Recent letters from Unum show indications that the company is once again using some sort of software (or review tactic) to arbitrarily assign recovery dates to claims.
For the last twenty-five years Unum used, off and on, a desktop software called MDA, to identify various diagnoses and then set recovery dates accordingly. The company actually denied claims for those insureds who were unable to return to work by Unum’s so-called “recovery dates.”
If you think about it, using MDA, or any other objective recovery guidelines is another type of “ERD” or Expected Recovery Date formerly used by Unum to end benefits. I doubt the company connected MDA recovery dates to the payment system financial reserves, but the intent of setting “recover dates” is pretty clear.
There are a lot of problems associated with using predetermined, projected recovery dates. First, insureds do NOT all recover at the same rate, or within the same time period. Second, insurance companies have a conflict of interest in setting ERDs or recovery dates within the shortest time period in order to manipulate profits. Third, use of MDA, or any other recovery software could be used in conjunction with “old” or “outdated” medical update information that isn’t accurate. GIGO principle applies here, “garbage-in, garbage-out.”
Lastly, the issue of “medical recovery” should rest solely with the patient and his/her treating physicians. Physicians have face-to-face exposure to their patients, while Unum review physicians are paper reviewers only. Leaving “recovery” decisions to claims handlers and managers is an arms length determination that is biased and prejudicial.
Arbitrary recovery dates also set-up insureds for AP&Cs, or Advance Pay and Close. This is when the claims handler “offers” to pay out the claim to the “recovery date” it arbitrarily set. Don’t fall for this sham, and be very careful of AP&Cs.
If you receive a letter from Unum telling you what your recovery period is, it is very important not to ignore the issue. Your physician should clearly include statements as to what your “recovery” period is. For example, most people on LTD should have “total disability” statements in the records and on their forms. Or, a statement the insured is at MMI (Maximum Medical Improvement).
If you need help with this please give me a call. And, don’t let Unum decide when you’re going to be well enough to work. This is the direction Unum is now heading in, and insureds need to be able to comeback for the record to discredit it.
My experience with these MDA-types of software is that once Unum (again) figures out that internal management of the recovery dates isn’t worth the bother, the software will once again disappear from the process. In the meantime, insureds should recognize Unum’s tactics in play and discredit any recovery date with a physician statement.
