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SettlementMost individuals who sign on the settlement dotted line are perfectly content and happy with their decisions to rid themselves of insurance harassment and abuse. However, there are some, who after making a decision to accept lump sum payments as full settlement of claim, go through a period of mourning when monthly benefits no longer arrive. Although this doesn’t happen in every case, it happens often enough for me to write about it.

Perhaps without realizing it, some insureds live through a build-up of stressful anticipation and fear just before monthly checks arrive, followed by relief and a sense of protective paternalism when the money actually arrives in the mail. Insureds live through the nail-biting worry of “I hope I get my check this month”, followed by, “thank God, it’s here.”, month after month and year after year. Over time Insurance companies become very much like parents, who pay their kids an allowance every  month. Worry followed by overwhelming relief becomes an emotional habit that’s hard to break.

Second, as long as tangible cash benefits still arrive, there are those who associate the money with the career or job they once had. In a strange way, insureds my not fully accept the loss of a career or occupation as long the money is regarded as a substitute for personal identity and self-worth.  As many of you know, our culture and work ethic encourage us to believe in the looking-glass self that defines us by what we do for a living. When asked the question, “Who are you?”, most Americans will respond, “I’m a secretary”, “doctor”, or “fireman.” We define ourselves in terms of how we make money – that’s the American way.

Post Settlement Syndrome is a process of “mourning” the loss of receiving a monthly benefit even when intellectually insureds know it was the right decision for them to make. Characteristics described above, such as the habit of overwhelming stress, followed by relief/security, and the identification of benefits with self-worth, can push insureds into “regret mode” wherein for a period of time insureds tell me they wonder whether a settlement was the right thing to do.

Insureds describe reactions of continual crying, not being able to eat or sleep, and constant worry when there are no monthly benefits to look forward to. “Perhaps I did the wrong thing…..What about the economy? Did I get enough money to live on? I’m panicking because I know there’s no monthly benefit anymore. What do I do?”

Allow me to further explain that DCS Inc. takes the position that decisions to settle disability claims are individual life decisions and neither a consultant nor an attorney should advise anyone to take or not take a settlement. The role of settlement counseling is to provide knowledge concerning calculations, present value, discount rates, process and value, so that insureds can have information necessary to make good decisions on their own. Once the decision is made to sign a settlement release and accept a payable lump sum the relationship between insurer and insured is forever severed.

Post Settlement Syndrome seems to involve a sudden realization that former jobs, careers AND monthly benefits are gone, and for a period of time there is no focus whatsoever on the lump-sum sitting in the bank. Old habits are hard to break, and although there is no monthly benefit check’s arrival to worry about anymore, insureds who have signed on the dotted line substitute “settlement stress” for “benefit stress” and the cycle repeats itself for a period of time.

In addition, once monthly benefits checks cease to arrive, there is total realization of loss of career followed by confusion. If we, as Americans, identify ourselves by what we do for a living, and the monthly disability benefit goes away,  there can be a period of re-examination and definition of self and what’s in store for the future.

Mourning a settlement decision is actually the pathway to ultimately achieving financial freedom and a desire to have the quality of life that, at least in part, caused you to settle the claim in the first place. Knowing why you’re feeling so awful and regretful after accepting an insurance settlement is a first step to moving forward. There are some insureds who are so physically and emotionally affected by Post Settlement Syndrome that they actually call the insurance company and give back the money. While we don’t recommend doing this, we certainly understand it. (If you had an attorney negotiate the settlement for you, there really is no turning back!)

Disability claims are not all business and financial reserves; there is a very personal and human side to managing through the disability claims process including emotions, stress and worry after the settlement process.

