directives about who must see the file before final determination, but does not set steps to take when working on a claim. The manual encourages the DBS to tailor the claim process to the individual claim.
In 1997, the Company published "Service Standards" which is a booklet that shows the standards to which agents and employees will be held. One section of this booklet is titled "Performance Standards/Disability Coverage." This section describes standards for new case administration, customer service responsiveness and claims administration. It does include standards for the areas covered by Washington regulations.
Results: The Company meets this standard
Standard #10 An investigation or payment of claim may not be delayed by requiring a claimant or physician to submit preliminary claim forms and subsequently requiring additional submissions of substantially the same information. WAC 284- 30-330(11)
Once a claim has been approved, the claimant and physician are required to submit monthly progress statements unless the claim is determined to be a short term claim with a definite return to work date (closed period claim). A closed period claim is paid through the return to work date and then closed. If the claimant does not return to work, the claim is reopened and more investigative work is done.
The Company requires monthly progress statements for open period claims. There are complaints in files from claimants and physicians pertaining to the monthly statement requirement and redundancy of the information required. When it is determined that a claim will run indefinitely, the claim is put on special handling or reduced handling status. This requires progress statements on a less frequent basis. However, the Individual Disability Benefit Guide manual states that this cannot occur until the claim has been open for at least 12 months.
In the claim files reviewed, there were occasional instances where the DBS would request duplicate medical or financial information. However, this does not appear to be standard practice, but rather an error on the part of the DBS caused by poor file documentation or a lack of understanding on the part of the DBS as to the information required in order to make a final determination.
Results: The Company meets this standard.