Lately, the scuttlebutt among legal and consulting circles is that Unum is out of control – again. Personally, I don’t think it’s just Unum, I am of the opinion that all insurers have left the realm of file review sanity.
Still, reports of Unum “migraine headache” denials in the last six months have circulated sufficient to once again identify the company as an “unfair reviewer.” I’ve written several articles having to do with migraines, but this article is also important because it deals with the reasons why neurologists are NOT the best physicians to certify disability claims.
First, I remind you that “migraines” are subjective, and for the most part are diagnosed via clinical observation, self-report, and trial and error. Given the fact that certifying physicians are getting more and more unlikely to support total disability, neurologists in particular, are now refusing to sign anything that has to do with functional capacity.
Part of it is that neurologists just don’t want to “put themselves on the line” for any impairment they can’t prove with testing. Clearly, neurologists are now alleging “they know nothing about functional capacity and are refusing to sign off on whether or not insureds can work. It’s the easy way out for physicians who are known to be somewhat “snotty” anyway. (Sorry, guys!)
Therefore, the best track is for migraine insureds to turn over regular care to either a family physician or internist, and see the neurologist twice a year. Physicians engaged in family practice or internal medicine are more than willing to sign disability paperwork without a great deal of fuss.
Orthopedic surgeons are also infamous for not supporting disability claims with their signatures. Having performed the surgery with a reasonable post-op period, orthopedic surgeons presume all surgeries were successful, and won’t sign off on continued disability. Last in line are PM&R (Physical Medicine & Rehabilitation) physicians since they believe EVERYONE can be rehabilitated and returned to work. Not a good idea for disability forms.
I realize that insureds get attached to their physicians and are hesitant to find other doctors. Although, I’ve said this many times, “No medical restrictions and limitations, no claim”, some insureds refuse to move on to other doctors who will help them support disability claims. That’s a shame.
In any event, Unum is reported as being on a rampage, particularly with migraine and other “subjective” claims. Any impairment that has the word, “Syndrome” in its name is also targeted, such as Fibromyalgia Syndrome, Chronic Fatigue Syndrome and Ehlers-Danios Syndrome (of which there are more than 40 varieties).
If you have any questions about any of this please feel free to send me an email. If you have a Unum migraine claim, you may want to talk about it at the earliest before Unum has an opportunity to deny the claim.
