Disability Claims Solutions

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Man crying2Within 7 days from the end of 2nd Qtr. we can easily see where Unum is focused. I’ve received several phone calls informing me that Unum is targeting HIV, near maximum duration claims. Although Unum has always denied individuals on claim long-term, this particular case is indeed egregious.

The claimant has been on Unum claim for the last 24 years, but Unum denied it yesterday under the pretense the claimant can work. This claimant’s monthly benefit is $980/month with benefits to reach maximum duration within a year. Unum could have just as easily “paid out” the remaining benefits with an offer of settlement and have the gratification of doing the right thing.

Unum’s medical interpretation of ability to work for HIV insureds allows T-cell counts as low as 200 when the standard of normalization to work is around 500. The above claimant is experiencing severe side-effects from “old first generation HIV cocktails” such as blindness, tremors, neuropathies, PML, and dizziness. Still, because his T-cell count is “normal” with no viral load, Unum documents work capacity. In  my experience, no insurance company can get worse than this.

Historically, Unum always challenged HIV claims with medical reviews that were unsound. For example, A T-cell count of 200 or less opens the door to very serious bacterial infections, yet Unum denied claims alleging work capacity.

Unum is also known for denying claims of low value and close to maximum duration as well. As the above client described to me, ” $980 is half of my income.” As I said, Unum could have done the right thing and just “paid out the claim”, but of course, that would not have been beneficial to Unum within a week from profit reporting.

Unum has never been a great supporter of HIV, but with the advent of newer, more effective medications, the company most often denies HIV claims despite ongoing standards that any prudent person would consider to preclude work capacity.

HIV is now one of the top 5 targeted impairments within Unum’s medical review process that also includes Traumatic Brain Injury, POTS and Migraines. The company has definately taken another downward spiral to bad faith and “unfair patterns of practice.” The above described denial is about as egregious and unfair as they come.