Yesterday, I received 4 calls from claimants reporting denied claims. Although three of them were non-clients I referred everyone to experienced attorneys for Appeal processing. They were all ERISA claimants with Unum Plans, and one person was from Texas. So, in the middle of a power outage, freezing cold, and no water, Unum decides to deny a Texas claim. Could anything be worse than this?
Unum is obviously attempting to recapture financial COVID losses by targeting and denying more claims for 1st Qtr. profitability. Previously, it appeared to me that the company was backing off of “targeting” but a recent claim denial provides convincing evidence that’s not the case.
Unum denied one of the claims for “failure to meet the Elimination Period”, an assertion it expressed early on in the claim. After a while it became obvious that regardless of the amount of paperwork provided, Unum was still going to deny the claim for the same reason, which by the way, would have paid a monthly benefit of $6,500. Given the claimant stats, Unum probably recorded $1.5M in profitability by denying the claim.
One of the cold calls I received was from a woman who had been complaining up the Unum chain of command hoping to get someone to overturn the denial and pay her claim. She actually got to the CEO’s office. What she didn’t know was that no senior official, including the CEO, will “make” the claims department pay a claim. CEOs are NOT involved in daily operations and they won’t do anything to tie the hands of the claims department who is held accountable to roll-in profits.
In addition, EBSA Regional offices of the U.S.Department of Labor do not have a federal mandate to assist claimants with their ERISA appeals. The only effect a complaint has at the Department of Labor is to ask the insurance company for an explanation, and then recommend you get an attorney. Most of the time, “complaining” only makes YOU feel better, but doesn’t really have any benefit to change the direction of your claim.
The truth is that Unum processes claims and has so many “bad things” it can do to deny that it would take me days to explain them all. Other insurers have the same claims practices but without “targeting” as much as Unum does.
Therefore, I’m sorry to say that Unum’s egregious claims practices to target and deny legitimate claims has begun for 1st Qtr. profitability. Remember, I can’t help you if your claim is already denied. Your options are extremely limited after-the-fact to retaining an attorney to process an appeal. This option is not timely, is expensive, and often not successful. The best solution to a claim denial is to avoid one as much as possible in the first place.
