Anytime “insurance” is paying a benefit you can be sure that “profitability” involving financial reserves are involved. We are slightly under two months to year-end and already I’m dealing with insureds who are battling Unum to keep their claims.
Already, Unum is using doc-to-doc calls, physician medical reviews, and numerous paperwork requests to target claims the company decides can be denied by year-end. Ridiculous requests are happening, particularly in the area of removing legitimate offsets, such as in a case where Unum asked for a copy of a dependent’s actual diploma before removing an offset due to graduation from high school.This is in addition to a formal termination notice from SSA stating the same. The obvious and deliberate time delay is obvious.
Unum’s physicians are sneaking in doc-to-doc calls in order to persuade treating physicians to agree with their agenda that patients can work. My readers should know that I always caution insureds about doc-to-doc calls and recommend patients discusss the possibility with their physicians and decide on a mutual course of action. Unum is entitled and authorized to request patient notes, and insureds should not be concerned about that.
However, Unum’s docs also send out question narratives to treating physicians that are very deceptive. Insureds should be extremely concerned when questions are sent directly to doctors. These narratives should never be allowed to be faxed back to Unum unless the insured has had an opportunity review it. Rest assured that I am not just spinning the fear wheels here. In most instances, doc-to-doc “anything” generally does not work out well for the insured.
I am also concerned about Unum’s physician timelines of requiring a 10-day turnaround on the narrative requests. Physicians who are unaware of Unum’s Plan/policy time requirements, are asking treating physicians to send back forms in 10 days when ERISA Plans generally cite 45-days, and IDI claims 90 days after the end of a period of claimed disability. Short deadlines are always tell-all signs of targeting benefits in time for year-end profitability.
And, you can be sure that surveillance teams are right around the corner. Year-end is the most crucial profitability reporting period for all major disability insurance companies. Therefore, this is no joke. Insureds should be well aware of what Unum and other major insurers are doing this time of year.
Many years ago, we had a saying at Unum that, “claims handlers should quit in October and come back in January.” It’s awful working for Unum during these months because of the pressure managers put on claims handlers to deny claims. Please take the requests received from Unum seriously, and remain in contact with your physicians so you can be notified of any Unum doc-to-doc calls. Don’t underestimate Unum’s docs either. They know how to get through when you least expect it.
Stay smart and know the process.
