As I read it…Metlife, the disability carrier and employer, sells the benefits package to its employees and then makes payment decisions when presented with a claim. Many “claims adjusters” who purchase, eg auto insurance, have experienced the unplesantness of purchasing from the company store. Cannot bite the hand that feeds them! I’ve had such experience. Sometimes employees’ backs are up against the employment walls and feel coerced in buying the company’s insurance products. It’s like a double-headed master over the employee. Hopefully the Supt Ct sees this in deciding this conflict.
Doesn’t the decision by the sixth circuit have the potential to invalidate all insurance transactions because for the most part, all companies process their own claims? Is there something in this expressly tied to ERISA that makes it a conflict that doesn’t apply to other insurance contracts?
Wrong gb, the article states clearly the employer was Sears, however you raise a good point. I wonder if Met is allowed to be it’s own DB insurer? Also Mr Obvious you raise a great issue. According to the conflict of interest reasoning every carrier would have to have claim handling TPA.
We have to remember that this is a benefit, and that the customer is the employer not the beneficiary. The conflict of interest begins when the choice to provide benefits is with the employer. Disability benefits in most cases are voluntarily given by an employer. It is not a requirement. Also, consider that outside of DBL states, there is no continuity relative to the definition of “disability”, “accident”, “sickness”, etc.
I am really confused here. This is more than obvious, this is flat out ridiculous. Anyone who has ever dealt with ANY business knows that it is about the bottom line. Let’s see, if I could decide whether to make money or give it away what would I do? Let’s hope the Supreme Court gets this right and for once disabled people are actually given a chance against the machine.
As I read it…Metlife, the disability carrier and employer, sells the benefits package to its employees and then makes payment decisions when presented with a claim. Many “claims adjusters” who purchase, eg auto insurance, have experienced the unplesantness of purchasing from the company store. Cannot bite the hand that feeds them! I’ve had such experience. Sometimes employees’ backs are up against the employment walls and feel coerced in buying the company’s insurance products. It’s like a double-headed master over the employee. Hopefully the Supt Ct sees this in deciding this conflict.
Doesn’t the decision by the sixth circuit have the potential to invalidate all insurance transactions because for the most part, all companies process their own claims? Is there something in this expressly tied to ERISA that makes it a conflict that doesn’t apply to other insurance contracts?
Wrong gb, the article states clearly the employer was Sears, however you raise a good point. I wonder if Met is allowed to be it’s own DB insurer? Also Mr Obvious you raise a great issue. According to the conflict of interest reasoning every carrier would have to have claim handling TPA.
We have to remember that this is a benefit, and that the customer is the employer not the beneficiary. The conflict of interest begins when the choice to provide benefits is with the employer. Disability benefits in most cases are voluntarily given by an employer. It is not a requirement. Also, consider that outside of DBL states, there is no continuity relative to the definition of “disability”, “accident”, “sickness”, etc.
I am really confused here. This is more than obvious, this is flat out ridiculous. Anyone who has ever dealt with ANY business knows that it is about the bottom line. Let’s see, if I could decide whether to make money or give it away what would I do? Let’s hope the Supreme Court gets this right and for once disabled people are actually given a chance against the machine.