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For decades, the supplemental benefits industry has operated on a quiet contradiction. The industry provides critical financial safety nets—Accident, Critical Illness, and Hospital Indemnity insurance—to employees who desperately need them. Yet, industry data suggests that a staggering percentage of eligible claims simply vanish. They go unfiled, forgotten in the chaos of a medical crisis, or lost in the labyrinth of manual paperwork.
For a long time, this "claims leakage" was viewed as an unfortunate administrative inefficiency. Today, in light of recent litigation and aggressive Department of Labor (DOL) scrutiny, it is something far more dangerous: a fiduciary liability.
The landscape has shifted. For carriers and brokers, the old model of "sell it and forget it" is not just obsolete; it is a legal and reputational risk. The solution lies in shifting from passive claims waiting to active claims resolution. Enter Nayya Claims - a battle-tested solution that has been solving this exact challenge for over 3 years across hundreds of large employers.
Recent months have seen a flurry of legal activity that should serve as a siren for every benefits leader. The Department of Labor has reached settlements with major life and supplemental insurance carriers regarding "Evidence of Insurability" (EOI) and claims practices.1
The core allegation in many of these cases is simple but damning: carriers and employers were happy to collect premiums via payroll deduction but failed to adjudicate eligibility or facilitate claims effectively until it was too late.2 The subtext of these settlements is clear: It is no longer sufficient to simply make a product available. If an employee pays for a benefit, the industry has a duty to ensure that benefit is accessible when the qualifying event occurs.
When a carrier’s loss ratio on a supplemental product is exceptionally low (sometimes dipping below 50%), regulators and class-action attorneys are now asking: Is this a real insurance product, or is it a fee collection scheme?
The problem rarely stems from malice; it stems from friction. Consider the average employee experience:
The result is billions of dollars in unclaimed benefits—money that belongs to employees but remains stuck in coffers.
Nayya Claims does not just smooth the process; it fundamentally inverts it. Instead of waiting for a stressed employee to raise their hand, Nayya Claims uses data to tap them on the shoulder.
Nayya integrates directly with medical claims data (medical carrier feeds) to "listen" for qualifying events.3 When an employee visits the ER for a fracture, Nayya’s engine recognizes the diagnosis code (ICD-10) and checks it against their supplemental coverage.
For brokers advising employers, Nayya is the ultimate risk mitigation tool. By automating the identification of claims, brokers help employers fulfill their fiduciary duty. You are ensuring that the benefits employees pay for are the benefits they actually receive. This creates a defensible audit trail of value delivery, directly countering the narratives seen in recent lawsuits.
Certain industry executives often worry that increasing claims volume will hurt profitability. This is short-sighted. In the voluntary benefits space, utilization is retention. An employee who pays $20/month for a Critical Illness policy and never uses it will eventually cancel it. An employee who receives a surprise $2,000 check from that policy when they are sick will be a customer for life. Nayya Claims transforms an "expense" into a tangible "financial lifeline," proving the broker's value proposition and stabilizing carrier persistency.
The regulatory changes we see today is likely just the beginning. The "protection gap"—the delta between what employees buy and what they use—is being closed by regulators.
Carriers and brokers have a choice. You can wait for the mandate that forces you to automate claims, or you can lead the market by adopting Nayya Claims now. By partnering with Nayya, you tell your clients: "We don't just sell you a promise on a piece of paper. We built the infrastructure to keep that promise." That is the only strategy that survives the scrutiny of tomorrow.
