More and more disabled Americans are contacting DCS, Inc. with personal stories of disability claim injustices followed by denied appeals leaving them to support their children and families with social security income only.
An insured called to tell us CIGNA denied her appeal leaving her to support her son on the $1,700 she receives from Social Security. Her mortgage is $1,200. Although the reasons given by CIGNA for not paying the claim aren’t valid this insured’s only recourse is to convince an attorney to take her case – another situation contributing to the unfair disability insurance scams allowed in this country.
Although this insured’s policy is not subject to ERISA with a net monthly benefit of $1,200 her claim has already been bounced from one attorney to another. No attorney wants to take a case with such a low benefit amount thus throwing the insured and her son under the proverbial bus. Attorneys are literally leaving large segments of the middle class without representation, which is well-known to insurers who are looking to deny more and more claims.
In addition, one of the issues DCS, Inc. writes about publicly is when claimants and insureds are required to produce expensive vocational and peer review reports (requiring money the disabled do not have) in order to overturn appeals for benefits they are already entitled to.
From what we can gather there is no regulatory agency in the United States willing to actually investigate insurance complaints and provide consumer protection to those burned by major insurers. Nearly 95% of those who contact us yearly with state and federal complaints report the failure of any state insurance agency or department to actually investigate any insurance complaint.
It is now agreed among scholars and others in the industry Unum’s multi-state fine of $15 million was little more than a pay-off to states who agreed silently to “leave the company alone” and give them a free pass in the future. The EBSA, an arm of the U.S. Department of Labor, consists of bureaucrats who waste taxpayer money by advising poor ERISA policy holders to find an attorney and go to court. This agency of the federal government does not directly protect or support ERISA policyholders from insurers who deny claims unfairly.
Therefore, in the United States the operation and regulation of the disability insurance industry can reasonably be said to be somewhere between corrupt and no more than a scam for the following reasons:
-
Disability insurers are permitted by state regulatory agencies to deny claims unfairly by using “discretionary authority” as justification for doing so. There is an inherent “conflict of interest” since each insurer is both reviewer and payor of claims.
-
Insured and claimant complaints are not investigated by regulatory agencies who prefer to give insurers a “free pass.”
-
EBSA, the federal agency paid to look out for ERISA claimants does not do its job.
-
Attorneys discriminate among disability claims selecting only the most wealthy benefits for litigation. This throws most of the disabled middle class under the bus since one of the major characteristics of “the American disabled” is that they don’t “have any money.” As one attorney put it, “I’m not a charity.”
-
Denied insureds and claimants are required to have personal funds in order to pay for medical and vocational reports to perfect an appeal when they are legitimately entitled to benefits anyway. The National Association of Insurance Commissioners (NAIC) identifies strategies forcing insureds to go to court to obtain benefits as an unfair claims practice.
Unfortunately, the disabled middle class is quickly becoming impoverished by multi-million dollar insurer corporations, republican judges and legislators, scrutinizing attorneys, and blind federal and state regulatory agencies.
The next time DCS, Inc. receives a call from an insured family telling me they have been forced to live out of their car because Unum (or another insurer) denied their disability claim unfairly, I may be forced to consider protesting the issuance of disability insurance at all.
Clearly, employer STD/LTD plans are currently providing no permanent financial protection to the middle class. And, there is no guarantee any ERISA policyholder will have access to the courts without an attorney willing to take their case.
I find myself wondering where America went these days because it certainly isn’t here anymore. When a system impoverishes an entire class of disabled Americans, it’s time to take notice and find a means to fight back.
No one’s family should have to live in one’s car because they are disabled and can’t work.
By the way, as part of the UNUM settlement in that state they were NOT REQUIRED to contact prior disability claimants as part of the agreement for reassessment!
Great post as usual Linda. Please keep fighting for those disabled!
Gosh, how fair was that? I’m not surprised though.
I can only say….I wish you had a VERY large audience who would listen. If there was a way to contact all in this sinking stinking boat we could decend on Washington ans at least get some attention and press to open the ears and eyes of policy makers.
