval letters are sent after the benefit begin date. On average, approval letters are sent out after the benefit begin dates over 50% of the time. 78% of test change decisions are made and communicated after the test change date as well.

First Real Claim Activity - Especially for LTD, there is little claim activity until after the benefit begin date. Nearly 40% of LTD claims - in a recent review performed involving 100 LTD claims, the first real claim management activity occurred more than 30 days after the benefit begin date 36% of the time.

The reasons for not paying attention to the day-to-day? Who knows for sure but we suspect it's some combination of budgets, shortage of expertise and training, lost focus, conflicting or opposing philosophies, a "widget" mentality ("Hey John, I'm on target with my diaries! I made 65 diary changes today") target performance metrics (incentives based on diary changes?), inability to collect and analyze data and/or, the sales and marketing message has become more important than the discipline.