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Archive for June, 2012

As most of you know DCS, Inc. publicly acknowledges insurers who pay claims fairly based on each unique set of claim circumstances. One of the claims required substantial financial support from the client’s CPA since Unum entirely misunderstood his company organization and flow through of part-time earnings.

Once Unum was provided with substantial financial data, including statements from the insured’s CPA, Unum paid the claim.

While Unum does engage in unfair claims practices, it does not always do the wrong thing. Therefore, we wish to publicly acknowledge Unum and its approval of two legitimate claims.

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IMEs – An Important Must Read

http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=55971

Very important information here.

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Unum – Even I’m Amazed!!

This link was sent to me and even I am amazed at how far Unum’s reputation has gone under. Believe it or not, I’m not generally looking for Unum bad  things on the Internet, but this really does amaze me.

Oh dear…check out the “Unum sucks” thongs.

http://shop.cafepress.com/unum-sucks

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This Week’s Poll

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In case you haven’t been watching, Unum stock went down to a little over $18.00 per share yesterday. Although the increasing decline in market value may be in part due to the volatility of the market, those who hold investments of Unum in 401(k)s and retirement mutual funds haven’t realized much overall gain in the last 12 or 13 years. Typically, Unum stock (as all other values of shares) is viewed as an indicator of steady, progressive growth in its core business which is group STD/LTD.

Unum depends on its re-enrollments of employer STD/LTD benefit plans, but it may be the company’s continued poor reputation discourages business from that source. In any case, Unum’s executive management was wrong 10 years ago when it informed employees Unum’s stock would go back up to over $50 per share. After the merger with the Provident Companies and Paul Revere, UnumProvident and subsequently Unum Group’s stock never recovered in the market.

However, Unum’s current low market share may be enough of a loss to encourage a buy-out or take over of the company. It might be a good idea for another insurer to put Unum Group out of its misery.

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Recently DCS, Inc. came under fire by those seeking total information disclosure to aid those self-advocating their disability claims. After taking a few weeks to “think through” an appropriate response I came up with the idea of discussing the history of informational based websites relating to disability claims and why Lindanee’s Blog exists at all. It’s an interesting history and I thought it might help put the Blog and its relationship to DCS, Inc. into perspective.

First of all, Lindanee’s Blog is an extension (and always has been) of Disability Claims Solutions, Inc. located at http://www.disabilityclaimssolutions.com  – a fee-based consulting Maine corporation. I am retained by clients seeking expert assistance with their private disability claims for a fixed fee and have been successfully practicing as a consultant for over 10 years.

Approximately one-third of the management expertise I have about claims management is ever published on Lindanee’s Blog. DCS, Inc. has never, in any of its articles, publications, blog postings, website or any other means of communication recommended “self-advocacy.”

This is not do to some self-interest because I want people to hire me as their consultant, but because there is still enough mis-information, and lack of information out there to give self-adovcators just enough information about the claims process to do themselves in.

DCS, Inc. turns away approximately 50% of claimants and insureds who contact me when I determine they haven’t been harmed enough to solicit the assistance of a consultant. In addition, DCS, Inc. does not accept cases which are not legitimate, or where it is felt the insured is malingering and could return to work in some capacity.

The origins of DCS, Inc. are quite interesting beginning in 2002 with the enormity of no-information and misinformation available to insureds on the Internet. When I came on the scene at that time insureds were already staking their claims on the Judy Morris website, which was a rogue source of information run by a physician after Unum denied both of her disability claims. Perhaps some of my readers may recall Judy Morris and her fight against Unum.

Overcome with anger and a desire to “make Unum pay” Dr. Judy Morris allowed her website to become so insightful and vulgar that her arguments and assessments about UnumProvident, although accurate, were viewed as less than credible. Although Judy’s heart was in the right place, her judgment was often flawed especially when she took a rubber gun into a courtroom and threatened the process before a judge in Massachusetts. (Posner)

Due to Judy’s less than professional reputation, no attorney would take her case to litigate the denied claims, therefore Judy represented herself pro se against Unum. After years of harassment, conflict, and confrontation Judy eventually won her case against her enemy.