Government agencies laugh and giggle when anyone mentions the word “conspiracy”. Most of the time anyone who suggests there is a conspiracy afoot is made out to be one of the crazies who is on serious medication. Therefore, most individuals who want to be regarded as credible shy away from any mention of a conspiracy. However, with respect to the whole mess of disability insurance we are getting (if not there already) close to a conspiracy. But of course, I never said that.
some day they are going to mess with the wrong person–they need to consdier-disabled people. many whom may be dying, have little to lose and every reason to be vindictive. I am not suggesting anything violent but I would say that If I worked there I would be concerned for my safer having so many angry clients-guess they think they we all in wheelchairs..I would assume a mass of protesting claimants might make for good TV…Maybe something to think about if the denials keep moujntintg Meanwhile my next review comes up I will be hiring DCS (If I can afford them, I guess I cant afford not toy frankly). When my oldest goes to college their payout to me will go up from about 3000 to 4200 since SSDI will not pay my child after age 18 and outs of HS so I would t think even a measly 1200 added to the 3000 IS enough to warrant the attention of Unum–course my claim has strengthened so I may not have to worry but with Unum its a random spin of wheel I feel mainly…and if you have very good doctors-I always go to the most reputable hospital and have the head of the dept as my Dr. so this way they are disagreeing with the head of the dept. of the number 7 hospital in US etc. Seems to strike what little fear into them possible. Thanks Linda
This is pretty interesting. When I was still working for Unum its security was pretty tough to penetrate for fear of claimants entering the building to do harm. However, we (the claims handlers) laughed and laughed because we were so much more afraid of our peers suddenly going nuts than anyone from the outside. Judging from some of the responses I’ve been getting from former Unum employees I’d say that’s still true. Inside Unum is a very scary place! Thanks for posting and of course for your support.
Makes sense the co. would think like that. SInce they are the one that has to pay you though someone going postal inside is probably more likely from the pressure and moral pressure it must apply to anyone with a conscience..karma must not be something many people are aware of who do a j ob the clearly is harming people-some agents when I asked how they could do their job said it was “There reward of paying valid claims” sounds like that is at best a pipe dream..lol
Thanks for another insightful post. With all the problems of disability policies–many seem to be under ERISA for some or limited protection. But, what happens when it is not under ERISA–such as a VEBA (volunteer employee benefit association) in which the monies are the employees and not the company? Are there any laws that protect under a VEBA?
Brian
You are right on many counts….I will tell you that I was snatched out of the Extended Duration Unit after 11 years of benefits when my last child turned 18. It was not THAT much more money that they had to contribute but I was certainly targeted. I am on appeal, Thanks to Linda, She has filed the appeal, but who knows the outcome as they have all the power and we and our physicians have none. You are RIGHT to go to the best hospital, with the best reputation for your condition…I left mine and that was another red flag for unum. I went back to a university physician. We really need an online clearinghouse or website that bands us together, and I am sure there are many, to join forces. Good luck to you
whoa–thanks for the heads up–yeah-its pretty clear that no amount of money is too small to make a difference to the greedy….it is sickening-the actuaries are supposed to underwrite policies and spread the risk around so that people need not be denied valid claims as their apparent sole method of increasing per share profits–it again makes no sense for disability insurers to be allowed to be for profit but in the US taken a hard right turn compared to rest of civilized world-health care run by private cos is soonsidered socialist-heck-FDR would be called a commie now…thanks so much for your reply..good luck as well..the better and higher reputation your doctor-obviously the less you have potential to be a person trying to make a claim that is invalid, and so I have worked my way up to heads of depts…and that aint easy to do…believe me…but if you donate enough etc. and let them study you IT HELPS A LOT_-i do it to help others not me-but it has not hurt my relationships to allow myself to be a guinea pig at times….alas..
by donate I meant blood of course-lol…
One day it will be unlawful to sell and profit from such a disturbing product. As I tell the Unum story in my part of the country, the response is, “Oh, I HAVE HEARD ABOUT Unum!” I will not stop telling the story. The product is inferior and problematic with loopholes that favor the company, the delivery of the product involves harassment, the relationship a claimant is forced into with this company is based on deceit, threat, and total lack of respect for vulnerable people. That “Unum” is mentioned in the same sentence with “benefit” is completely laughable. It would be funny, if people weren’t suffering to the great extent they are, from the antagonism this company practices.
