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Doctor Phone CallsDuring the last twelve years DCS, Inc. maintained communications with many treating physicians across the country, most of them in private practice.

The most common complaints made known to us are the frequent, vexatious and harassing contacts made to the offices of treating physicians by Unum to obtain patient notes, medical records, set up doc-to-doc calls and  requests for  completed forms and narratives. Most physicians regard such requests as “annoying noise” in a busy office of patient consults and want the harassment “to just go away.”

It is not uncommon for physicians to “fire” patients when Unum’s constant contact with them becomes disruptive with staff and facility office managers. One neurologist told a client, “We just can’t have Unum calling our office everyday and demanding paperwork. Please find another physician to treat you.”

In reality, physicians have more control over Unum’s harassing requests than they imagine and can usually “nip Unum in the bud” quite easily. Although more and more physicians are “kicking Unum to the curb” with good reason, most physicians find Unum’s repeated requests for information costly and disturbing to the everyday operation of a busy medical practice.

All insureds and claimants have a contractual responsibility to provide insurers with medical “proof of claim”, and while no one disputes insurers’ rights to obtain and review medical records, there are occasions when Unum claims handlers request the same information over and over again, or appear to “make it up as they go along.”

In addition, Unum seems to think it has an endless direct line of communication with treating physicians for doc-to-doc calls when in reality physicians do not want to have verbal exchanges with Unum’s doctors whom they view as “paper reviewers” and “insurance-paid” defense physicians trading ethics for steady paychecks and benefits.

In fact, it seems as though neither physicians nor their patients want any verbal contact with Unum or its representatives.

In truth, narratives from Unum docs are nearly always regarded as “nuisance paperwork.” In most instances physicians report to DCS that Unum’s internal physicians frequently misrepresent and distort patient disability leaving them shaking their heads in disbelief that other physicians can construct such “inaccurate and medically unsound” assessments of disability.

It isn’t surprising either that many treating physicians, themselves insured by Unum policies, wonder if they shouldn’t toss their coverage and start over with another company such as Northwestern Mutual.

In my opinion, Unum’s “internal board certified physicians” may not fully recognize the negative reputations they have with practicing physicians. Even within the medical profession, Unum’s physicians receive poor reviews from treating physicians who themselves have notable standing within the medical community.

In short, IME and insurance physicians in general aren’t well-regarded by their own peers. “Bastardizing” the medical profession in order to support the insurance industry’s agenda to deny more claims is not something reputable physicians generally do with their expensive education, board certifications, and goodwill within a practicing community. I think it’s reasonable to conclude that “those physicians who can DO, and those that CAN’T, work for the insurance industry.”

In any event, there are certain actions that can be taken by insureds and claimants to work with, and protect treating physicians from Unum’s vexatious harassment of treating physicians. Although Unum appears to be the most frequent offender, the plan below can be applied to any insurer that harasses physicians for medical records.

  • Patients should have frank and open conversations with all treating physicians as to what actions will be taken when physicians are contacted by Unum, either by phone or in writing. I am aware that conversing with doctors can be difficult, but patient and physician can decide in advance what actions are to be taken when contacted by any insurance company.
  • Patients have the right to ask their physicians to contact them first before releasing any information to insurers. This includes the right to review physician narratives and completed forms before they are faxed to Unum. This allows the patient to dispute any inaccurate or unclear statements with physicians before information is faxed or sent to any insurance company. (Physicians who refuse to do this are often sharing information with insurers they have not discussed with patients.)
  • Patients have the right to withhold permissions for treating physicians to speak verbally on the phone with Unum or any other insurance doctor. In my experience, most physicians refuse phone calls from Unum and other insurers anyway, but patients have the right to make it perfectly clear that they do not authorize their treating physicians to respond to phone calls, but prefer instead that physicians ask for all information requests in writing. Most physicians are way ahead of these requests and refuse doc-to-doc calls anyways.
  • Physicians have the right to charge Unum for reasonable administrative office costs, photocopying or CD fees, office staff costs, physician fees for reviewing and completing paperwork, and any other reasonable costs incurred in responding to Unum’s requests. Although many physicians do not yet realize it, they are entitled to fees and costs every time Unum makes a request for medical records, or form completion. Although Unum attempts to limit these costs to “reasonable photocopying” or maximum costs of $200, physicians may expect payment for any additional costs incurred for responding to Unum, including administrative and office costs. Physicians can also withhold medical records until payment is received.
  • Physicians may also instruct their office staffs to inform Unum that “Dr. _________ does not accept phone calls from insurance companies but will respond to requests for additional information in writing only for which a fee will be charged.”