Unfortunately, Judy’s self-advocacy took its toll and after spending thousands of dollars she recovered from Unum, she took her own life. Judy Morris was a very heartfelt human being, but her hate of UnumProvident became an obsession causing her to perhaps think there was nothing more to live for after her case against Unum was won.

In the meantime, a very noble and generous man by the name of Jim Mooney began a newsletter which eventually reached insureds, and attorneys from coast to coast. Jim Mooney was one of the few individuals who reached out to me to assist him in providing insureds and claimants with accurate information rather than the word-of-mouth tidbits circulating in the industry.

For many years, Jim Mooney sent out his newsletter via a mass electronic distribution list and included a column written by me entitled “Inside UnumProvident.” In this column, I exposed Unum’s unfair claims practices and gave insureds and claimants accurate information concerning the claims process. Jim Mooney’s support of insureds such as Joan Hangartner, who was then litigating her famous bad faith case against Unum, won him nothing since after continuous promises of financial support for the newsletter, she deserted him and took a long trip to Italy.

My connections to Jim Mooney went on for many years, but failing to raise sufficient subscription fees to support himself, Jim eventually dropped the newsletter and moved west to begin a new career. Through Jim Mooney, however, I met John Metz (California) who was and still is a prestigious advocate for both disability and health insureds. John and I co-filed a qui tam case in the state of California attempting to change insurance statutes in that state allowing any private citizen to initiate lawsuits against insurance companies.

Although the lawsuit failed in the California Supreme Court John and I worked with the then insurance commissioner, John Garamendi, to bring about California’s own conduct market examination and settlement with Unum. As a result, Unum was fined $8 M as a result of documents and other information, provided to the state of California by John Metz and myself in addition to its own investigation.

In the meantime my relationship with Anderson, Kill and Olick, a prestigious law firm in New York, prompted a connection with Elliot Spitzer’s office who had then begun its own investigation of Unum leading to criminal charges. Eventually, the Sptizer investigators threw in the towel with the multi-state examiners and the U.S. Department of Labor to fine Unum an additional $15 M.

During the last 10 years, DCS, Inc. increasingly worked(s) to bring about social reforms to prevent insureds and claimants from being cheated by corporations who sell “better than sliced bread” insurance policies and then refuse to pay them. Many of the articles written on Lindanee’s Blog are intended to raise the level of awareness of the general public, hence readers may find posts relating to financial planning, and doing away with the entitlement mentality of the middle class.

Although there are those who inaccurately claim “by the time someone reads Lindanee’s Blog they are already in crisis” the middle class need not “remain in crisis” when a bit of planning for the future can prevent years of financial hardship. Not everyone tuning in to the Blog already has a disability claim.

Although not everyone is expected to agree with me, my opinions concerning social reform stem from a 10 year history of attempting to prevent insureds and claimants from unfair claims practices initiated by corporations run amuck by greed.

Inaccurate misinformation is still prevalent on the Internet and is communicated by word-of-mouth from one insured to the next. Perhaps the worst source of information is that obtained from insureds and claimants, who like Judy Morris, are so angry and obsessed with making “insurance companies pay” they will do anything in the way of complaint even though they themselves have not been harmed. It is partly for this reason DCS, Inc. and Lindanee’s Blog continues to provide information about the claims process, and will continue to provide information as long as misinformation about the process is still out there.

Finally, amidst interviews with journalists, bond investment agencies, SEC accountants, insurance scholars, DOIs, congressional senate committees etc. Lindanee’s Blog and DCS, Inc. remains a successful consulting business with high success rates. Those critics who suggest Linda Nee should “take a step back” from her own consulting firm, non-profit organization, and Blog should re-think those comments in light of the amount of involvement and experience accumulated over a decade.

Feedback I receive on a regular basis overwhelmingly supports my efforts to continue to provide accurate information about the claims process at least equal to that of the insurance companies who sell disability protection products. Further, I have never supported “romancing” insureds and claimants to gain their business. DCS, Inc. supports honesty and truthfulness regardless of whether it is insureds who are right, or insurers who are enforcing legitimate policy provisions.