Here are a few helpful suggestions that may help with Post Settlement Syndrome:

  • If you receive a lump-sum settlement offer, think it through. Read the letter carefully and determine if it makes sense.
  • Draw a line in the middle of a sheet of paper. On the right side write in all of your living expenses including prescriptions, rent/mortgage payments, doctor’s bills etc., and on the left side all sources of income if you were to take the settlement. If you have a spouse who is still working, include his/her income along with any other sources of income from rents, interest or dividend income. Determine if there is a surplus or deficit.
  • Explore investment opportunities with either a financial advisor or CPA before accepting the settlement. How will you invest the settlement money to provide interest or dividend income in the future?
  • Talk to your CPA about any tax consequences. This is a real cost and reduces the amount of actual cash available in the future.
  • Discuss the option of settlement with your spouse or partner and agree on any changes in lifestyle, or downsizing that may be necessary. The important thing is to make decisions everyone in the household can agree to and live with.
  • Think about any emotional conflicts or ongoing issues with your insurer that may be pushing you to accept a settlement when financially it may not be the right thing to do. Have clear expectations as to why you are moving in the direction of settlement.
  • Ask yourself if you have the skills and personality to manage money well. Lump-sum settlement won’t do you much good if you spend it all in 6 months.
  • Make settlement decisions based on the probability of future financial security balanced with any emotional goals to be free from insurance scrutiny.
  • If you do not understand any aspect of the settlement offer, obtain help and assistance from those who know.
  • Decide for yourself and your family whether a decision to accept a lump-sum settlement offer is right for you.

There is life after an insurance settlement, but sometimes you have to do the work to feel comfortable with your decisions.

Knowing why you’re feeling so depressed after an insurance settlement is the first step toward achieving your own family goals for the future. The good thing is that Post Settlement Syndrome does end and most people do not regret their decisions to settle.

Carrot & Stick Awards

Carrot and StickNot surprisingly, DCS, Inc. awards Mass Mutual a carrot for finally paying client benefits due for the last 8 months. With the assistance of DCS, Mass Mutual was finally persuaded its delay in investigating our client’s claim wasn’t reasonable. However, it was through this process that we discovered Mass Mutual could be following in CIGNA’s footsteps by insisting on speaking with treating physicians before paying claims. “Since when has it been a Mass Mutual internal protocol to call all treating physicians?”, we asked. The response to us was that “each claim is reviewed according to its own merits.” Good response, but Mass Mutual’s delay in paying our client wasn’t reasonable. Finally, after contacting the company on a daily basis, our client received all back benefits due.

A stick is given to Unum’s CEO Tom Watjen who appeared on CNBC and described Unum as helping employees because federal programs are insufficient. It has never been our experience that Unum helps anyone. Perhaps CEO Watjen needs to come out of the rock he’s been managing from and take a closer look at his claims and medical departments that deny claims unfairly for profit. Unum continues to be in violation of the multi-state settlement and remains an “unlawful organization.”

Although Unum’s stock price appears to be increasing, buying back 500 million in Treasury Stock artificially raised the market price. Any incremental increase in stock may not have been attributable to real growth particularly when Unum UK lost money. In fact, the Brits are still looking to rid their welfare system of Unum’s influence and in 2013 took to the streets in social protest. In my opinion “Mad Money” didn’t do their investigative homework before asking CEO Watjen to appear on the show.

Daily Buzz

Reminders

RELEASE OF PSYCHOTHERAPY NOTES

There’s quite a bit of talk these days surrounding the issue of whether or not insureds are required to submit actual psychotherapy notes as proof of claim. In this regard, insurance companies are way behind the times and continue to demand mental health information they may never get.

Several years ago, HIPAA was amended to give mental health providers greater decision-making authority as to whether they are required to release psychotherapy notes or not. The general consensus by most health care providers is that psychotherapy notes are created for their own purposes; are not written to either support or deny disability; and remain their own private property for which they have the discretion to release or not release.

Today, most mental health providers respond to requests for psychotherapy notes by stating, “As a matter of normal business practice I do not release actual psychotherapy notes to any outside third-party. However, I am happy to provide restrictions and limitations in summary form if submitted to this office in writing. All responses will include an invoice for my time.” (Yes, anytime insurers request information directly from any treating physician, he/she can bill reasonable fees for time, and use of office staff.)

