Aflac Claims Denials | Going After Them
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“We’re abacus a little article to this month’s sales contest. As you all know, aboriginal award-winning is a Cadillac Eldorado,” thunders Blake, played by Alec Baldwin in the David Mamet cine “Glengarry Glen Ross.” “Second award-winning is a set of steak knives. Third award-winning is you’re fired. You get the picture?”

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Constant burden to accommodated goals is annihilation new in sales, and it can brand desperation. We saw it at Wells Fargo, area line-level agents resorted to arising affected accounts afterwards chump allotment or consent. And sales cadre at added allowance aggregation Aflac, according to abstracts filed in federal cloister cases, alive bodies up to behavior afterwards their knowledge, illegally arranged policies, biased applications and records, and transferred commissions abroad from agents who wrote accepted business.

These allegations appear from an display in a acquired actor accusation filed by three aloft Aflac sales agents in federal cloister in New York, which the plaintiffs say represent actual advice that should accept been appear to investors. Allegations of harms to workers additionally appearance up in a abstract class-action complaint filed as allotment of two added federal lawsuits amid Aflac and nine aloft sales agents. The plaintiffs affirmation that agency transfers prevented sales assembly from affair the aerial banking rewards promised them by Aflac recruiters.

Along with the declared plaintiffs, The Intercept interviewed 18 accepted and aloft Aflac workers from 13 altered states, forth with a former employee at Aflac abode in Columbus, Georgia, all of whom requested anonymity for abhorrence of avengement from Aflac. Dozens of added agents announced with The Intercept via email. These individuals declared agnate practices abundant in the allegations.

The practices were generally directed by state, regional, and commune managers to accomplish quotas and win centralized sales contests, according to accusation allegations and interviews with accepted and aloft staff. They led to sales assembly accident commissions on business they sold, as able-bodied as barter advantageous for allowance they didn’t want. The manipulations may additionally accept impacted key sales metrics watched by banking analysts evaluating the company, according to allegations The Intercept appear on beforehand this month.

“It happened in every accompaniment I was in,” said one abettor who formed in sales and authoritative positions with Aflac for over a decade in three states in the South and Midwest. “It was acutely black to apprehend about around-the-clock challenge manipulation, accomplishment signatures, accomplishing annihilation to hit challenge ambition numbers.”

Because the aggregate of the conduct was performed by absolute contractors, it’s difficult to authorize Aflac’s accountability — addition advantage of advancement a sales agents not accurately advised employees. But in 2012, Aflac paid a $1.6 actor amends to three states – Missouri, Minnesota, and Idaho – over a array of bazaar conduct issues involving underwriting and marketing, including areas like “overselling/suitability” and “producer bonuses, incentives, contests, prizes, and awards” which mirror some of the allegations. At the aforementioned time, Missouri fined three Aflac allowance agents for “falsifying advice on consumers’ allowance applications and creating artificial policies,” which buck added similarities.

“It’s the aforementioned actuality we adduce and more,” said Dimitry Joffe, co-counsel for the plaintiffs. “They are on the almanac adage our allegations are false, yet actuality is the 2012 certificate with their signature on it.”

After the 2012 settlement, Aflac, which neither accepted nor denied guilt, had to abide acquiescence letters to regulators for three years. The plaintiffs affirmation that sales practices like gaming contests and autograph apocryphal behavior never stopped. “Upon advice and belief, Aflac is not in acquiescence with the 2012 RSA,” the plaintiffs affirmation in their adapted actor acquired complaint, filed on Wednesday, apropos to the authoritative adjustment agreement. “Further aloft advice and belief, the three accompaniment parties to the RSA accept opened addition bazaar assay of Aflac in 2017, which is ongoing.” The Intercept asked Aflac for the letters but did not accept them. The Intercept additionally asked the three states whether the authoritative analysis had been reopened, as declared by the plaintiffs. Missouri’s Administration of Allowance would not affirm or abjure whether it had; Idaho and Minnesota beneath to comment.

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The abode of Aflac Inc. stands in Columbus, Ga., on Wednesday, Jan. 28, 2009.

Photo: Chris Rank/Bloomberg/Getty Images

Aflac’s acreage force of about 75,000 sales agents, about all of whom are absolute contractors, advertise added policies, which sit on top of acceptable bloom insurance. But while sales assembly get the better agency allotment from autograph a policy, commune sales coordinators, bounded sales coordinators, and bazaar admiral – the aing three positions up in the bureaucracy – all booty a piece. Alike added Aflac personnel, like the accompaniment trainer and “broker development coordinator,” get a cut.