It is for this reason thousands of insureds who contacted me over the years know when asked a question they get a straight answer. Linda Nee has been around long enough to be a relatively small spoke on the wheel of insurance company concern, and will likely be around for as long as disability claims are denied because of misinformation about the claims process. You can count on it!

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IME – Let’s Laugh A Little

Contributed by a client who thought we might as well laugh a little!

http://www.youtube.com/watch?v=v9j16Ptx5xI&sns=em

 

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Unum – In Case You Missed These

http://www.youtube.com/watch?v=gknSNvGoX-c

http://www.youtube.com/watch?v=OnW_8XrqfKA

http://www.youtube.com/watch?v=9jtlPFeK0Ng&feature=relmfu

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Recently, DCS, Inc. was contacted by a very likable woman, formerly in public relations, who wanted to speak to me concerning filing a disability claim. Apparently, she had purchased an “own occupation” policy back in 1998 and after a year or two had to stop working due to multiple illnesses. At first, she thought she might be able to go back to work, but over time she never did and continued to pay premiums on her Individual Disability policy  while remaining a housewife – for 13 years.

Then…….someone suggested to her that since she had the policy and wasn’t able to work she should file a disability claim. She actually went to an attorney friend who told her it appeared she had a valid medical reason for disability, Although that was true, Ms. X’s claim would never be paid.

First of all, DI policies are written to insure the loss of “income” (income replacement) due to a medical disability and inability to work. Therefore, there must be provable earnings and income to replace. An insured who has not worked for 13 years has no income to replace. I asked Ms. X what her occupation was for the last 13 years and she responded, “I am a housewife.”

Before I incur the wrath of women all over America let me first say housewifery certainly deserves to be classified as “an occupation.” Any woman who runs a home will tell you being a housewife isn’t easy. However, my next question to my caller was, ” You were paid then? You have W-2′s or 1099′s to prove you were paid for housewife services?”  ( I disliked reducing her to a category of “maid”, but I was trying to make a point.) “Of course not, she responded.

And, here we have a problem among many. If there is no income to replace, there is no claim.

Second, insureds do not have “forever” to file disability claims. In most instances DI policy holders have a year and 90 days to file proof of claim. Thirteen years also exhausted the statute of limitations. In addition, most insurers would claim “prejudice” meaning the insured waited so long to file the claim it would be impossible for the insurer to fully investigate by obtaining 143 years of records etc. An IME today would NOT be the same as an IME 13 years ago, and it is doubtful any insurer would even consider paying such a claim.

Perhaps the worst part about Ms. X’s situation is that she paid the expensive premiums on a policy she had no chance of filing unless she returned to work full or part-time and generated income. If Ms. X had been able to return to work in the recent past and then discovered she was unable to continue, she could have filed a disability claim.

When DCS, Inc. recommends reading disability policies and understanding them, it is because it is very important to know just what insureds are covered for. This is a message that often gets lost.

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It has come to my attention insureds and claimants who post negative information concerning MES Solutions on the Net are threatened by company attorneys who seek to keep the reputation of MES free of adverse information. I personally know this to be true since in the past DCS, Inc. was contacted by one of MES’ internet watchdogs after posting information describing the company’s physicians and IME outcomes.

Enforcing threats of libel and possibly slander will likely be difficult for MES attorneys since information communicated on the internet by blog posters tends to be accurate. DCS, Inc. finds a majority of MES physicians have foreign names and it is unclear whether MES transports physicians from India, the Philippines and other nations specifically for the purpose of conducting Independent Medical Evaluations.

At one time I contacted MES and asked questions, “Are your physicians licensed to practice in the United States? Are they US citizens? Do they have permanent offices in the US, or use rented offices?” Of course, the person I spoke to refused to give answers to my questions. I am wondering when the United States suddenly became so devoid of qualified physicians, however, I’m sure hiring foreign physicians is probably more cost-effective as well. So much for the quality of IMEs conducted by MES physicians.

MES has been in operation long enough to show “patterns of practice” among their physicians suggesting insureds and claimants do not obtain fair and objective medical reviews. If a call were to be made to those who underwent MES IMEs and their files obtained, my guess is that there would be overwhelming evidence MES physicians render reports predominately in favor of insurance companies. As a company DCS, Inc. has been contacted often by victims of MES IMEs, surveillance and other snoop-dog activities.