Unum and other insurers often attempt to obtain psychotherapy notes by using signed Authorizations that clearly say, “does not include the release of actual psychotherapy notes.” Nearly  all insurers have separate authorizations for the release of mental health records. The problem often is that mental health providers DO NOT READ the authorizations sent to them.

DCS, Inc. has always taken the position that disability policy contracts generally do not state specifically under “Proof of Claim” provisions that actual psychotherapy notes have to be released in order to be paid benefits. The demand for mental health records is an administrative requirement of management, not a policy contract duty.  Prudential, and The Standard have denied claims because they were unable to obtain actual psychotherapy notes. This is an unfair claims practice since claim denials on this basis are punitive and punish insureds when therapists refuse to release records

Whether to release or not release actual psychotherapy notes should be carefully discussed with all mental health providers so that there are no surprises. To be clear, although mental health providers are not required to release their notes to insurance companies, they are still required to complete forms and provide mental restrictions and limitations in summary form. Information concerning impairment and why insureds are unable to work still must be provided to insurers when requested.

INSUREDS AND CLAIMANTS WITH ATTORNEYS

There has been another rash of calls to DCS, Inc. from insureds and claimants with attorneys. Although I’ve posted at least twice on this issue I feel as though I should at least mention my position again. This week I received so many “bad attorney calls” I found myself a bit frustrated in explaining once again that attorneys “aren’t great claims managers!” One gentleman told me a real horror story about his attorney who in negotiating a settlement kept telling him he made multiple mistakes in determining what the settlement offer should be. First, it was $82,000, then, $36,000 and finally his attorney told him if he didn’t accept the final offer of $21,000 yesterday, he was withdrawing from the case.

While the ethics here are atrocious, others who called me said over and over again the attorneys they contacted are telling them to come back when claims are denied. Oh my goodness……

My goal at DCS, Inc. is to be proactive and prevent denials so that claims issues never need to wind up on an attorney’s desk to the tune of 30% of future benefits. Although outcomes are never guaranteed, my goals are consistent with those of insureds who would rather benefits continue than fight a losing battle in court. I am aware that many attorneys do not want to spend their time managing claims because there’s no money to be had there. Going to court is where the bucks are and attorneys are always looking for the “biggest bang for the buck.” Back/future benefit agreements as well as six-figure settlement fees are highway robbery in most cases.

What bothers me most are insureds who contact me after having retained attorneys looking for free information because they either suspect the attorneys are not doing the right things, or do not have the answers to claims management questions.  In these instances, I always refer callers back to the attorneys they hired.

“But Linda, my attorney is doing exactly what you described on your Blog – having lunch with Unum attorneys and demanding I take a settlement when I don’t want a settlement!” You would be surprised how many times I hear this. In any event, I do not provide answers to questions when insureds and claimants have already retained attorneys. These insureds should rely on the attorneys who are taking up to 30% of their future benefits for answers. As I’ve said many times, attorneys “aren’t great claims managers”, but if you hire one anyway, I’m going to refer you back to them.

By the way, many attorneys call me to obtain answers to claims management questions themselves. I highly respect the attorneys who do this; at least they care enough about their clients to become knowledgeable enough to manage claims after they’ve already taken the fee.

DISCRETIONARY AUTHORITY AND TRYING TO ICE SKATE UPHILL

While some insureds and claimants are taking my advice to “read their policies”, there seems to be some misunderstanding as to which contract provisions can be enforced during the claims management process. ERISA Plans can still contain “discretionary authority” language. “Discretionary authority”, as you may recall, is permission granted to Plan Administrators to decide by themselves what claims to pay or not pay, and/or what the policy means. Many states have systematically banned or restricted the inclusion of “discretionary authority” in policy provisions because it acts in opposition to reviewing claims in “good faith and fair dealing.”

