Disability Insurance Blog

Disability Claims for Behavioral Health/Mental Nervous Claims Be Warned About New Entity

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Friday, September 4th, 2020

PDA – A well-known third-party vendor, pandering to the disability insurance community, has launched another way to further impact claimants negatively.  A recent press release from PDA – a subsidiary of The Advocator Group and Brown and Brown Inc.— announced the launch of a behavioral health claim management service, which it touts as an offering to its clientele (the disability insurance community), “to assist disability insurance carriers with improving the decision making, duration management, resource utilization, and return to work outcomes” for claims.

This marketing is a transparent pandering to insurance companies that they will deliver results to the insurance companies to support the denial and termination of claims.  The terms used “improving the decision making” and improving “return to work outcomes” are clear indications of providing support to deny and terminate claims.

This unabashed pandering should make this entity a clear no-use entity for ALL insurance companies who are seeking to treat claimants fairly.  Unfortunately, entities such as PDA have a symbiotic relationship with disability insurance companies.  By regularly delivering these results, PDA will ensure itself continued industry growth – in a very competitive and lucrative space, where tens of millions of dollars are annually expended collectively by disability insurance companies on these medical reviews.  There are a handful of major entities who act similarly to PDA, and this troublesome development can only be harmful for claimants in the disability insurance claim process.

PDA reveals its intentions through the biased lens it approaches these claims through – demonstrated by its own words.  Its CEO stated that mental health claims are “among the most nebulous and demanding to manage for a disability claims operation.”  He champions PDA’s ability to save money for insurance companies, stating “we are eager to bring more value to our customers by establishing long-term, meaningful strategies to address these claims.”

WHY DO THESE COMPANIES GET AWAY WITH THIS?

Many of the claims we handle are governed under ERISA, a federal statute which covers most group disability insurance claims.   These policies are litigated in Federal Court, but the Court in ERISA litigation is limited in what can be considered, and discovery is also quite limited, if permitted at all.  Thus, the evidence which might reveal the lack of legitimacy to these reports, or the incredible bias of the vendor (like PDA) is often unable to be developed, due to the constrained process and limited record available for the Court’s consideration.  Often, the Court will simply reflexively determine the doctor is “independent” because they are not directly employed by the insurer.  The reality, often, is that the doctor is engaged regularly, and through an entity such as PDA, who ensures that it will deliver results for its clients for strong “return to work outcomes”.  This “cozy” relationship has been noted by many courts, but other courts still remain unconvinced to the arguments – impacting a claimant’s ability for the issues to be fully developed.

Another piece of this enigma which is unfair to claimants is the relationship between The Advocator Group and PDA.  The Advocator Group is often provided to disability insurance claimants to work on their behalf (allegedly) to pursue Social Security disability claims.  However, we have always been troubled by the symbiotic relationship between the insurance company and vendors like The Advocator Group.   They regularly report to the insurance company, and take actions to benefit the insurance company, often to the detriment of claimants.

Now, we are deeply concerned for claimants as to this clear conflict of interest between these intertwined entities.

No good can come to claimants from this relationship.

Be wary of companies like PDA if you are involved in the disability insurance claim process – they are not going to be helpful to you, but rather, are working to help the insurance companies contain costs, and support the denial or termination of claims.

Jason A. Newfield

Written By:

Jason A. Newfield

Disability Insurance Attorney