As most of you know, I continue to have access to disability attorneys across the country, particularly those who stood with me back in 2004 to hold insurers accountable for their bad faith.
According to those I’ve spoken to recently, it appears that Unum (and other insurers) are worse than they’ve ever been. Lincoln and Guardian are close runners-up when it comes to aggressive claims management.
One of the scams I wrote about 10 years ago is back with a vengence. This particular scam involves using METS (Metabolic Equivalents) to determine functional capacity for work. METS are defined as the amount of energy expended as compared to the energy needed for sitting in a chair. Therefore, if someone had 5 METS, it means that “the activity” in questions requires 5 times the energy to do then sitting quietly in a chair.Of course insurance companies have given various definitions of work capacity based on the number of METS achieved.
Why do you think you are always asked on the update forms what your activities are? Or, whether you do your own laundry, or gardening? These questions trap the insured in to giving themselves “work capacity.” For example, doing laundry and carrying it upstairs is the equivalent of 7 METS, which insurers define as “Light” functional capacity for work. There are no published standards for using METS to determine functional capacity, other than what the insurance company “thinks they are”.
The problem with using METS to define work capacity is that METS measure performance “at a specific moment in time.” The METS ratio DOES NOT prove, or define “endurance”, or the ability to “consistently, or sustainably” perform physical activity over time, say for an 8-hour day. Nevertheless, insurance companies jump in with both feet and deny claims because an insured tested out at 7.5 METS on a cardiac stress test. This is why insurers are always chasing stress and PFT test results.
You can easily see the problem when, if an insured had a “good” day and ran on a treadmill for 7.5 METS on a stress test, but in reality only has “sedentary work capacity”, which is usually 5 METS or under. In addition, certain medical impairments cause fatigue over the course of an 8-hour work day. The ratio of METS achievable will decline over the course of a day just due to fatigue alone. Therefore, using METS to allege insureds are capable of “consistent and sustainable” full-time work capacity is a fallacy, and they think we’re stupid enough to believe it.
Insurance companies have been doing this for 20 years, but an unknowing public and their attorneys have allowed it without challenge. Perhaps it is time again to challenge everything an insurance company does and says. What is scary though, is that there is not going to be chance of public out cry to blow the whistle and make things better.
Companies like Guardian take another tack to their bad faith. It appears they NEVER stop “investigating” claims – ever. I know of one claim that has been under “investigation” (if you believe the letters) for about a year and a half. Once medical records are obtained, the company seems to start all over again, and the harassment continues for the duration of the claim. With Guardian there never seems to be enough records for “proof of claim. The Standard’s arguments rest with “we never received the records.” Unum is sending out letters saying the only thing they received is the APS form.
Now is not going to be a good time to think that you have all the answers to keeping your disability claim. These insurance scams can be undone, but you need to know how they work and what to do about it. I’m not trying to scare anyone, but those of us who worked in the insurance industry 20 years ago know how devastating it can be to lose a claim due to these internal scams.
If you would like to speak to me, please feel free to send an email and leave your number. It’s time again for insureds to take their heads out of the sand and realize what’s what – again.