Unum = the Un-Benefit.
Claimants who have been hurt by this self-centered company must find their voice, however challenged they are with their disability, as Unum counts on us to be passive and submissive. Do tell your family and friends about Unum, so that individuals will avoid this company like the plague. Eventually, employers will not associate with this company, as well. We Shall Overcome. Linda, thanks for continuing to illuminate the path, it may seem like the one less traveled, but more and more weary people will join in the effort toward truth and transparency, in the future.
I really wish I could bring back the non-profit corporation I created to help disabled insureds form coalitions to change the system. Unfortunately, insureds are too scared to speak up and lend their voice to make changes. If all disabled insureds came together, the system might be different.
Maybe disabled insureds who have lost their benefits would comply……..I for one would..It is scary to have your name in their face but at one point there is no other alternative
This is such a microcosm of such a large problem.. Who will help to solve or at least address these issues…in a larger way ..? For me, this venue is great for venting…I would love to see a force of disabled persons act and I would help in what ever way possible. And…I have vented and am willing to act.
Only one last post on the matter…I am fortunate enough to have my family…my mother… who is 94, has helped me to keep my house during this unsettling time, otherwise, it would have been on the market, sold for less in this economy, and I would have lost the only investment I have, my home. She cannot keep up supporting my investment. I still have an uncertain future and two dependents,,,,even though one is 23 he is living at home and finding himself, the other in college is worried about leaving her home because of my financial circumstances. We all move on.. but should it be this way? I am almost 62, I know that at 65 I would have to find an alternative lifestyle but at that point my children, hopefully, would at least be on their own. I am blessed to have what I have ….Food, shelter and clothing. Only, at this point, because of my mother,,,,she is 94 today! …am I fortunate not to have to face extenuating circumstances today. I empathize with those who do not have a mother to lean on but i can tell you it is uncomfortable and unsettling at my age and it is only temporary.
Linda-if the reasons that Cigna denied the woman’s claim why does she need to hire an attorney? Has the 180 day appeal time period passed? Can’t she write an affidavit and submit it to Cigna as others have done that points out the info provided by ex-Cigna employees?
What can be done to change this?
Let’s get going and get people together who have had enough. This intimidation has got to stop. They would rather me be dead and quiet, but that hasn’t happened yet. Just because your body fails you doesn’t mean you don’t have a fight in you left. I would like to see a response by many that indicates that you are sick and tired of whatever insurance bully is taking you for a ride.
As I tell my story, people cannot believe that Unum can sell the crap they sell for so called peace of mind…Linda, It is time to bring your non-profit corporation back and for coalitions to be formed….For Unum people who read this blog, is your career with such a company truly fulfilling? The things you do such as constantly being suspicious of those on disability – how does that really make you feel? Gratified? I feel for you.
I hear you Dave..
But how does one gather all of us together…? THIS is my big question … Yes, Linda, what would it take to bring the non back? I have no idea of the scope of work you would have to endure..
Don’t be angry with Unum employee;s Dave..They are making a living and probably not in the frame of mind to understand how damaging their decisions, and cooperation with this company affect the thousands of us involved in this process. Also, if Linda is correct, they are young, invulnerable to painful conditions and never think about loss of income due to disabitity . I remember being young and invulnerable but..never envisioned my circumstances as they are today… I am not making excuses for employees but it is rather a microcosm of young adults trying to make a living and staying out of the radar of contempt of their bosses. I am glad I never had to endure that type of work. SO let us bring Linda into the SOLUTION ..even though she is only one person…what can WE do.
Linda-I am ready to assist you with the non-profit. Tell me how I can help.