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Really, Really Bad Idea – Per Se ERISA Appeals

Most of you know I maintain contacts with attorneys across the country who keep me generally informed of trends and insurance actions that continue to be unfair and egregious. For the last year or so, I’ve been hearing a great deal about claimants attempting...

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Unum’s Denial Abuse For 2nd Qtr. Profitability

Unum’s abuse of power denying claims for 2nd Qtr. profitability results has reached an all time high. Using broad and unclear provisions to deny high value reserve claims, Unum is likely to be sued by many seeking recovery of benefits legitimately due to them....

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Friday Q&A

Can you explain how Worker’s Compensation offsets due to Lump Sum Settlements are determined? Sure. As most of you know, Workers’ Compensation is always included in most ERISA Group Plans as an offset to benefits. The WC system has progressed to a process...

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Those Awful Misleading Insurance Questionnaires

  The insurance industry has always been a “paper” dedicated rule book beginning with state regulators and moving down to individual companies. There are often more “forms” required than needed, making the entire claims process an...

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Former Clients Reconnect – Always A Pleasure

It never ceases to surprise me when former clients contact me many times after 10-15 years when they’ve long since reached the maximum duration of their claims. It is always a pleasure to speak with former clients, and I rarely forget a name. The formation of...

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First 104 Pages Of My Book

Anyone who is interested in reading the first 104 pages of my book please send me your email address and I will send you the first 104 pages. It’s a history of Unum’s claims paying process and contract abuse. I’d like your feedback as well. If...

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Accountabilities- Real And Presumed

  So much is written and said about what accountability insurance companies have to the disability Plan or IDI contract. However, claimants and insureds also have obligations to enter into the contract in good faith and fair dealing. Since most...

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Summer Surveillance Is Alive And Well

Reports of summer surveillance are already coming in to DCS with the potential to deny claims. Although I try to remind readers of increased surveillance, I’m pretty sure most insureds exceed medical restrictions sometime during the summer. The problem is...

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So What’s Up With Guardian?

Guardian’s reputation with the public is slowly dwindling, and for good reason. The newest fiasco, is not having a process in place that provides IDI insureds with forms needed to file disability claims. I had to personally get involved with giving “Notice...

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Who Are The Claims Handlers And What Do They Do?

In today’s terms, insurance claims handlers are really not “specialists”, but are considered bottom rung glorified Administrative Assistants, hired for the sole purpose of chasing paperwork and routing files back and forth among resources. Claims...

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Is Your Doctor Becoming Troublesome?

  The new normal, “after COVID”, seems to be driving disability physicians to tighten-up their support, and the manner in which they choose to support claims, and not in a good way either. Physicians are more cautious, skeptical, and selfish about the...

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Hungry Vulture 2d Qtr. Profitability Results End of June

I just wanted to send out a reminder that the end of June is the end of the 2nd Qtr. profitability results for insurance companies. This means there are organized efforts to locate vulnerable claims, and conduct investigations to create the illusion that claims should...

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New Fee Structure Reflecting The Times

I wanted to remind my readers, and in particular those who are looking or needing help with their disability claims, that I offer new insureds the option of paying my annual fee  on a monthly basis. It has always been my practice to offer insureds the option of paying...

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Summer Surveillance

Surveillance in one of those insurance investigative actions that does not require insureds to do anything wrong. It is an interpretative risk management activity insurers use to identify “inconsistency of report” between R&Ls reported, and observable...

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A Unum Issue – Regular And Appropriate Care

Prior to 2000, Unum’s Group Plans and policies were issued from a category referred to as “XL” or “XLL”. These Plans lacked clarity and resulted in Unum’s infamous “blue memos” directing claims handlers to deny claims...

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A Unum Blast From The Past – 1994-1996 History

From 1994-1996 Human Resource functions were split between two separate departments—UNUM America HR (payroll, and all HR functions for non-executive personnel), and Enterprise HR (HR functions relevant to the CEO, Jim Orr III and the top 26 Senior Vice Presidents.) I...

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