Friday Q & A
What you are referring to is called a field representative visit, and “yes” they do ask to visit you in your home. HOWEVER, you don’t have to allow the reps into your home at all.
If your policy requires you to submit to a field visit, you may ask to meet with the representative at a public place such as MacDonald’s, Wendy’s or a local coffee shop. The purpose of Unum’s asking to meet you in your home is to enable you to “talk” and “feel more comfortable” potentially sharing information Unum has no right to ask, or know.
Visits allowed to take place at home usually last a great deal longer, such as two-three hours while visits in public places only last for about an hour. The field investigator is a professional profiler who writes in his/her report about your home, how you are living.
When I went to “Unum school” years ago, the instructor, and head of SIU (Special Investigations Unit), described various means of “trickery”.
For example, on the day of the visit in her home one insured described how she had to use a cane to walk all the time and had also placed a very conspicuous cane leaning against her table. During the interview, the Unum investigator asked for a drink of water and the insured walked up three steps to the kitchen to get it, forgetting her cane.
Another example included an insured who was alleging he had severe cognitive issues and couldn’t take care of his finances. The rep pulled out all of the change he had in his pockets and asked the insured to count it, which he did perfectly. Oops!
DCS, Inc. does not recommend field visits take place in anyone’s home for all of the above reasons. There are several other posts on Lindanee’s blog dealing with field representative visits. If you search from the home page you will find more details on the subject.
Are we allowed to see what Unum’s investigator’s write?
No. You may have access to the report after your claim is denied which is something you do not want to happen. Northwestern Mutual will send out a synopsis, but it isn’t the same report that goes into the record. ERISA insureds aren’t entitled to see anything in the Administrative Record until the claim is denied. IDI insureds have no right to disclosure and insurers may or may not send copies of the file at the time of termination.
What does ERISA have to do with pre-existing conditions?
The answer is quite simple – nothing. Group Plans and policies contain provisions that describe under what circumstances claims would be considered pre-existing. Although there are many types of pre-existing conditions, ERISA doesn’t deal with the issue directly, or more so than any other provision in the policy.
The courts have considerable influence over what is and isn’t a pre-existing condition.
Can Unum deny STD benefits?
Of course they can, and do, on a regular basis.
In the past STD was viewed as a “sure thing” since no financial reserve was required for that line of business. However, Unum’s management is now aggressively managing STD and denying more claims than ever. Unum’s motto? “Deny sooner rather than later.” It’s generally accepted at Unum that it’s better to deny the shorter 26 week STD claims sooner rather than to inherit the more expensive LTD liability to age 65.
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