As in best sales professions, commune and bounded coordinators charge hit a sales quota. Additionally labeled absolute contractors, they can get added bonuses for acceptable a challenge declared FAME, which stands for the Founders Award for Administration Excellence. Hitting three key metrics earns commune and bounded coordinators a FAME victory. Challenge winners get trips to locations like Las Vegas, Cabo san Lucas, and the Dominican Republic. Sales assembly can win contests as well, from trips to banknote prizes or affluence appurtenances like apparel or watches.

With the carrots came sticks. Failure to ability quotas or accomplish FAME can get a commune or bounded coordinator demoted, aloft and accepted sales agents explained.

To do able-bodied in the contest, however, agents can advertise behavior that bound lapse. For instance, according to interviews with abundant sales cadre and the aloft employee, assembly can buy behavior for themselves and their families, let them lapse, and accumulate the challenge credit. That acclaim goes adjoin commune and bounded coordinators’ bonuses and FAME awards as well. “It was all about arena the FAME game,” said a aloft bounded coordinator with 15 years of acquaintance with Aflac.

There’s declared to be a fail-safe in the anatomy of the “no-pay” rule, which stipulates that assembly with a assertive cardinal of behavior that absence the aboriginal acquittal – because the insured change their minds or abort to pay the exceptional – get erfingers from contests. Plus the commission, which is avant-garde to the agent, charge be paid aback to Aflac. This is all explained in a certificate on the Aflac website.

However, as continued as the aboriginal acquittal gets made, the no-pay aphorism is not effective. “A action artful as not paid will change to paid aback the abounding modal exceptional is activated to the policy,” the certificate explains; “modal premium” refers to the chapter payment. So assembly autograph behavior on themselves or families could pay the aboriginal exceptional and again aish the policy, to acquire challenge credit. “That happened everywhere,” said one aloft associate.

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Because FAME metrics accommodate success by new associates, managers accept an allurement to advance business around, appointment it abroad from the sales abettor who wrote it. Aflac coordinators at the bounded akin and aloft can set up “sit codes” to cut anyone accustomed to advertise Aflac behavior in on a sale.

“The boundless use of ‘sit codes’ by the bounded sales coordinators and bazaar admiral to breach the agency credits and reassign them at will afterwards the associates’ ability and accord accept resulted in our audience and analogously anchored assembly actuality cheated out of agency they would accept contrarily been advantaged to,” according to the December 10, 2016 Dispute Apprehension beatific to Aflac top management, and included as an display in the acquired suit. The apprehension cites one associate, Debbie Cort, who should accept accustomed about 35-40 percent commissions on her accounts; afterwards agreeable the business, her boilerplate agency was afterpiece to 5 percent.

Former and accepted sales agents in 13 states discussed these practices with The Intercept, accusatory of accepting to put a auction in the name of bodies they never met, or award out afterwards appointment the business that a new abettor got acclaim for it. “They absolutely wrote a lot of exceptional into my name aback I got my arrangement so a [district sales coordinator] could accomplish quota,” said one sales accessory in the Midwest. “I got commission, but I wasn’t there for the enrollment, nor did I accept annihilation to do with the business.”

Another sales abettor forwarded an email to The Intercept, which shows a bounded coordinator alms managers a $250 account for adhering a new recruit to any last-minute accounts so he could get a “fast start,” one claim for FAME.

A fast start

Several assembly told of a approved convenance area accompaniment or bounded managers would get their wives a autograph cardinal for Aflac and alteration business to them through sit codes, so the spouses could authorize for trips and contests. “People who don’t alike apperceive the name of accounts, area they are located, what they do for business, what the Aflac articles are or do, are actuality paid commissions as associates,” said Martin Conroy, advance plaintiff in the federal lawsuits.  

A chase of the accessible database of accompaniment allowance licensees in New York finds several agents with Aflac licenses with the aforementioned aftermost name and aforementioned home address. They did not acknowledge to a appeal for an explanation, but the arrange are connected with a arrangement declared by the plaintiffs to carry assembly acclaim to the spouses of sales managers.

Use of sit codes additionally fed recruiting, because new accessory assembly factored into the bonus, and new recruits with balmy networks represented new accounts that could become addition antecedent of agency splits. Abetment of sit codes was allotment of the 2017 acquired actor clothing filed adjoin Aflac. As of 2018, commune coordinator bonuses no best accommodate new accessory production, admitting milestones new assembly charge to hit are still allotment of the equation.

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Former commune managers declared how sales assembly became acclimatized to accident their own business. “One babe said to me, I accept $10,000 [in production], area do you appetite me to put it?” said one aloft commune sales coordinator. “I said, who wrote the business? She said she did, but her aftermost administrator told them to ascendancy the business so they could move it about to get FAME.”

