Unum – Chronic Fatigue Syndrome – Another “Collaborative Strategy” by Linda Nee

In 1995 Unum’s Atlanta Southern Region Benefits (SRB) put together what it called a “collaborative strategy” to “manage CFS files more aggressively” and in a “proactive rather than a reactive fashion.” The so-called strategy was called the Chronic Fatigue Syndrome Management Program (CFSMP) and involved members of Unum’s management such as Dr. Carolyn Jackson, Sally Fowler, Dr. Don Abbott and potentially Susan Steele and Anne Dinsmore.

The 1995 document specifies that in part the role and responsibility of those involved will be to “engage in open and objective discussion on interpretation of results from IMEs and FCEs.”  Unum’s objective regarding the CFS  project states the following, ” The CFSMP is based on the premise that CFS impacts more than just UNUM  employers, attending physicians, and claimant are at risk. Many attending physicians are having a difficult time managing through the subjective nature of CFS. Group policy holders (employers) are paying higher premiums and losing valued employees. Many highly educated and trained professions are losing motivation and slipping into self-imposed oblivion because of CFS.”

Unum claimants and insureds with CFS should not walk over the last statement….”slipping into self-imposed oblivion!” If the statement truly represents the philosophy of Unum in reviewing disability claims, then insureds certainly are being subjected to a deliberate prejudicial review process in which the claim doesn’t have a chance of being paid. Although the CFSMP project documents are old, there is sufficient file evidence to suggest CFS claim applicants today are subjected to the same highly discriminative view documented by management years before.

The document itself contains a page titled Chronic Fatigue Syndrome, Current Thinking at Unum. Quoting directly from that document here’s Unum’s Diagnosis, Claimant Profile, Condition Profile, and Treatment.

Diagnosis – “Neurosis with a new banner.”

Claimant Profile – “Professional working women ages 30-50; Susceptible to doctor’s power of suggestion; Self-reports symptoms; Longer Claim Duration; and Difficult return to work (recovery claims).”

Condition Profile – “Burnout: loss of concentration, memory, sleep; Sensitive immune system; CFS is a symptom, not a cause; Cause involves other psychological, psychosomatic issues; Often linked to soft tissue conditions (fibromyalgia).”

Treatment – “Eliminate all other conditions before giving CFS diagnosis.”

In its conclusion Unum outlines its final objective called Executive Summary as follows:

“The objective of the Chronic Fatigue Syndrome Management Program (CFSMP) is to effectively address the growing number of Chronic Fatigue Syndrome claims through collaboration with attending physicians, claimants, employers, and internal Unum groups thereby reducing Unum’s financial exposure while simultaneously motivating claimants to gradually and willingly return to work.”

As CFS insureds you need to be careful of what is called UNUMSPEAK when reading its literature. What this paragraph is directing to those who understand the lingo is this:

“The objective of the Chronic Fatigue Syndrome Management Program (CFSMP) is to effectively target and “risk manage” the growing number of Chronic Fatigue Syndrome claims by contacting physicians, claimants, and employers using a “collaborative strategy” to return CFS patients to work, thereby reducing Unum’s financial reserves by limiting the number of CFS claims that are paid.“

Amazing how different the message from management is when UNUMSPEAK is appropriately translated. As a former employee of both Unum Life Insurance and UNUMProvident I can accurately state I’ve sat through many “pilot projects” given by management where the objective is to target certain groups of claims intended to “reduce Unum’s financial exposure.” Great term for “deny more claims.”

Currently as evidence suggests from Unum claim files, CFS remains a “compilation of subjective complaints” by individuals who are “highly educated professionals slipping into self-imposed oblivion.” On occasion, Unum’s medical department appears to have some difficulty distinguishing chronic fatigue as a symptom of fibromyalgia as compared to chronic fatigue syndrome which is diagnosed using a set of diagnostic criteria published by the CDC.

Although there is a great deal of research going on in the medical community linking CFS to an identified virus, it is, of course, advantageous to Unum to claim results have not yet resulted in solid evidence. CFS claimants and insureds need to be careful what they wish for. If it should happen the medical community approves a blood test to identify a virus present in CFS patients, Unum and other disability insurers will no doubt look for results of that blood test in every CFS patient and will consistently eliminate all CFS claims with negative results. This is consistent with how UNUM currently manages Lyme patients in the absence of a positive Western Blot or CD-57 blood test.

Bottom line the existence of Unum’s CFS “collaborative project” report, even though the document dates back to 1995, is that it suggests the company had internal strategies to target certain impairments and occupational groups for the intended purpose of reducing its “financial exposure”. (Not paying claims.) Of course when asked about the project Unum alleges it never implemented the CFSMP program and didn’t promote it, although one might also argue Provident didn’t really know WHAT was going on at the time of 1999 merger.

In reviewing Unum Group’s CFS claims today, there is documented evidence suggesting the company: 1) still targets CFS claims; 2) considers the impairment to be “subjective”; 3) rejects physician’s medical reporting for CFS as over-restrictive; and 4) denies a disproportionate number of CFS claims as compared to other impairments. (Fibromyalgia also fits conveniently into this category.)

Once again those CFS insureds and claimants with Unum policies may not be getting a fair shake when the disability is described by the insurer as “highly educated professionals who are slipping into self-imposed oblivion.” The philosophy behind such statements suggests a claims process that isn’t fair or objective.