Lately, insureds are reporting to me what Unum Group claims handlers are doing to delay payment on claims. Most of it, to be honest, is a bit silly, and yet it is frustrating many claimants with positive insurance company results. While it’s not unusual for Unum to pull out its bag of tricks around the holidays, one would have thought the company could have grown up a bit by now.
Unum is alleging that paperwork faxed by physicians, and/or claimants themselves is lost. Second, claims handlers are alleging that paperwork is not legible. In fact, one claimant called me to say that the claims handler threatened to deny the claim because paperwork is not legible.
Unum pulled the “not legible scam” on me once with a client. I had the client completely do over her paperwork with a blank pen, printed. This was the only way Unum accepted the paperwork. By the way, this claim had a $10,000/month benefit. Funny how that works, paperwork leaves the claimant totally readable, and arrives at Unum not legible.
Apparently, Unum’s claims handlers are threatening claimants and insureds with denial when paperwork is allegedly “lost” or not readable, or so THEY say. Of course, you aren’t communicating with Unum by phone, but if you are, the door is open to verbal abuse, and threats, and a whole string of other insults. Don’t speak to Unum on the phone, I’ve never recommended that.
You may recall on this blog how many times I written about how negligent, chaotic, and disorganized insurers are. My observations are telling me that claims handlers are too lazy to take the time to even TRY to read challenged paperwork; and, since they are only reading the top 10 pages of any file, they have really no idea what paperwork was previously received or not.
I doubt very seriously whether any Unum claims handler is trained on Unum’s role as a “fiduciary.” A “fiduciary” acts in the best interest of their client, claimant, or insured. Disability policies are essentially “contracts of adhesion” meaning that one of the parties has no say in what the contract contains. Because of that, all insurance companies and group employers are considered “fiduciaries” and differences of opinion should be decided in the best interests of the claimant.
Whether this is actually in practice is another article entirely, but with respect to alleging paperwork is not readable, making threats to deny doesn’t seem to be acting in a fiduciary way. Claims handlers and medical reviewers just do not want to take the time to try to decipher anything.
Losing paperwork is a result of disorganization, and all insurers are now so disorganized that it is surprising they find anything. Although I understand the insureds’ frustrations, it appears to me that no one is targeting lost paperwork deliberately, but insurers can’t find anything due to their own internal problems they themselves created.
If you’re getting the Unum runaround while it is claiming your paperwork can’t be read, do the paperwork over with a black pen and print it clearly. DO NOT use your iPhone or iPad to “take pictures you intend to send to your insurance companies. They do come out illegible, brown and dark. Paperwork should be scanned, converted to PDF documents and then faxed. Don’t give Unum an excuse to delay payment on your claim.
If Unum is telling you they didn’t get your paperwork, then obtain it yourself, and send it to Unum US Priority Mail Signature Confirmation. The large envelope can be tracked and you’ll have a record of who signed for it. If you’ve already confirmed Unum received your documents, send Unum a copy of the confirmation of receipt and tell them, “go look for it.”
We are approaching year-end results. Unum will try anything, regardless of how out of contract, stupid or silly to either delay payment or deny outright. IT DOES NO GOOD TO RANT about the “who done its” regarding these issues. It’s far better to “solve the problem.” By the way, DCS clients do not speak with any insurer on the phone, and are recommended not to use Unum’s website portal.
As a Consulting advocate for you, it is far better to put best practices in place that counter Unum’s allegations rather than to accuse and rant and show an insurance company your frustration. I get it, I’m on your side, of course, but these types of issues should be “resolved by you”, not “argued by you.” These are the types of issues I handle for my own clients with excellent results.
Never buy in to Unum’s dragging you down the black hole. My recommendation as a Consulting advocate is to just solve the problem.
