Although I haven’t been aware of Unum’s occupational targeting in a long time, I received three phone calls this week from insureds, all Nurse Anesthetists with claims managed by Unum.
Complaints center on harassment such as frequent phone calls and excess paperwork. Nurses have always been aggressively risk managed by Unum, but especially when individual monthly benefits are $9,500/month, or in excess of $3,000. Unum gains an immediate contribution to profit of an estimated 1.5M with a single denial. It’s a sure bet Unum is targeting wealthy Nurse Anesthetists claims. Again.
Nurses who file claims with Unum have always been victims of over reaching occupational reviews that allege RNs of all specialties can perform all other specialities. For example, Unum assumes all RNs can be “school nurses”, or ER RNs can perform patient care. Most RNs will tell you they aren’t trained for all nurse specialties, and would need to receive more training in order to be able to perform in specialized areas.
Unum seems to get a great deal of leverage in defining the occupation of RN as a one size fits all job. Not all ERISA plans contain provisional language, “If you have a specialty, it is determined to be the specialty just prior to your date of disability.” Even if the Plan does contain this definition, “any occupation” investigtions open the door again to all areas of nursing. By the way, nursing isn’t the only occupation Unum defines broadly – attorneys are also victims to one size fits all possibilities.
Anesthesiologists are often victims of Unum’s occupational prejudice regarding the medical profession, even though physicians tend to have IDI policies more so than ERISA Plans. However, Nurse Anesthetists rely on their employer’s ERISA Plans and, of course, Unum takes advantage. Members of the medical professions who have Unum Plans need to take great care when managing their claims. In my experience, it’s very important to present claims in ways that prevent Unum from defining occupations broadly enough to deny claims after 24 months.
In addition, we are very close to year-end and therefore, Unum’s targeting of claims is very important for profitability sake. My recommendation for RN claimants is to be very careful of paperwork, and what you say and document. I can accurately say that it will be interpreted in ways that lend to allegations RNs can work in all areas of specialty in order to deny claims.
If I’ve received three phone calls already this week, it is likely there are many more Unum RNs out there who are targeted for year-end denial even though occupational targeting is done year round, not just at the end of the year. If you are a Unum RN Anesthetist and are having problems with Unum, please feel free to give me a call.
