Disability Claims Solutions

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Angry at InsurerRecently, I spoke with an individual who received a letter from Unum that really was “the ghost from hell” letter. The letter itself was 8 pages in length consisting of one regurgitation of policy provisions after another.

The issue was that the claimant refused to release her SSDI file, and Unum’s “Lead Specialist” thought she had a contractual obligation to release it. Unum is well aware that it cannot force claimants to disclose their SSDI files, but this particular specialist, who apparently “didn’t get it” made himself look the fool.

When I read the letter I was amazed. None of the Plan provisions cited in Unum’s letter said anything about “a contractual obligation” to release government files as “proof of claim”. In fact, Unum’s ERISA Plan provision citing “proof of claim” is pretty slim anyway. Here it is:

“WHAT INFORMATION IS NEEDED AS PROOF OF YOUR CLAIM?

Your proof of claim, provided at your expense, must show:

  • that you are under the regular care of a physician;
  • the appropriate documentation of your monthly earnings;
  • the date your disability began;
  • the cause of your disability;
  • the extent of your disability including restrictions and limitations preventing you from performing your regular occupation; and
  • the name and address of any hospital or institution wehre you received treatment, iincluding all attending physicians.

We may request that you send proof of continuing disability indicating that you are under the regular care of a physicians. This proof, provided at your expense, must be received within 45 days of a request by us.

You must be under the regular care of a physican unless regular care

  • will not improve your disabling condition(s); or
  • will not prevent a worsening of your disabling condition.

In some cases, you will be required to give Unum authorization to obtain additional medical information and to provide non-medical information as part of your proof of claim, or proof of continuing disability. Unum will deny your claim, or stop sending you payments, if the appropriate information isn ot submitted.”

It is quite likely that information sent as proof for SSDI was also sent to Unum. The information Unum is really after is not “medical” as described in the above provision, but SSA’s internal listings and SSA Form 831 with the  name of the DDS (Disability Determination Specialist) and review documents. If Unum requests SSDI medical information, inquire specifically what they are looking for in terms of “medical” information and send it to them.

The problem here is two fold. First, Unum’s citing provisions NOT requiring the release of SSDI file information scare the heck out of claimants so that they will sign SSDI Authorizations because they think they have to. Second, Unum is not really after medical information they already have, but other SSA internal review documents they can use against claimants to deny claims.

As I indicated, Unum specialists who cite provisions that do not require something as proof that they do, is acting the Village Idiot. Citing multiple provisions in 6 page letters does not give Unum the bigger raisin.


Please also notice that Unum’s actual “proof of loss” provision requires claimants to submit proof at their own expense within 45 days. From time to time I still hear Unum claims reps insisting medical records have to come directly from the physician’s office using a “do not disturbe the chain of evidence” agrument. It’s all bunk.

ERISA Plans require medical information to be submitted by the claimant (or their physicians within 45 days, not 1 week as Release Point letters seem to indicate.)