Unum’s Deception About SSDI Files – A Necessary Read

Reader’s have often read posts in which I clearly state “insurance companies do not tell the truth.” Unum’s continuous harassment of insureds with requests to sign SSA releases to obtain SSDI files is an excellent case in point.

In 2004  state commissioners who reviewed UnumProvident’s unfair claims practices identified Unum’s strategy of forcing claimants to apply for SSDI and later terminating the same claims alleging work capacity as an unfair and egregious claims practice.  This process was and remains very profitable to Unum. Unum forces all claimants to apply for SSDI and when they are awarded benefits collects on the overpayment. Then, when the claim reaches the 24-month change in definition the claim is denied because Unum’s reps “identify alternative occupations the claimant can perform based on their training, education and experience.”

One of the worst things that can happen to a Unum insured is to receive SSDI benefits (at Unum’s urging) give back the overpayment, and then be informed the claim is denied after the “any occupation investigation” at 24 months. The insured doesn’t have the benefit of the overpayment, and no longer has a claim. If the employer integrated health benefits with LTD, the claimant no longer has any health insurance coverage either. Not good.

Therefore, as part of the multi-state settlement Unum agreed “to consider” SSDI awards when making its own liability decisions. (No other disability insurer has ever agreed, or has been forced to do this by any governmental body.) Although the multi-state settlement agreement did NOT specifically require Unum to force claimants to give authorizations to obtain the entire SSDI file, Unum found it to be to their advantage to obtain the file since SSDI decisions often contain additional information Unum can use to deny benefits especially if the claimant appeared before an Administrative Law Judge.

It is important for readers to understand if Unum strictly adhered to the multi-state directive to “consider” SSDI awards Unum might not be very profitable. Therefore, Unum had to devise some sort of internal strategy to “satisfy regulators” while at the same time neutralizing the effect of “considering SSDI awards” as proof of disability. Make no mistake, Unum and its management are experts at camouflaging internal unfair claims practices to appear credible when in reality they are not.

Here’s Unum’s current strategy:

• Force claimants to apply for SSDI even when it appears the claimants may not be eligible for federal benefits.
• Collect the overpayment to reduce the cost of claims.
• Convince and persuade claimants to sign authorizations to obtain entire SSDI files by informing them their request is “for their benefit” and that “Unum will give the information considerable weight when making their own liability decision.”  Obtaining the entire SSDI file may provide Unum with additional ammunition to deny claims while having possession of the actual file will satisfy regulators Unum is considering the information even though they are not.
• Follow-up with continuous requests for signed SSDI authorizations until the claimant gives in and provides it. Inform the claimant it is in their best interests to “give up” the file.
• Obtain updated medical information such as an IME, doc-to-doc call, or simply update medical information so that “more current” medical restrictions and limitations are in the file.
• Obtain surveillance of the claimant, most notably performing activities not allowed or restricted in the SSDI file.
• Deny the claim with the following rationale: “We do not dispute that she (the insured) was impaired at that time and have approved benefits beyond that date. However, we have received significant information since that time, which demonstrates that the insured has greater capacity than previously opined. This includes reports of her activities, medical records, surveillance and an IME, which serves as compelling evidence that the SSA award is inconsistent with the applicable medical evidence. Therefore, our decision differs from that of the SSA.” 

Remember this is AFTER Unum cajoled its claimants to apply for SSDI, demanded repayments, and harassed claimants to sign SSDI authorizations, “so that Unum can give claimants the benefit of the decision.” And by the way, “if you do not sign the authorization and we (Unum) cannot give the claim the benefit of the SSDI determination, Unum’s decision will be made using only the information we currently have.”

We all have to admit Unum’s strategy to remain complaint with the multi-state settlement agreement is very clever. The problems, however, are the misleading (if not dishonest) written communications made to the claimant claiming SSDI files will be used to the claimant’s benefit. DCS, Inc. has read as many as five Unum denial letters all claiming the existence of “more current medical information” invalidates its mandate “to consider” SSDI files before making their own decision. This means the current strategy to disregard SSDI file information where more recent medical information exists is most likely a company directive.

I’m sure there are many claimants out there who succumb to Unum’s consistent harassment to sign SSA authorizations to obtain SSDI files. Claimants are reminded there are no contractual provisions requiring any claimant to provide SSDI file copies as proof of claim. But of course, Unum doesn’t tell you that. Unum simply covers its behind with regulators by adding the SSDI file to the Administrative Record while at the same time neutralizing profitability losses.

Recommendations – Claimants should request their own SSDI files from SSA and read them. If claimants choose to send their files to Unum do not expect the company to actually “consider the award” and automatically pay benefits. Unum’s letters informing you the SSDI file “is to be used to your advantage” are NOT necessarily true. Unum can (not legitimately, mind you) inform you newly obtained information invalidates their multi-state requirement to consider SSA’s decision to award benefits.

Unum’s SSDI file request strategy, like many other areas Unum covered up over the years, is admittedly very clever, but misleading and untruthful. It would be very unwise for Unum claimants to take anything Unum communicates to them as the absolute truth.

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