Although 31+/- states have now banned discretionary authority, it is not something insureds can beat over the heads of insurers while claims are paid. “Discretionary authority” is ultimately a legal argument, not a claims defense. It is a judge who will decide (assuming the claim is litigated) whether an insurer abused its discretionary authority, not an insured who writes to Unum, “there is no discretionary authority in my state, so pay me.” Claims handlers have absolutely no idea what “discretionary authority” is, and will ignore the issue anyway.

This is very similar to insurer violations of ERISA timelines in the review process. Yes, insurers often go way beyond 45-90 day review periods, but then again, “who’s watching?” Neither EBSA (US Department of Labor) nor state departments of insurance have mandates to assist claimants with ERISA complaints. A future judge may decide MetLife violated too many ERISA timelines, but it is the judge’s discretion to hold insurers accountable.

Trying to enforce a state ban on discretionary authority during the claims management process is trying to ice skate uphill. There are better policy provisions to focus on, such as the definition of disability, mental and nervous and proof of claim provisions. No one wants to be in court with a disability claim, but that’s exactly where abuse of discretionary authority should be addressed.

TALKING YOURSELF OUT OF YOUR CLAIM

Despite the fact that neither this blog nor DCS, Inc. has ever recommended speaking to insurance claims handlers on the phone, nearly every caller tells me, “I called my insurer and now I’m so sorry I did.”

While it is possible to OVERSPEAK a disability claim, most human beings feel compelled to “defend” their benefits by trying to convince claims handlers claims are credible. Already feeling guilty for not working, the tendency is to, “talk, talk, talk” at a time when the opposite is actually true. Insureds and claimants have a responsibility to answer questions asked in a truthful and honest manner, but that’s where the duty ends. To be frank, insurers really don’t care what else you have to say about, “I’m so sorry I can’t work,” or, “If I could I’d go back to work in a heart beat” etc.

Let’s face it…if disability insurance were any other retail transaction, insureds would insist on everything in writing. (Can you imagine buying a used car without a bill of sale?) It’s just good business. But, for some reason, insureds “are scared talkative” and will chat with a claims handlers for hours if allowed. It is not a good idea to have verbal exchanges on the phone. Insureds have the right to ask for all communications in writing. Doing so creates a much-needed paper trail of putting your point of view officially into the record.

Additionally, many insureds are taking opiates or other medications that may restrict their ability to communicate in a meaningful way.

HIV PhotoThere are recent reports that Unum may be focusing on HIV claims and limiting benefits to 24 months due to mental and nervous impairment. Boy, does this sound familiar since it’s the same Unum scam the company played with cardiac claims classified as mental and nervous.

In the past, Unum took giant leaps by alleging most cardiac claims were actually mental and nervous beyond a reasonable recuperative period. For example, insureds recuperating from recent heart surgery were allowed 12+ weeks to recover and return to work. Beyond that, insureds were classified as mental and nervous particularly if they began therapy as part of the rehabilitation process. Claims management could always depend on profit results from aggressively attacking psyche/cardiac claims and alleging “depression” was the primary diagnosis preventing claimants from returning to work.

The problem with this strategy was that not everyone physically heals at the same rate and “reasonable ERD (Expected Recovery Date) recovery periods” were not accurate indications of ability to return to work.

Likewise, in the last decade, Unum appears to also risk manage HIV/AIDS claims as mental and nervous alleging HIV medications are so successful that most HIV insureds could return to work in some capacity if they wanted to. Although it seems reasonable HIV patients might benefit from counseling, “depression” is generally NOT the primary diagnosis precluding work.

While it is true third and fourth generation HIV drugs are more successful in promoting health, HIV patients continue to suffer from a wide variety of medication side-effects, diarrhea, neuropathies, cognition problems, and fatigue. T-cell counts of 500 or above might show close to health in the lab, but in real life the co-morbidity of remaining symptoms makes HIV patients unreliable to compete in work environments that demand 40-hours+ per week with above exceeds performance. It isn’t possible for most HIV insureds to return to work full-time, and Unum knows it.

