It has now been over 20 years since a 48-State Commission publicly slapped UnumProvident’s hands for engaging in Unfair Claims Practices. A fine of $15M and a directive to reassess 250,000 claims failed to change the direction of a company that should have met the same fate as Enron.
An additional fine of $18M by the State of California did little to curb Unum’s practices of “stacking the deck” against insureds and claimants. In fact, in 2008 at the end of the “reassessment” Unum re-branded itself as Unum Group and emerged worse than it’s ever been.
At the time, the insurance commissioners found that among other egregious claims practices, Unum engage in the following:
- excessive reliance on in-house medical staff to support the denial, termination, or reduction of benefits;
- unfair evaluation and interpretation of attending physician or independent medical examiner reports;
- failure to evaluate the totality of the claimant’s medical condition;
- and an inappropriate burden placed on claimants to justify eligibility for benefits.
I don’t think it would be unfair for me to say Unum Group has never been in compliance with the Multi-State Settlement Agreement. It emerged from the abyss unscathed. Today, Unum Group is reported as denying many claims for 3rd Qtr. profitability using the same techniques it used 20 years ago. Unum, as a business, never changes.
As a person who was managing Unum claims, for Unum, from 1996 to 2001 I can attest to the validity of the above listed Commissioner concerns. Unum’ main tactic is to use its own medical resources to review claims, making doc-to-doc calls, and certifying IME results on its own behalf. Unable to police itself, Unum’s “thing” today is to claim medical information was reviewed by more than one internal doctor.
Managers at Unum can be pretty stupid sometimes. Does it seem logical to anyone that Unum’s reviewing physicians would ever disagree with each other? If they want to keep their jobs they will agree! One denial letter I reviewed documented as many as 4 separate internal reviews all resulting in the same conclusion. This is what I mean by “stacking the deck” against their own claimants. Unum doesn’t seem to realize they produced one bad opinion and 3 that are complicit in the cover-up.
Unum is obviously under the impression that the more opinions you can add to the file, the more credible Unum’s denial is. In reality, if it quacks like a duck, swims like a duck, and waddles like a duck, it is a duck. More than one medical review listed in the denial letter is a clear sign of deck stacking, however wrong it is.
The second concern of the Commissioners is the fact that Unum ignores the opinions of treating physicians AND/OR misrepresents them. Using claimant and misrepresented patient notes is another one of Unum’s specialties. Usually, what is written says itself, but you’d be surprised at how many times Unum puts forth all that is favorable to itself at the expense of all that is favorable to the insured.
The next Commissioner concern speaks to Unum’s omission of evaluation when it comes to “co-morbid claims”. Unum’s tack is to evaluate each diagnosis separately and eliminate one by one as not resulting in impairment. In truth, for someone who is co-morbidly impaired the logic formula is true, a+b=c. In other words, the diagnosis is not just one or two diagnoses, but combined, a whole new “total body” impairment exists. Unum refuses to evaluate the “total body” co-morbidity as causing total disability.
The last concern is Unum’s inability to complete an investigation. Although it has several “third-party-paper-chasers running around attempting to get patient notes, it is often unsuccessful. When this happens, Unum blames the insured and turns the tables that “proof of claim” was not provided.
In theory, for ERISA Plans, it is the responsibility of the claimant to provide continued proof of claim within 30-45 days of being asked to do so at their own expense. Although Unum does “go out” to get information, it doesn’t really have to. If the information is not received, Unum’s throw-back to claimants will surely happen and claims will be denied. For IDI contracts, Unum does have accountability to request and receive proof of claim, although it may try to use the same throw-back on IDI insureds.
I hope people are listening to me this time around. I’ve been writing this blog since 2004, and I can honestly say that sometimes insureds think I am over-reactive. We are right back to 20 years ago and Unum is once again denying claims indiscriminately. Don’t allow yourself to be one of them.
