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Fibromyalgia1Unum’s Fibromyalgia Position Statements and Guidelines (7/29/2002)

Just before leaving Unum in 2002 one of its physician consultants handed me a copy of Unum’s “position statement” regarding Unum’s handling, review, and philosophy in administering fibromyalgia claims. Although this report is now over 17 years old, there are strong evidences based on current Unum file reviews of fibromyalgia claims that many of its former guidelines are still supported by the company’s medical staff and claims managers to the demise of many insureds and claimants.

The report itself states, “Please note that although these guidelines have been written for fibromyalgia, considerable overlap exists between fibromyalgia and other defined syndromes of medically unexplained symptoms (such as chronic fatigue syndrome.”)  Therefore, it is clear Unum considers CFS in the same impairment category as Fibromyalgia Syndrome.

Unum’s Fibromyalgia Position Statements and Guidelines list the following internal Unum physicians as contributors to the report:

  • Edward C. Alvino, MD
  • Nancy Ball, MD
  • Robert N. Anfield, MD, JD
  • Norman Bress, MD
  • Alan Cusher, PhD
  • Marianne Justin
  • Les Kertay, PhD
  • Paul Martin, MD
  • Buron McDaniel, MD
  • Thomas McLaren, PhD

Many of these physicians are still hired by insurance companies to review medical information on behalf of the insurance industry. Now referred to as “claim killers”, these physicians continue to review claims in prejudicial ways to favor denial on behalf of insurers.

It is reasonable to assume then, at least in July of 2002, Unum’s executive medical director had already provided the company’s medical resources with a “position statement” regarding the management and review of fibromyalgia claims submitted for payment.

On page 2 of the report entitled: Our Current Position Statements of Fibromyalgia the following statements are made:

  • Fibromyalgia is a defined syndrome; one that represents a patient population experiencing a constellation of medically unexplained symptoms.
  • Current evidence does not allow one to conclude that fibromyalgia is a physical disease – it etiology remains unknown and to date no pathophysiological process has been established.
  • Psychological factors may exist in a significant portion of individuals label with fibromyalgia.
  • Treatment plans, which include cognitive behavioral therapy and a graded low impact aerobic, conditioning program, have been shown to improve symptoms in some fibromyalgia patients.
  • The vast majority of individuals labeled with fibromyalgia have no physical impairment; they are on a physical basis able to return to work (especially with appropriate care). Generally, continued activity (including work) is of value even in the face of symptoms.

Contained within the position statement are Unum’s general “current findings on disability” related to fibromyalgia. The document makes the following statements:

  1. It is estimated that between 10-12% of the general population experience chronic widespread body pain. Most do not see a physician for this symptom and proceed with the business of daily file.
  2. The majority of fibromyalgia experts are presently in agreement that fibromyalgia patients are not physically impaired.
  3. Severe psychological distress in patients with fibromyalgia not only plays a significant role but also may lead to psychological impairment.
  4. Physicians should discourage inactivity and disability in fibromyalgia patients because if these are prolonged there is an adverse effect on the prognosis.
  5. We must halt the trend to label patients with FMS as disabled, and we must interfere with the social trend toward encouragement of the disability concept.

In 2002 Unum’s solution to the “somatization” of symptoms of fibromyalgia culminated into: A Fibromyalgia Process Proposal.

In summary, Unum’s contributing physicians proposed getting involved early with the insured’s primary care physicians in order to prevent a disability from being supported. Recommendations were also made in the report for detailed phone interviews, nurse-to-doctor and doc-to-doc calls for the purpose of Unum’s early intervention of a disability due to fibromyalgia. Unum’s general consensus or understanding of the disease, as indicated in the position paper, is that fibromyalgia is NOT a physical disease, is “somatoform” (imagined), and that with a little persuading of the doctors, in most cases the insured could return to work full time.

The idea of a major disability company writing a “position paper” stating “the official position of the company with respect to fibromyalgia (and related impairments)”, means all insureds who file claims for fibromyalgia will not receive an objective fair review since outcomes and liability determinations are predetermined by Unum’s medical department before any claims are actually filed.

Further, Unum’s position that fibromyalgia is NOT a physical disease but a “made up mental one” allows the company to abuse the 24-month mental and nervous provision in the policy by limiting benefits to a much shorter period of time. Further statements by Unum calling fibro symptoms “somatoform” also gives the company a great deal of wiggle room to claim the impairment is “self-reported” and also limit or deny benefits.

There was also a time when the Unum policy was to conduct surveillance on every fibromyalgia claim. I thought this to be a tremendous waste of Unum’s time and money because the treatment plan for nearly all fibromyalgia patients includes “exercise and daily activity as able.”  Physicians want their patients to remain active, so catching someone on a CD walking around a Mall is exactly what the doctor ordered. Fibromyalgia patients are NOT required to remain in bed with the covers up to their nose.

Today, Unum continues to deny most fibromyalgia claims, or, if the claims are initially paid, they aren’t paid for very long without aggressive Unum intervention to encourage rheumatologists to return the insured to work as soon as possible.

Although Unum’s position in 2002 was as described above, one can reasonably document from  current claim files the company’s position hasn’t changed in the last seventeen years despite advancements in new technologies and using innovative clinical approaches for the diagnosis, treatment, and management of pain.

Medical authorities now know fibromyalgia isn’t “all in your head” and aerobic exercise on a treadmill won’t cure disabling muscle and joint pain. Fibromyalgia, and all of the symptoms associated with it, such as fatigue, insomnia, joint and muscle pain can be extremely disabling thereby preventing insureds from sustaining work on a consistent basis.

Still, Unum has a long history of labeling fibromyalgia as a psychological syndrome rather than a bon fide physical impairment which often precludes work. After all, it’s in Unum’s best financial interest to not pay fibromyalgia and CFS claims.

In addition, Unum’s internal physician consultants are quite skilled in convincing physicians their patients can work full time jobs with a little effort. Unfortunately, fibromyalgia and chronic fatigue are two areas of disability management easily used by Unum to support goals for financial profit. Incidentally, FMS and CFS are only two of the impairments Unum has difficulty paying. Others include early onset MS, RSD, Lupus, PTSD, and chronic back pain.

Unum does a grave disservice to its customers when it denies claims by telling insureds, contrary to the recommendations of the American College of Rheumatology, “their pain is all in their head”, and symptoms are all “imagined or made up.” Instead of realizing Unum is using this defense to get out of paying claims, insureds may actually begin to think perhaps they really ARE crazy, and the severity and length of the disability is nearly more than some people can actually deal with.

Fibromyalgia insureds must now realize: 1) fibromyalgia is a real physical disease; 2) the condition is often treated with medication; 3) symptoms of joint pain, fatigue, and depression are real; and 4) fibromyalgia is always treated with recommendations for exercise and daily activity; do not be afraid to exercise because Unum conducts surveillance and holds your treatment activity against you. Obey your doctor.

If you have any questions concerning Unum’s 2002 position paper or how to successfully manage fibromyalgia claims, please contact me privately. I am always here to help.

This article will also be uploaded to my new website under “Linda’s Editorials”.