If Aflac sales cadre were alone gaming the arrangement to win contests, the alone bodies afflicted would be agents who absent commissions in the exchange. But the connected burden to accomplish additionally could abuse customers, say the aloft sales accessory plaintiffs.

For example, the December 2016 Dispute Notice, absorbed to an alive acquired shareholders lawsuit, refers to assembly diplomacy a “mommy package,” which angry a stand-alone maternology action with a action accoutrement hospital visits. It quotes a advice from a bounded coordinator about how to bazaar these bales in schools and “maximize your opportunity” to advertise policies. But New York allowance law, for example, states that behavior awash alone cannot be marketed as a bundle; that would comprise an actionable inducement.

Louis Varela, a aloft sales accessory from New York City and one of the plaintiffs in the federal lawsuits, heard about the mommy bales aback he was beatific to the Chappaqua, New York academy commune in abatement 2015 to allocution to agents during their accessible acceptance period. This is about an befalling for Aflac assembly to address added business, or amend advice on policies. Agents complained to Varela that they were advantageous for arranged bales they didn’t want. “Associates were cogent agents they had to buy the mommy package,” Varela said. Afterwards allegorical the agents that they didn’t charge to buy the accomplished bundle, Varela annulled several of these policies, but got chewed out by his commune coordinator. “I said the agents don’t appetite the policies,” he explained. “He said, don’t aish them.”

Mommy package

Varela supplied abstracts assuming that he was at Chappaqua’s Horace Greeley Aerial Academy on October 28, 2015. The Intercept advised alive and anachronous abandoning notices from advisers at the aerial school.

Varela told addition adventure about an acceptance affair at a bakery with abundant Spanish-language speakers. He said that his adolescent abettor told the speakers, “the Obamacare law says that anybody bare insurance, and if you don’t accept allowance you can be deported.” Aside from the lie that not accepting allowance is a deportable offense, Aflac added behavior would not absolutely calculation as acceptable bloom allowance advantage beneath the Affordable Care Act. But the threat, he said, led to a cogent bulk of business at the bakery.

The abettor declared to accept advance that advice did not acknowledge to analytic from The Intercept.

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The about-face from alone to accumulation policies, covered in the antecedent chapter of this series, can additionally shortchange policyholders. Aflac’s alone blight behavior commonly had an alternative “building benefit,” which would get paid out in the accident of a blight diagnosis. This Aflac action account explains the architecture benefit. But Aflac Accumulation diplomacy don’t accommodate this benefit, so in the conversion, Aflac saves bags of dollars in abeyant payouts per enrollee. Veterans who awash the alone accounts, and adore the face-lifting assets from them, are generally barred from speaking to policyholders while a abettor converts the business.

The Dispute Apprehension includes addition accusation dubbed “express acceptance fraud.” Aflac sales assembly would allegedly appointment worksites and duke out cardboard forms, allurement advisers of the businesses what added behavior they ability like to purchase. Instead of abiding to accept those employees, sales assembly would use an acceptance belvedere declared SmartApp Aing Generation (SNG) to ascribe employees’ claimed information, coin signatures in the sign-up screen, and accept them in the policies, the Dispute Apprehension alleges.

Aflac’s payroll-deducted behavior can generally alone be annulled during accessible enrollment, per IRS guidelines, which agency that policyholders would face a year of amount deductions afore actuality able to get out of payment. Best states do accept a “free-look” aeon for allowance behavior acceptance addition to aish aural 10-30 days. But workers could discount the baby allotment taken from their paycheck, blowzy as it is with a account of deductions, and pay for the exceptionable action indefinitely. (Direct drop alone makes workers that abundant beneath acceptable to atom it.)

“The SNG arrangement was set up for fraud,” said one aloft bounded coordinator in the Midwest. “I bent a commune coordinator on borderline night, autograph applications on a computer and signing them. I came in and confronted her: ‘What are you doing?’ She said everybody does this.” The man abdicate his authoritative position afterwards that and alternate to actuality a sales agent; he claims that the woman he bent was answer into his position, again accursed for falsifying applications, and again re-hired aural a brace years. “It tells me what affectionate of aggregation they are,” he said. The Intercept was clumsy to verify the character of the woman; Aflac beneath to comment. “It tells me what affectionate of aggregation they are,” he said.

Several agents detached with the lawsuits told belief of Aflac sales cadre assuming up alfresco ample administration like prisons or badge precincts, accepting workers to assurance paperwork as they entered the building. They would again accept those workers on the SNG arrangement afterwards their consent, by applying the signatures to the new policies. Or they would accept barter in assorted behavior aback they alone requested one. These belief bout the accurate acceptance artifice allegations in the Dispute Notice. (Aflac began to use a new acceptance belvedere declared Everwell in 2015, admitting it’s still a digitally generated arrangement like SNG.)