Most HIV patients treated for “depression” are treated as “secondary to physical disease.” Despite Unum’s awareness that HIV with secondary depression should be treated as a “physical” cause of disability, the company often opts to rename the disability as mental and nervous in order to benefit from a limited pay period of 24 months.

This is consistent with Unum’s patterns of practice of supporting claims decisions with a financial profit conflict of interest using internal reviews that are medically unsound and generally not supported by other HIV physicians. For example, a HIV patient with a T-cell count of 200 would most likely not be able to return to the workplace even if he/she was receiving treatment for depression.

Of late, Unum is taking advantage of every possible strategy in order to deny more claims including reclassifying HIV (a physical disability) as mental and nervous. In my opinion, Tom Watjen’s reports of Unum’s financial strength are a direct result of implementing bad faith strategies in order to increase denials or limit benefits to 24 months.

He isn’t really pulling the wool over anyone’s eyes when the company continues to engage in unfair claims practices in order to make more money.

HIV/AIDS is primarily a physical impairment, not a mental one– and Unum knows it.

 

PassportMr. X was diagnosed with a very serious medical condition and began receiving Unum benefits in 2005. In order to receive appropriate treatment he returned to Germany in 2011 and stayed approximately 7 months. As a dual American/German citizen, Mr. X was eligible to receive expert medical care for minimal cost.

In 2014, a Unum review discovered that since Mr. X had lived in Germany for more than 6 months as his contract stipulates, his claim should have been denied in 2011. Please note here, Unum paid the claim for two more years after Mr. X returned from Germany.

Although Unum is not asking for benefits from 2011-2014 to be repaid, Mr. X’s claim was recently denied and his question to DCS, Inc. was, “What do I do now?” I asked Mr. X if he had a copy of his policy, or if he read it prior to living in Germany, and he responded, “I don’t think I ever had a copy of my policy, but I’ll try to get one.”

How can any insured defend their rights under any disability policy contract when they do not have a copy of it, and haven’t read it? This is a very good example of why I continue to publish Lindanee’s Blog. It is extremely important for all insureds and claimants to read their policies and have a clear understanding as to what it says.

In answer to Mr. X’s question of, “What do I do now?”, my answer is to read the policy carefully. Although I haven’t reviewed his policy either it’s a sure bet that it stipulates benefits are not paid if the insured is out of the country more than 6 months. Note, the policy doesn’t say “except that if you are receiving medical treatment”, it just says “outside the United States for more than 6 months.”

If Mr. X’s policy is a DI policy, and he remains impaired, he can file another claim. He may go to Germany for medical treatment, but he may not live outside the United States for more than 6 months. If the policy is an employer group policy, benefits are lost since he would need to return to work full-time with the same employer in order to be eligible under the same Plan.

DCS, Inc. has been contacted on several occasions by insureds living outside the United States. They tell me it is easier to live on a fixed income in South America, Mexico and Thailand than it is in the United States. We strongly recommend to insureds that if they are thinking of moving abroad, a close read of their disability policies is essential. It’s far better to be sure than to lose benefits after relocating so far away.

 

Cancel ButtonSeveral other insureds have told Unum to “take a hike” giving up monthly benefits to rid themselves of Unum’s ever lasting harassment and allegations of wrong doing. Despite the appearance of those who say Unum is OK, there is no evidence to suggest the company is a pariah of disability claim management particularly when its customers are quitting camp.

Take insured X, for example, who went out on disability with an own occupation DI policy. Bored at home, he visits his wife’s ice cream business everyday so he can be closer to his kids who also work there. Occasionally, he scoops up a crinkle cone to help out, but as a former telephone line man he never worried a scoop here or there mattered much. After a three-day Unum surveillance and Internet check, Unum accused him of working and having unreported earnings.

