Why won’t Unum release in-house physician’s names?
The primary reason is that insureds and claimants are not entitled to any internally generated information until such time as claims are denied. Therefore, neither Unum nor any other insurance company will release internal information unless claims are officially denied. Then, under ERISA full disclosure is required. DI claims have no such disclosure requirement, but Unum releases the claim file copies anyway.
The second reason is that, like all employers, Unum protects its employees from harassment and prosecution. However, once claims are denied, physicians’ names can be easily obtained from the claim file copy, and physicians can be reported to their medical licensing boards. DCS, Inc. recommends reporting any internal physician who deliberately misrepresents information from patient records and filed reviewed.
Unum also goes to great lengths to protect disclosure of salaries of its medical staff, physicians and medical directors. Yearly percentage bonuses are paid to physicians for adhering to Unum’s agenda and physicians are threatened under termination not to share their salary or bonus info to peers. Management uses these bonuses to compensate “the best” physicians who support the greater denials and therefore “sharing” bonus percentage is a no-no.
I told The Hartford I paid the premiums on my policy and they said, “I don’t care”, and offset my benefit anyway?
Your question points out the grave misconception and error you have regarding the significance of paying LTD premiums. LTD benefits are taxable only to the extent the employer pays the premium. In other words, if the employer pays 100% of the premium for your LTD Plan, benefits are wholly taxable. If, on the other hand your employer pays 60% and you pay 40%, any benefits received are 40% non-taxable.
Who pays the premium has absolutely nothing to do with benefit offsets. Group STD/LTD nearly always contain provisions for offsetting additional income received such as SSDI benefits, worker’s compensation, retirement income etc.
Your question makes me wonder what The Hartford offset exactly. I’m guessing it offset your SSDI award which is legitimate if your policy is “integrated” and allows for offset reductions. Again, who pays the premium has nothing to do with offsets, but does determine what portion of your benefits are taxable.
How do insurance companies calculate over payments?
Actually, the methodology for calculating over payments is very simple. First, the insurance company will make two calculations:
Actual benefits paid from the time of your first benefit check to the last check received. (What we DID pay.)
Benefits we SHOULD have paid if we had known about the SSDI award(s).
Gross over payment
Attorney or advocate fees Plus Policy COLAs paid
Net over payment
Granted, sometimes these calculations can appear to be quite complicated since benefits paid and should have paid are broken down in actual days. But basically, the calculation is “What we should have paid” subtracted from “What we did pay”.
What exactly is “doctor shopping?”
Doctor shopping is the insurance practice of continually obtaining multiple medical opinions for the purpose of supporting one point of view over another whether it’s the insurance company or insureds who do it.
This practice is predominately noticed when insurance companies demand more than one IME particularly when the first is written in the insured’s favor. Insurers often submit continual “addenda” to IME physicians until they “buy-in” to documentation supporting no restrictions and limitations.
Unum is currently engaging in practices which could be described as “doctor shopping” by requesting multiple IMEs sooner than 6 months of each other. Other insurers engage IME physicians in circular rounds of continual “addenda” in order to obtain preferred decisions.
Insureds and claimants are also found to engage in “doctor shopping” when one or more physicians fail to document or support the diagnosis desired by the patient. Yes, there are some insureds who actually “tell” their physicians what they have and expect them to support their point of view. When they don’t, these same insureds move on to new doctors and start all over again demanding documentation for their long list of complaints.
Neither party is acting in good faith when engaging in “doctor shopping.”