As Unum tightens the rope around insureds’ throats to deny claims (again), the old-time, biased internal physician review re-emerges with aggressive internal non-acceptance of medical restrictions and limitations, doc-to-doc calls, and treating physician questionnaires sent without insureds’ knowledge.
It’s the old insurance scam of “misrepresentation of reported medical information” taken from patient notes. While Unum’s internal physicians are still leaving their ethics at the door, doc-to-doc calls seem to be the most disastrous to insureds and claimants.
Doc to doc calls repeat the company “stack the deck” agenda with telephone calls to treating physicians. Specifically, the agenda is to convince treating physicians that Unum’s opinion about their patients’ work capacity is correct, namely that everyone can go back to work.
Although treating physicians with a backbone may be willing to support their patients’ medical restrictions and limitations, increasing numbers of doctors just want the problem to go away and wind up agreeing with Unum’s biased physicians, IF THEY TAKE THE CALL. Interestingly, treating physicians are NOT required to speak with any insurance company on the phone, and usually don’t, but there’s always a few crusaders who think they can compete and win against Unum’s experienced insurance doctors. It sometimes doesn’t work out well for the patient/insured.
For those treating physicians who won’t speak with Unum on the phone, the next jack-in-the-box is a narrative questionnaire putting forth Unum’s opinions with questions for the insureds’ physicians, usually involving a release to return to work. If the physicians fail to send the narrative back in, it is assumed by Unum that the treating physicians agrees with its opinion and disability claims will be subsequently denied. This is why it is so important for treating physicians to inform patients when they receive insurance narrative requests and allow patients to review their doctor’s responses.
Treating physicians who refuse to do this are usually saying one thing to Unum and something else to their patients. These physicians shouldn’t be trusted to support you and your claim.
Unum also seems to use PM&R (Physical Medicine and Rehabilitation) doctors as reviewers. My opinion of PM&R physicians is admittedly not good since if you break your leg playing basketball these physicians could probably treat you; anything else forget it. There’s a lot of money in sports medicine these days!
In addition, consider…..”Rehabilitation”; my experience proves nearly all PM&R physicians are of the opinion that all patients can be “rehabilitated” and returned to work. They think if they sign disability paperwork or agree someone is disabled, they’ve failed at their jobs. But, this seems to be the perfect specialty for Unum’s docs to direct reviews and doc-to-doc calls.
It’s pretty messy out there right now, however, I have had good outcomes with Principal, Northwestern Mutual, and surprisingly, Sun Life. Speak with your treating physicians and let them know your decisions about speaking with any insurance company on the phone. It’s a risk, that perhaps you and your doctor may want to avoid.