Unum harassed Mr. X and eventually stopped paying him because he couldn’t produce 12 years of tax returns. Even the IRS informed Unum old tax returns weren’t available; still, Unum persisted and demanded copies his wife’s business tax returns. Although Unum’s contractual relationship with Mr. X did not extend to his wife’s business, the company continued to persist Mr. X had unreported earnings and investigated he and his wife’s passive income from real estate. Even though Mr. X’s policy explicitly excluded rentals and passive income as sources of earnings, Unum demanded to know what Mr. X’s involvement was in the properties. In truth, he collected the rent, that’s all.

After a year of Unum’s abuse and harassment I received a call from Mr. X asking me to notify Unum he was withdrawing his claim. “My wife and I decided that the money we get from Unum isn’t worth it anymore. Although I have an own occupation policy and I’m not doing anything wrong, we don’t want to live under Unum’s control that allows the company to harass us.” Mr. X went on to explain, “We want to have a quality of life unfettered by Unum’s unfair allegations. We want out.”

Mr. X’s decision is becoming more and more common among Unum insureds who cannot live under constant stress and harassment. While no one objects to Unum’s right to fully investigate claims, there comes a time when the company needs to acknowledge it has liability for claims and stop harassing its insureds. (All this is going on while CEO Watjen appears on CNBC and expounds on Unum’s virtues to investors.)

Ms. T, a former real estate agent, stopped working 14 years ago and was approved by Unum for benefits. After receiving benefits for 14 years, Ms. T became a victim when Unum reorganized its SHU and EDU and sent its best and finest to deny as many claims as they could. Unum’s Internet “snoop dogs” found information that she was listed as “Secretary” for her husband’s tile business and all hell broke loose. Although Ms. T kept her real estate license intact (just in case) she never worked and certainly was never put on her husband’s corporation as Secretary.

Unum went ballistic, and accused Ms. T of working as a real estate agent and never reporting her earnings. Even after submitting proof from her husband’s CPA that she was never an officer of the corporation and her former boss that she never sold property or had earnings, Unum continued to harass her for 10 years of tax returns and her husbands’ business returns. Again, Ms. T’s contractual relationship with Unum did not extend to her husband’s business, but Unum remained persistent that unless she produced multi-year tax returns her claim would be denied.

After a year of stress and frequent letters from Unum, Ms. T said, “I just want to be able to live my life without Unum accusing me of something I didn’t do. I never worked during the entire period of my disability. I want to withdraw my claim so my husband and I can live without being stressed out all the time.”

What can you say about an insurance company when its insureds throw money away to get away from it? One can’t discount the fact that Unum must be doing something wrong when insureds withdraw their claims and walk away. In my 20+ years of experience I have never had other insureds withdraw claims from any insurer other than Unum. There is a message here, and its bad news for Unum insureds and claimants.

Although there are those who contact me with, “Unum’s a good guy”, and “Unum doesn’t do anything wrong”, I would differ in that from where I’m sitting, Unum has a problem accepting liability and paying claims it should pay.

DCS, Inc. does not recommended walking away from legitimate disability claims across the board, but when insureds tell me they want unfettered, stress free lives that do not include looking over their shoulders everyday, I have to agree.

Mr. X told me he is reporting Unum to his Union, and Ms. T is happily spending more time with her family. Both of them agree they have better lives without Unum insurance and no monthly benefit is worth the abuse they had to put up with.

“I don’t have to worry about anything now”, Ms. T tells me, “My husband and I are free of worry and abuse.”

Mr. X smiles now when he scoops up the occasional chocolate fudge crinkle cone with sprinkles from behind the counter. “I may be disabled, but I’m happy being with my family everyday. To hell with Unum, and good riddance.”

https://www.linkedin.com/today/post/article/20140709173931-11228988-why-i-quit-facebook-and-we-are-sharing-much-more-than-you-think?trk=eml-ced-b-art-M-2-8101905734586409085&midToken=AQEwp1S–x_-KA&fromEmail=fromEmail&ut=2ZlqnJ9nlFl6k1&_mSplash=1

 

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