As indicated, physicians have a great deal of power in determining how their practice handles requests from insurance companies particularly when the office begins to hear from the same insurance company over and over again. Insureds and claimants should insist on a “no surprises” relationship with their treating physicians including a mutual understanding of how insurance requests are to be handled.

No physician is required to endure persistent phone calls and harassment from insurers and can “nip the problem in the bud” by demanding all requests in writing, and following through with a plan previously discussed and approved by patients. My impression is that Unum’s very poor reputation is already well-known among credible treating physicians and Unum’s requests are already regarded as “nuisance annoyance” by most.

Having said all of the above, I want to point out to insureds that they DO have a responsibility to provide insurers with ongoing medical proof of claim, and without it, claims can be denied. Unum will tell you they have a right to receive patient information directly from physicians and that is true; however, patients also have a right to know what patient information has been requested, and how physicians are responding to medical narratives and other questions before it is sent.

In addition, insureds and claimants have the right to obtain patient information themselves and submit it to Unum when requested to do so. We suggest that patients obtain their own medical records, record the dates and general summary of content in a journal, and then send to Unum in a timely fashion. This way insureds have a record of what is actually sent, and when, preventing Unum from alleging after-the-fact, “we never got it.”

U.S. Priority Mail with Signature Confirmation is a relatively inexpensive way of sending medical information to Unum since insureds can track and verify information was received. Journal notations prevent Unum from requesting the same information over and over again.

The difference with the above plan is that insureds know exactly what is sent to Unum in advance and that there will be no surprises with what or how physicians are communicating with insurers. There is nothing worse than receiving a denial latter from Unum saying they were able to contact Dr. Smith. and he said “there were no restrictions and limitations precluding work.” Readers would probably be surprised to learn how often this really happens.

Any physician who is releasing a patient to return to work should first discuss it with the patient, not an insurance doctor on the phone. Remember, no surprises! Talk with your treating physicians and mutually decide in advance how these matters should be handled.

Patients should always be informed by their physicians of any contact they have with insurance physicians or claims handlers in advance of exchanging information. Do not underestimate Unum or any other disability insurer; they have underhanded ways of seeking information without your knowledge.

Talk to your doctor and mutually agree on a plan of action well in advance of any contact from Unum or other insurers; and, make sure your doctor knows you wish to be informed in advance of any requests prior to information being released.

And, don’t be surprised to find out that your doctor already has an office policy dealing with insurance requests – apparently no one really likes dealing with Unum or any other insurer. Physicians have much more control than they think!

challenge medical indemnityRecently, an insured called with a question regarding Unum’s “catastrophic indemnity” insurance, and although I had forgotten Unum entered into that market, I was quickly reminded that perhaps group STD/LTD insureds should not pay additional premium for Unum’s indemnity insurance when they are already harassed over disability claims.

Indemnity insurance is very different from group STD/LTD in that the riders pay a flat benefit per day (diem) For example, a hospital indemnity rider might pay $150 per day of hospitalization; catastrophic indemnity plans pay only for certain diseases such as cancer or heart attacks.  While indemnity plans may appear to be uncomplicated, insurers still risk manage and investigate claims and if they can, avoid payment.

According to Unum’s website the company offers employers a variety of indemnity group plans such as hospital indemnity, term and whole life insurance, dental and catastrophic plans. Although these group Plan riders may seem attractive most employers do not contribute toward indemnity insurance and employees pay premiums.

Interesting. Nearly all group disability insurers require insureds to apply for SSDI. If approved, claimants are eligible for Medicare and have the option of purchasing supplemental plans at reduced rates. Although Medicare pays approximately 80% of co-pays, a good supplemental plan will pay the difference and add additional services. Plan D, or Prescription plans are also available to cover most costs of prescribed medications.

I’m actually wondering why healthy employees would pay additional premium for hospital indemnity or catastrophic plans when if they become disabled under Unum’s policies they will be forced to apply for SSDI and be eligible for Medicare within two years. The original intent of indemnity plans was to provide a fixed daily benefit to pay the additional per diem and uninsured costs of a hospital room if hospitalized beyond Medicare’s allowable number of days.

