Most of you probably weren’t in the disability environment when Unum was found to be engaging in claims practices that were unfair. (2004) One of the concerns of the Multi-State Regulators was that Unum was depending solely on internal medical reviews and were ignoring all information submitted by primary care physicians.
As a result there was an Amendment to the RSA (Regulatory Settlement Agreement) requiring Unum to consider all treating physician opinions, and, if they don’t, give reason why they did not. In retrospect I think most people involved with disability claims would agree that Unum has been in violation of the Multi-State Agreement from the time it was signed.
Intertwined with Unum’s bad faith claims practices are strategies that bring back the old familiar stereotypes of “Stacking the Deck”, “Biggest Bang for the Buck” and “Hungry Vulture”. It appears Unum is right back to where it started with egregious claims practices when Must-State regulators held them accountable.
I recently read a Unum denial letter where it was documented that Unum had the medical information reviewed by no less than four separate internal medical resources. This is a clear example of “Stacking the Deck”.
I had to laugh. Unum was actually stupid enough to think that the more internal reviews you have done, the more credible the decision to deny. Actually, multiple internal reviews point exactly to Unum’s intent to deny. Remember, I’ve always said that internal medical reviews created the ILLUSION of credibility, but do not document the truth.
I’m writing this article to inform insureds that Unum’s back in full force with their “Hungry Vulture” medical reviews. (Reliance Standard and Lincoln Financial aren’t too far behind.) This is serious folks! Insureds and claimants need to sit up and understand very clearly that it is possible for Unum to misrepresent your medical information to create fictitious credibility in order to deny claims. It’s a reality, and it’s back!
A sure fire way to prevent Unum, or any other insurer, from creating an Aesop’s Fable from your medical is to make sure that your physician DOES NOT SPEAK WITH ANY INSURANCE DOCTOR ON THE PHONE. Unum loves these, “doc-to-doc” calls when they can intimidate your doctor into giving you work capacity, or even to “take back” what was previously reported on a form. You don’t have to give your doctor permission to speak to anyone on the phone, and you should discuss this with your doc and mutually decide how to handle the calls.
Second, don’t allow your doctor to “get away with” not filling out your forms completely. The forms MUST document medical restrictions and limitations, treatment plan, diagnosis, prognosis, whether or not you are at MMI (Maximum Medical Improvement), current medications, and statements about appropriate and regular care.
Don’t be surprised if your medical is challenged, or claim denied, if the above information is not present. I know, people always tell me, “I’m surprised Unum denied my claim”, or, “I’m frustrated.” But, now that Unum is in aggressive mode to deny more claims, you can be sure the “Hungry Vulture” is out there waiting for you.
I used to try and soften this type of message, but 20 years ago people listened, and tried to do the best they could to stave off Unum and its unfair claims practices. Today, most people don’t listen, and that’s to Unum’s advantage isn’t it?
I sincerely hope you accept this message in the spirit of good intention. If I were a Unum insured I would make it a point to have a serious conversation with. my physicians and let them know what you expect from them. You can’t afford not to anymore.
