Disability Claims Solutions


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Q&AWhy do we not use the GAF (Global Assessment of Functioning) scale anymore?

GAF was removed from the DSM-5 in October, 2018 and was replaced with WHO DAS 2.0. The DSM-5 is the Diagnostic and Statistical Manual for Psychological Disorders that replaced DSM-IV. In my opinion the GAF score was a better pairing for disability claims,  and most mental health providers continued to provide GAF scores far beyond 2018.

WHO DAS 2.0 is a questionnaire that can be completed by the insured, family members, and anyone else who has contact with someone on claim. Most mental health providers ignore WHO DAS 2.0 and opt for their own observations and clinical reviews to determine overall functioning.

My clients are often asked to complete The WHO DAS 2.0, which I score for them.

How do I prepare for a Unum phone interview?

Yikes! I must have at least twenty articles on my blog about not speaking with any insurance company on the phone. While I’m referring you to my other articles, let me say one more time that the top preparation for a Unum phone interview is to not give one.

In brief, insureds who are taking pain or depressive medications should NOT speak on the phone with insurers particularly when spontaneous answers are required. Second, claims handlers are trained, and are provided templates of questions that management wants them to ask. Most of the questions are repeats from information provided on initial applications looking for inconsistency of report.

Insureds can never trust that information provided on the phone is documented accurately. Therefore, it is never a good idea for insureds to speak directly on the phone with claims handlers. Ask for all communications in writing so that you will actually have time to THINK about your answers.

Who should I contact with an ERISA complaint?

I’m sorry to say, but the ERISA folks have no one to file complaints with until AFTER claims are denied. There is no mandate from the federal government for EBSA offices (Employment Benefits Security Administration, local regional offices of the U.S. Department of Labor), to assist with ongoing claims management issues. In other words, no one cares, until after the damage is already done.

Although I already knew this was true prior to the April 1, 2018 amendments, it became very apparent after the amendments came into effect. I have to say that many claimants mistakenly think that ERISA somehow sets up rules for “claims review and management”, but ERISA law does not do that. Most of ERISA has to do with setting disclosure and litigation standards of review after claims are denied.

Therefore, the awful truth is that ERISA does not cover the backs of claimants when insurers engage in unfair claims practices and/or stretches timeline limitations. ERISA law applications come into play with litigation, which is why I do not recommend claimants attempt to do their own appeals.

And, by the way, Unum’s internal complaint department is a waste of anyone’s time. Unum always responds with 6 pages of the old famous, “we did nothing wrong song” and nothing is ever done to resolve problems brought to the company’s attention.

Let’s face it……claimants have no backing or support from the feds when claims management fails them. BUT…….claimants can still write to state Departments of Insurance and request it engage in a Conduct Market Examination of Unum’s claims practices. Specifics about one person’s claim may not be relevant, but if many request the same thing, DOIs will respond.

Always notify your state’s Department of Insurance if you feel any insurance company is engaging in unfair claims practices. State DOIs can’t help you specifically because they don’t have jurisdiction, but numbers do count and Unum will be investigated if many people are contacting them.

Although ERISA may still provide some protection for non-discrimination in employer welfare Plans, any protections initially afforded to disabled workers has long since been eroded by the courts.