Disability Claims Solutions


Give Linda a Call

Texas hold emDuring the time of the Multi-State Settlement Unum et al was accused of “stacking the deck” against insureds by using deliberate schemes to target and deny legitimately payable claims.

Although the company was required to pay a significant fine and reassess 250,000 claims, the deterrent lasted only until 2008 when the company renamed itself “Unum Group” and began its unfair practices as before. Today, the company is worse than its ever been and hides its “stacking the deck” schemes in plain sight. Here is a good example.

Recently, I read a Unum denial letter for a claimant diagnosed with POTS and several other related impairments common to that diagnosis. Unum really bungled the claim review and had been requesting information for the last 6 months. Contacting the wrong doctors, misrepresenting information already received – basically the same Unum tactics resulting from administrative negligence.

A questionnaire was sent to the treating physician who, despite the great sell of a Unum doctor toward “light work capacity”, held firm and responded his patient remained totally and permanently disabled. Within a day of that report, Unum denied the claim stating it had the information reviewed by its “Board Certified physician” who opined the insured could return to her job full-time. (And, here comes the “stacking.”)

Unum’s denial letter stated that since the treating physican disagreed, Unum had the information reviewed by a second “Board Certified physician” who also documented the insured could work. What do you think the probability is of a second Unum physician disagreeing with a previous review? No Unum physician is ever going to disagree with another Unum physician, at least not if he/she wants to keep their jobs!

Although including a second physician’s review in the record might appear to add credibility to Unum’s decision, in reality, the first bad decision was just followed by a second one. Instead of asking the insured for an IME (a report that would most likely have been favorable to the insured), Unum took the cheap route and stacked the deck with a second, equally inaccurate, medical assessment. This insured and her treating physician didn’t have a chance!

Unum’s relying solely on the medical reviews of its own physican employees is an old common practice that Unum still uses. It’s pretty easy to deny claims when the only opinions considered are Unum’s own.

A few years ago, one of Unum’s claims handlers described a “three source” scheme for denying claims. If the claims handler could obtain three sources of documented “return to work”, then the claim was automatically denied. For example, an offer of employment from a same employer, buy-in of the treating physician, IME, or any other source willing to document work capacity, the claim was automatically denied. Most insureds didn’t even know what was going on until it was too late.

Unum’s targeting is also an example of “stacking the deck.” High reserve IDI claims are taken from “metrics” reports and are provided each morning to claims reps with an objective of working toward a planned denial. Unum officially will never admit to “metrics” chasing although a few terminated employees still tell me managers have access to claim reserve figures.

We all know Unum doesn’t “walk the talk” when it comes to financial reserves, and the public never really knows (or, wants to know) how much influence the claim reserve has on claims decisions, or how under-reserved Unum probably is. Nevertheless, card by card, the deck is stacked against insureds looking for much needed benefits, when Unum already knows from the time claims come in the door, that most of them will not be paid.

Unum seems to know what insureds do not – you can’t win at the poker table with a stacked deck!

Lindanee’s Blog appears to have gained interest from the claimants in the UK again. Let me add this. Unum stopped selling IDI claims in the UK quite a few years ago. However, Unum UK is still selling employer’s group coverage. I had an opportunity to review one of the Plans sold in the UK some years back, and unfortunately none of the covered employees in Great Britain have a fair chance of benefit approval.

UK employers actually have much more input into the management of claims for its employees. The policy itself requires automatic Independent Medical Evaluations and an endless stream of medical examinations conducted by “incapacity physicians”. Unfortunately, employees in the UK begin the disability process with an incredible Plan that stacks the deck against them by giving employers, and “the state”, the authority to say who gets paid and who does not.

The only good thing is that in the UK, the connection (or ownership of the process) by the state provides for a government controlled arbitration that is a far superior process for complaints and unfair decisions. Insureds in the US need not waste their time filing Unum complaints to a “do nothing” complaint department run by Rick Josephs, or Brian Cheever telling you, “We [Unum] did nothing wrong.”

Over the years Unum UK caused a great deal of grief for Britain’s employees by interfering in socialized medicine particularly in the area of Fibromyalgia, Chronic Fatigue/ME claims. Formerly run by ATOS, a computerized decision-maker for incapacity benefits, disproportionate numbers of claims were denied, often causing untimely deaths of those who otherwise qualifed for benefits.

Mo Stewart, a leading researcher into the failure of Britain’s accountability for, and operation of incapacity benefits, as well as Unum’s governmental interference, is a major source of information about Unum’s foreign malfeasance in designing a system in the UK that is not working.

Unum’s attempts to assist the UK in “stacking the deck” in a system of “socialized” medicine probably underestimated the reactive responses of those most hurt by Unum’s recommendations. Here in the US, insureds seem to “tolerate” the abuse in anonymity rather than attempting to change the system.