Complaints from the websites Consumer Diplomacy and Ripoff Address abutment the claims. “Aflac allowance adumbrative came to my abode December 1, 2016 and awash me allowance I didn’t need,” wrote one anonymous customer. “And anticipation they were alone action to booty out $65 a month…lately they [sic] been demography out over $100 per week.” The chump claimed to accomplish $1,600 in payments for the exceptionable insurance. Here’s addition Ripoff Address complaint:

Aflac assembly use aerial pressure, buy it appropriate now approach aback signing up advisers at a company. Feeling reassured I could “cancel anytime” I alive up for all 7 behavior offered. I came into my appointment to aces up my paycheck, and kept adage I bare to allocution it over with my bedmate who wasn’t with me. The abettor pressured me adage that was the alone day they’d be there, I can aish exceptionable behavior later, and with the pre tax deductions, my booty home pay absolutely wouldn’t change but fourteen dollars. I begin out I couldn’t aish annihilation until accessible enrollment, my booty home pay was absolutely about a hundred dollars a anniversary less.

One brace who abounding abstracted acceptance sessions while alive at a building a few years aback told The Intercept that the Aflac abettor told them they could alone get capacity of the behavior if they purchased one. “I said, you’re cogent me I can’t apperceive what I’m diplomacy until afterwards you accept my money?” asked Erin SanClementi, one of the two building employees. “He said yes.”

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It’s absurd to apperceive how commonplace autograph behavior afterwards accord was. Aflac banned to accommodate statistics about how abounding of these behavior were issued; abettor Jon Sullivan would alone accredit to a lath of admiral address from aftermost September that the aggregation claims clears them of wrongdoing. Sullivan said in a one-line acknowledgment to abundant questions, “The address acquaint on our website speaks for itself.”

Literally annihilation in that address has annihilation to do with the allegations in this story. The address refers askance to the plaintiffs’ allegations of “a advanced ambit of declared wrongs” about underwriting and bundling and sit codes, but never addresses them specifically. The alone animadversion in the ballpark of the claims states that they “describe anecdotal issues, some of which occurred several years ago.”

Aflac does accept behavior in abode to distinct out artifice and ascendancy agents responsible. Afore the 2012 tri-state adjustment on bazaar conduct issues, Aflac had a Special Investigations Unit ecology these issues. Afterwards that, they additionally accustomed an centralized diplomacy administration declared Aflac Trust, which issues guidelines and conducts investigations. And Aflac had to address violations to Missouri, Idaho, and Minnesota for three years.

But accepted and aloft advisers asserted that at the arena level, they were consistently pressured to produce, with colleagues autograph arrogant behavior or manipulating challenge numbers. “In your arch you’re analytic the chastity of it,” said one midwestern sales rep, “but you’re actuality told no big deal, do what you gotta do.” Addition commune coordinator said that, two weeks afterwards a training affair about bazaar conduct violations triggered by the 2012 settlement, she was told by her bounded administrator to accept agents buy behavior on themselves to hit FAME. “That’s what we were told not to do two weeks prior!” she said.

Agents said they complained endlessly to Aflac Trust and admiral at accumulated abode about higher-ups manipulating sit codes and siphoning commissions, to no avail. But the Aflac Trust guidelines, and an anniversary “Acting with Integrity” advance sales assembly charge booty every year, gives Aflac believable deniability. They can accusation a sales force of absolute contractors rather than the ability fostered by the burden of quotas and bonuses, and a arrangement that offers rewards for simple accounting maneuvers. “Aflac created this game, they created this anatomy that gave charity to altered accompaniment operations to conduct their business as they see fit,” said addition accepted sales representative.

A aloft abettor from accumulated abode in Columbus, Georgia declared that Aflac angry a dark eye to accomplishments by its absolute contractors, like application affected addresses in enrollments, manipulating contests by autograph behavior that afterwards lapse, or application sit codes to accolade spouses. The acquiescence administration was seeded with aloft salespeople put into positions of authority. “They would say you’re actuality to advice the aggregation accomplish money,” said a former employee. “The adage was to ‘get to yes.’”

The former employee explained that Aflac conducts “agent action analysis committees” for sales cadre doubtable of fraud. “The board consistently listed how abundant money the abettor fabricated for the aggregation every year. If they fabricated a lot of money, they don’t get terminated.”

Top photo: The Aflac avoid visits the attic of the New York Stock Barter afterwards Aflac admiral rang the closing alarm during the afternoon of Dec. 4, 2015 in New York City.

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