From the perspective of the insurance company MES Solutions must appear to be a perfect solution. Foreign physicians are cheap. Although there is no proof, it could be possible for MES to import foreign physicians and pay to have them board certified in exchange for less expensive fees. Temporary offices could be rented in less desirable locations. Most of the CVs I’ve read of MES physicians are pretty thin in terms of experience, publishing, and medical journal notoriety even when board certified. From reports made to DCS, Inc. some of these physicians can barely speak English and conduct IME in less than acceptable offices.

Bottom line, from what I hear posters on other blogs are telling MES attorneys to ‘take a hike” and continue to post information relative to their experiences with MES. Clearly, MES attorneys won’t stop the flow of adverse information by threatening those who post on the internet. In addition, it’s beyond belief reputable attorneys would even use threats and intimidation to posts on the internet – a free speech protected environment.

From my perspective if it takes an army of MES attorneys “watching” the internet for adverse information to the point of making threats to those who post their stories, there must definitely be something “not right” with the company. Any IME organization who performs fair and objective medical IMEs with qualified and experienced physicians would not need to “snoop and threaten” to keep adverse information off the Net.

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Great news for DCS, Inc. which is in the process of re-developing its website to include additional information for those looking to obtain assistance with the management of their claims. It hoped the new site will be able to assist our clients with more information concerning the management of claims, and will include proprietary forms, discussions and other information helpful to our client base in general.

DCS, Inc. has been in operation for approximately 10 years and  successfully assists thousands of insureds and claimants with the management of their private disability claims. We look forward to rolling out the new website within the next month and encourage everyone to stop by.

In addition, Linda Nee will be publishing her book: “Managing Successful ERISA and Disability Income Claims” which will be available directly from the DCS, Inc. website sometime in early 2013.

DCS, Inc.’s website is currently located at: http://www.disabilityclaimssolutions.com

Please feel free to stop by in July and visit us.

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This Week’s Poll

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This is a friendly reminder to Unum claimants and insureds  NOT to sign more than one Unum Authorization at a time. If you actually read the Authorization forms they are valid for one to two years depending on the form used.

Although Unum sends out Authorizations every month, it isn’t a good idea for insureds and claimants to have TWELVE (potentially 24) signed Authorizations out there. Do you really want 12-24 signed Authorizations floating around?

Just because Unum sends out Authorizations every month with benefit checks doesn’t mean you need to sign them.

Other insurers may have wording suggesting Authorization are “valid for the duration of the claim”, and that means only ONE Authorization need be signed.

If insurers include wording in Authorizations proclaiming a time period of validity, call them on it. In any case, having multiple Authorizations floating around with multiple dates of signature isn’t a good thing for insureds to do.

While it is true many physician offices won’t accept Authorizations older than 6 months, insurers need to change the wording of their Authorizations if they want to obtain documentaiton within that time frame.

For the moment, however, if an Authorization is valid for a year or two enforce that wording and don’t sign another one until the former has expired. This is a situation where insureds and claimants often blindly sign what they are asked to sign when it isn’t necessary or required.

Be smart and read the Authorizations and sign one at a time.

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Recently, DCS, Inc. was contacted about the tendency of Unum representatives insisting on obtaining actual psychotherapy notes from mental health providers. In reality, all disability insurers engage in the same practices regarding psychotherapy notes expecting the same identical outcomes – more claim denials.

“Psychotherapy notes” are the actual writings of mental health providers at the time therapy is rendered. In recent years HIPAA passed several amendments giving psychologists, psychiatrists and other providers considerable discretion to withhold their actual notes as private “self-aids” to patient treatment and counseling. Despite the current tendency of mental health providers to establish policies of not releasing psychotherapy notes to outside third-parties, Unum and other insurers often harass and threaten claimants and insureds under threat of termination of claim if actual therapy notes are not provided.

Why do they do that? From the insurer’s perspective actual psychotherapy notes document private “sharings” of information to a therapist about self, family, past abuse, desires, longings, and secret inhibitions. Written in narrative form, the text gives internal insurance reviewers the opportunity of “snatching” which is defined as the “pulling of information from patient records favorable to the insurance company at the expense of all else in the record.”

