Unum’s Scamming Again

In nearly two decades Unum Group continues to fail in creative imagination! When caught red-handed by the multi-state regulators in 2004, Unum didn’t improve it’s claims practices, but became an old mare of a different color and continued its abuse of authority under different titles, names and practices.

One of Unum’s old “scams” being reported is to send files for financial review only to have them emerge from Aesop’s Fables accounting methods alleging claimants owe exorbitant overpayments, sometimes in the hundreds of thousands of dollars.

A recent case reported to me describes a claim situation where Unum alleges a claimant owes $316,000 because his employer changed its group plan from a $10,000 max benefit to a $6,000 max benefit. Upon further investigation I found out that Unum alleges the claimant’s employer specifically wanted the change “retroactive.”

First of all, let’s take a look at a few things we need to know here:

  1. Employer’s can only change the writing of their group Plans during the annual enrollment period. Plans may not be changed at any other time during the year.
  2. When employer Plans ARE changed, either a written Amendment is issued to the old policy with an effective date, or a new Plan is issued with a new effective date.
  3. The policy in effect as of the claimant’s date of disability is the policy that is adjudicated. While employers may in fact change the provisions of their Plans in the future, the new changes to DO NOT affect a prior policy.

Disability policies are subject to contract law. Therefore, when a claimant files a claim, the policy that was in force as of his/her date of disability is the policy that is used for the duration of the claim. New Employer changes to future Plans with different Effective Dates of Coverage have no effect on prior claims.

Therefore, if the claimant in this case has a Plan with a $10,000 max benefit with an Effective Date of Coverage prior to, or on his date of disability, Unum cannot make any future employer changes to the Plan “retroactive” as it alleges.

This is a situation that makes me wonder if the individuals reviewing Unum claims are    competent or not. It’s not rocket science here – the policy in force as of the claimant’s date of disability is the policy that is adjudicated.

The malicious attempts of Unum to force claimants to repay money that is not owed, at least in my mind, is deliberate fraud. Unum immediately reduces monthly benefits to $0 to recover its alleged overpayments and claimants are caught helpless by a Robber Baron profiting from its own internal financial scams.

As an expert in this area, and also considering Unum’s “suspension” of benefits tactics, I suspect the company may have a cash flow problem. Why would the company “suspend” benefits for little cause, and also allege large overpayments in order to reduce benefits to $0? This isn’t a financial reserve problem, but a cash flow problem.

Anyone who finds themselves victimized by Unum’s financial scams should insist on seeing calculations, spreadsheets, and other data that proves Unum has a right to recover money from their benefits.

In my opinion, this is insurance fraud and is well-deserving of a RICO case involving racketeering. It’s not fair to claimants, and it needs to be addressed in the courts of public opinion.

 

Filed under: Scams
Source: Linda Nee