Also, given Unum’s very poor public reputation for managing disability claims fairly, one has to wonder why employees would be willing to risk additional dollars to pay for indemnity insurance when it’s unclear  as yet how the company will attempt to avoid payment.

As we all know Unum’s long-term care product was relatively unprofitable even after attempts to deny legitimate claims particularly in the state of California where Unum’s LTC was investigated and found wanting.

Insured’s and claimants need to consider whether Unum’s added group indemnity riders are worth paying the additional premium for. Unum also offers term life and whole life insurance which may not be such a bad investment considering that life insurance isn’t generally “risk managed.” If there was a way, I’m sure Unum would find it! (Life insurance is generally “underwritten” carefully in lieu of “risk managed.)

Sometimes claimants need to be a bit smarter than the insurance company’s benefit rider options. Although the riders may seem to be attractive, employees and claimants spend critical dollars to duplicate benefits paid for by Medicare and related supplemental plans.

Add-ons to group STD/LTD policies can be extravagant investments for duplicate benefits. Claimants should consider carefully whether the added riders are worth added cost.

 

Democracy not CorportocacyIn his book, “The Price of Civilization”, Jeffrey Sachs describes the United States as an emerging country controlled by corporations and corporate interests he refers to as “Corportocracy”.

Despite President Dwight D. Eisenhower’s warning to the people in 1961 to exercise restraint  in consumer habits, Americans have not resisted the “humanization” of corporations that now overwhelmingly control the national economy as well as all goods and services, governmental agencies and the media.

Corportocracy is most keenly felt by those who buy disability insurance and file disability claims since no American corporate entity follows the rules of what any prudent person would consider “good faith and fair dealing” in adjudicating disability policies or investigating claims for payment.

Although one could accuse state regulators of dropping the ball of oversight into repeated violations of state laws and continuing support of “discretionary authority”, it seems fitting and obvious that state regulators have also given up the fight in support of fair disability claim review.

Rarely do state authorities side with insureds’ complaints against multi-million dollar corporations who have thousands of lawyers defending what bad faith corporate moguls can get away with. Further, state authorities refuse to enforce Conduct Market Examinations and Multi-State Agreements once pay-offs have been paid to the states to ignore future conduct. (It has been suggested by academics that Unum’s payments to the 48-states were merely cash purchases of free passes to bad faith in the future.)

Most claim review processes currently in place hide in plain sight unfair strategies to deny payment of legitimate claims for profit at the expense of unsuspecting insureds and claimants who is good faith continue to pay premiums for insurance that never pays out, or at least not for very long.

Disability insurers such as Unum, Prudential, The Hartford, CIGNA, Aetna, and other group STD/LTD insurers no longer consider any medical, occupational or financial opinions obtained from other qualified resources outside the company when rendering claims decisions.

Apparently, these unfair claims practices are OK with state regulators who seem to have blind eyes when it comes to insureds’ rights and fairness of process. In addition, the U.S. Department of Labor has no mandate to support claimants, only employers.

In fact, in my opinion, most American insurers conduct their business entirely unregulated or bound by state laws, ERISA, business ethics, or medical impairment assessment generally accepted by the medical community. In order for laws to be effective, they need to be enforced. This is certainly not happening in our states, nor in our courts.

Corportocracy not only controls the disability market, but controls the process of review so that insureds and claimants “do not have a chance in hell” of receiving much-needed benefits they depend on for future financial security.

Whether American workers educate themselves to the potential pitfalls and limitations of group insurance remains to be seen. Employer-paid STD/LTD benefits are typical examples of “you get what you pay for.” Something for nothing is not always the best solution to meet future financial needs particularly when claimants receive no benefits on the other end.

For example, when Unum renders a denial decision stating, “our internal board certified physician concludes that restrictions and limitations are not reasonable and that you are able to work a full-time sedentary job”, that there has been  no consensus of medical opinion between a treating physician and the insurer;  and the denial decision was made solely by the very entity with a conflict of interest to deny more claims for profit. Corporate greed is a major component of Corportocracy.

In recent years there is some evidence to suggest that Unum may be attempting to integrate and influence the Social Security Administration in the same manner it infiltrated welfare and disability programs in the UK.