Although insurers often “snatch” key phrases such as, “Patient feels better today and is looking forward to going back to work”, other comments contained in patient notes such as, “…but patient continues to exhibit depressed affect and is recommended to restrict activity…”  are ignored as part of the patient’s total mental impairment and inability to function. Claims have been denied as a result of “snatching” from patient records, an activity Unum appears to be very good at.

“Snatching” from patient notes in general has been identified by regulators (California in particular) as an unfair claims practice. The problem is that insurers continue to “insist” on obtaining “the notes” under threat of claim denial which is also an unfair claims practice. Claimants and their therapists often “wear down” after considerable  harassment with frequent phone calls and give up their private therapy notes even though there is no reason to do.

No disability policy I am aware of contains provisions requiring submission of actual psychotherapy notes as “proof of claim.”  Insurers attempt to get around this by citing the phrase, “…must submit proof acceptable to us…”  which abuses the insurer’s “discretionary authority” to determine what is and what is not proof of claim. Claimants and their therapists do have a responsibility to provide mental restrictions and limitations in summary form which is often by filling out various mental health forms and questionnaires.

Insurers have the right to know: 1) a claimant’s Axis I-V diagnosis include a Global Assessment of Functioning (Axis V); 2) specific mental restrictions and limitations which preclude the patient from returning to work in any capacity; 3) a description of the provider’s treatment plan; 4) prescribed medications; and 5) prognosis for the next 12 months. This information is sufficient for any insurer to determine whether the claimant meets the definition of disability contained in the policy contract or not.

In addition, not all mental health providers are talented note-takers. Some barely write two sentences while others write several pages resulting from one session of therapy. Psychotherapy notes are, on occasion, not legible and need to be transcribed. With today’s technology psychotherapy notes may be dictated later to a permanent electronic record. In any case, payment of a disability claim should not depend on the talent of the mental health provider to write mental restrictions and limitations directly in the notes, when the purpose of patient “notes” is not to document and support a disability claim.

In most instances mental health providers most often respond, “we do not release actual psychotherapy notes to any outside third-party”, and insureds cannot be penalized by the non-submission of actual notes. Unfortunately, Unum claims handlers attempt to obtain actual psychotherapy notes with its general authorization when the forms itself states it “excludes psychotherapy notes.” Mental health providers DO NOT actually read the authorizations and unfortunately notes are sent without proper authorization.

Finally, submission of written documents describing one’s most private “self” to an insurance company often impedes the value of mental health counseling in general. Insureds and claimants who know their most private thoughts will be communicated to an insurance company on which benefits depend might not be willing to share personal information with their therapist. The value of the therapy is therefore lessened, and  therapists lack sufficient information to provide adequate care and valuable counseling.

Insurers have a right to receive information as described above, but neither the mental health providers nor insureds are required to release or submit actual psychotherapy notes to insurance companies.

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An insured contacted DCS, Inc. today in regard to Unum requiring her to participate in a conference call with SSA to prove she isn’t currently receiving benefits.

Although I don’t have the complete claim history, a Unum claimant was receiving SSDI until an IME (performed by SSA) reported she could do sedentary work. SSA denied further benefits to the claimant after the IME.

Of course the claimant contacted Unum to stop the SSDI offset, but Unum refused because they didn’t believe her, insisting on a conference call with SSA to prove it.

It is important for claimants to realize “conference calls” with SSA are totally unacceptable. In fact, I’m surprised if any representative of SSA would even agree to it.

The Unum claims handler should ask the claimant to sign an SSA authorization so that information could be obtained verifying the cessation of the benefit.

In addition, the claimant could obtain the same information with a trip to the local SSA office.

Depending on a Unum representative to accurately document a phone call is probably not a good idea.

Claimants are not required to participate in conference calls with Unum reps and SSA. This issue could be quickly resolved by visiting the local SSA office and obtaining a letter stating future benefits would not be paid. Once this letter is faxed to Unum the offset for SSDI should be immediately removed and full benefits paid.

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