One of the more interesting cases that was brought to my attention today involved an individual who filed a Unum behavioral STD claim and had to wait 5 weeks for a decision.
The claim went smoothly until Unum reassigned the claim to a rude, argumentative, and unpleasant woman who called the claimant today and threatened denial of benefits unless she received copies of actual psychotherapy notes.
Unum’s STD department has always had a very poor reputation for smooth processing of claims. What the claimant told me today is consistent with previous criticisms I’ve made on the blog based on comments and phone calls i’ve received in the past.
Interestingly, the claimant’s therapist refuses to provide actual psychotherapy notes and offered to provide Unum with mental restrictions and limitations in summary form. Both the therapist and the claimant have the right not to provide therapy notes, and in fact, the claimant can designate information as “Private Health Information”, or PHI under HIPAA. The only time a therapist would be required to submit notes is when a subpoena is received during litigation.
Apparently, Unum’s STD claim specialist told this claimant that since her therapist refused to submit therapy notes, she, as the claimant, should obtain the notes herself and send them to Unum. What in the world?
Therapists generally DO NOT provide patient notes to mental health patients for the obvious reason that they could be extremely upsetting to someone who is receiving therapy. To demand the patient, (under threat of claim denial), obtain the notes herself and submit to Unum, is in my opinion, a type of malpractice that could potentially put this claimant in harm’s way, or prompt self-harm. What is Unum thinking?
Another problem I have with this situation, and Unum knows it quite well, is that none of their ERISA Plans specifically state that in the case of mental impairment, claimants MUST submit actual psychotherapy notes as proof of claim in order to get paid. As long as the therapist is submitting restrictions and limitations precluding work, actual therapy notes are not needed. In fact, readers with Unum Group STD or LTD Plans should read the “proof of claim” provision, I think all of you will be amazed as what it DOES NOT require.
Obviously, this Unum STD claims specialist wasn’t thinking clearly, and went out of her way to be particularly nasty and threatening. My advice? Well, this claimant doesn’t have to take any “crap” (sorry couldn’t resist!) from a claims handler on the phone and should immediately request that all future communications from Unum be provided to her in writing only.
Secondly, the issue of therapy notes can be “nipped in the bud” by this claimant’s therapist by sending notification to Unum that she does not intend to provide therapy notes but will be happy to provide restrictions in summary form. I think this therapist could also “suggest” to Unum that it stop threatening her patient.
As I indicated earlier Unum’s STD’s review reputation has been in tatters for years, and I can well imagine the stress and pressure that must be going on now with the over run of COVID claims.
However, that’s no excuse for idle, out of contract threats, particularly to mental health patients. The irony of all this is that the claimant only has 1 month left on STD and has made arrangements with her employer to return to work.
So, congratulations Unum for alot of muck made out of nothing! Still, this situation was difficult enough for the claimant to handle given the nature of her disability and added stress.
Unum STD claims handlers have often been reported to me as rude and threatening individuals. Still, claimants need to defend their Plans and claims by requesting all communications in writing.
Let’s get all of that out of contract “nasty” phone conversation officially in the record.