Although SSI, SSDI, SSR and Medicare are federal entitlement programs paid for by the American people, it is probable Unum is influencing decisions made by this governmental agency run by Congress. If Corportocracy waddled like a duck and fluffs its feathers like a duck, then I’m pretty sure it also quacks like a duck and is invading what little remaining entitlement Americans have – Social Security.

Although there are those who claim the United States is already beyond redemption on the issue of “corportritizing America”, DCS takes the view, consistent with our philosophy” that enlightened and knowledgeable insureds and claimants can take honest and truthful steps to manage disability claims in ways that are beneficial to them.

Giving a corrupted insurance process a name such as Corportocracy is the first step toward understanding what is actually happening to the disability claims process in this country.

It’s also pretty scary to realize that disability insurance is only one industry of many that is currently controlled by Robber Barons.

Thumbs upLindanee’s Blog continues to be a big hit with a diversity of readership that includes insureds and claimants, regulators, attorneys, peers, insurance companies and their employees, agents and brokers, government agencies and many others.

Articles posted on the blog are directed to a wide audience of those who are interested in learning more about private disability insurance and how the claims process works.

We receive a great deal of feedback from callers who tell us how helpful and useful the information located here is and how it helped them better understand the disability claims process. Thank you to all those who have expressed appreciation for the level of professionalism and quality of information I’ve tried to maintain on the blog.

Lindanee’s blog also holds insurance companies publicly accountable for the manner in which disability claims are managed and claims decisions made. Information articles educating the general public can also be found by searching insurance topics from the site.

Consistent with our philosophy of providing information as least equal to that of insurance companies, Lindanee’s Blog now has 1,096 Posts in 87 categories, 1, 246 Comments with total reads of over 653,787. The Blog also records 183 followers and 201 comment followers. On average, there are 1,024 reads from the blog each day.

In addition, DCS, Inc. receives on average a total of 50 phone calls per week and over 100 emails per day from insureds asking urgent questions about their claims. Although I am unable to address each and every call or email individually, questions are addressed in the Friday Q & A posts. Readers are encouraged to let me know what issues continue to be of interest.

As a fee-based consulting corporation DCS, Inc. continues to experience a better than average success rate of 95% overall, assisting insureds and claimants in managing in excess of $10-15 million in claim financial reserve. Our success rate is based on initial applications, ongoing case management as well as helping insureds through the appeals process. DCS. Inc. currently has a client base of over 300 clients who are receiving benefits from all major US insurers.

On a personal professional level, I continue to work directly with attorneys as a claims consultant assisting them with whatever issues are required for their own cases. I also provide information relative to the claims process when approached by state regulators and the SEC.

To the best of my knowledge I remain the only Disability Claims Consultant in the US with actual claims experience since most of my peers hail from underwriting and sales. Nevertheless, the success of DCS, Inc. is by far the result of the many insureds and claimants who find relevant and useful information on the blog and seek assistance from DCS with their claims.

In 2015 a decision was made to drop the expose book I originally started writing about my experiences working for Unum replacing it with a reference guide-book entitled, “Filing A Successful Private Disability Claim.” This book will detail the disability claims process and provide a valuable table resource for initial applications and ongoing management of claims. Stay tuned…….

NCDI_Logo_colorDCS’ sister non-profit corporation, The National Coalition of Disability Insureds (NCDI) is still active and looking for insureds and claimants who are willing to support challenging political issues intended to force insurers to review claims in “good faith and fair dealing.”  Although I continue to remain hopeful  insureds will want to participate, in 2015 the trend of insureds to openly support insurance causes remains dismal, although I continue to rally for various causes as a “force of one.”

Overall, DCS, Inc. and Lindanee’s Blog will remain valuable resources for those with private disability insurance claims. Off to a good start in 2015, we will continue to support our own objectives by providing information helpful to those who file disability claims.

Thank you to all those who continue to take advantage of the information located on Lindanee’s Blog and those who remain with us as supporters of our efforts to ensure fair and equitable reviews of disability claims.

Friday Q & A

Q&ADoes Unum allow living abroad?

The easy answer to this is to check your policy. Remember, all of the answers as to what you can and cannot do are in your policy. Some Unum policies terminate your claim if you live overseas more than 6 months. Check your particular policy to see what it says regarding living abroad. Not

Does Unum pay taxes on the SSDI overpayment for me?

No, it doesn’t. There is an excellent post on this blog regarding the taxability of the overpayment and I defer to that post. At any rate no insurance company pays taxes for you at any time.

Why can’t I get a good ERISA attorney to take my case?

Most attorneys reject claims with monthly benefits of less than $4,000 (or thereabouts) per month. The non-wealthy claims fall by the wayside as non-earners and not worthy of an attorney’s time. To be clear, there ARE attorneys who send me emails telling me they do take some of the lower benefit claims, but these attorneys are few and far between. I have high regard for the attorneys who are giving of their time and expertise for reasonable fees.

However, there are also attorneys who send claimants packing when “the money” doesn’t meet certain high standards. One prominent attorney in California prides himself on his high-profile reputation and alleges he’s trying to change ERISA when he wouldn’t accept a non-wealthy ERISA claim to litigate if his life depended on it.

Such attorneys recite their resumes every time I speak with them and clearly they are missing the point that claimants “just want their benefits to be paid” and could care less how many books he’s published.

One insured told me this week she hired another prominent and well known California attorney who is charging her 40% of a $10,000 a month benefit, but that she’s never spoken to him personally. When claimants have to make their way through layers of “assistants” and “publicists” to get to an “associate attorney” who communicates with the “attorney of record”, there may be a problem. For $4,000 a month I think I would expect to speak with my attorney on a regular basis – not a publicist or associate.

Also, attorneys are beginning to use Internet technology such as You Tube for advertising purposes. Claimants should exercise caution since these attorneys aren’t cheap and often “settle” claims when perhaps settlements are not the right resolution for some claimants. While there are other attorney “settlement mills” out there, claimants should investigate and make decisions that are right for them without giving away most of their future benefits.

There IS something to be said for attorneys who put themselves in the trenches with claimants and understand their concerns rather than using disability insurance to further public reputations. I’ve met many attorneys in the last decade who do not expect large profits or reputations from helping ERISA claimants. We are all thankful for them.

In my opinion, ERISA claimants are better off doing everything they can to prevent disability claim denials rather than litigating them on the other end. I sympathize with the ERISA folks who find attorneys are part of the problem and not the solution.

ADDENDUM

After this article was posted yesterday I was contacted by an attorney who suggested that one of the reasons why lawyers are not accepting ERISA cases is because of the uncertainty that claimants will actually allow winnable litigation go to its logical conclusion. Attorneys who accept cases on contingency depend on court awarded fees and fee petitions that can be significant over time. However, on occasion attorneys can be thrown under the bus when claimants suddenly decide they want to settle their cases. This particular attorney lost $400,000 in fees when his client decided to settle the case in the middle of litigation he knew he could win.

I can certainly understand the other side here and why attorneys are reluctant to invest their time and energy into cases when clients suddenly decide to accept settlement. ERISA litigation is a great deal of work and claimants who agree to litigate probably shouldn’t blind side their attorneys. In any event, I am happy to include information on both sides of the attorney/client fence.

Stop and ThinkThis week I had the opportunity of speaking with two prominent attorneys, one in California and the other in Florida. Both attorneys are knowledgeable, high-profile counselors with a great deal of experience with Unum Life, UnumProvident and now Unum Group.

One attorney told me, “Unum isn’t any worse than any other US insurer and the company is cleaning up its act”; the other said, “Unum is really awful and I’m still looking to file a RICO (Racketeering) case against it.” The dichotomy of these two differing points of view from attorneys who should know what’s going on is puzzling to say the least.

The question I’m asked most often is, “What IS going on with Unum these days?” Well, let’s take a look at what information I have access to by reading thousands of Unum letters, files, documents, and receiving emails and phone calls. Then, decide for yourselves what you think Unum is up to.

Voodoo Medical Reviews

Unum’s denial letters appear to reject any and all recommendations from primary care physicians in addition to rejecting FCEs, vocational reviews, and any other objective data obtained or submitted by anyone outside of the company. Although in 2004 Unum was required to consider the opinions of treating physicians by the multi-state settlement and RSA amendments, the company refuses to consider a consensus of medical opinion when it is not obtained, or paid for by itself.

Relying solely on Unum’s internal opinions is an unfair claims practice recognized by state regulators but Unum carries the process one step further by attempting to create the illusion of credibility by engaging in a hierarchy of medical review with multiple internal reviewers. One denial letter I read cited internal medical review by no fewer than four Unum physicians each one agreeing with the review before it. The obvious picture Unum creates is that the more opinions that can be obtained, the more credible the denial is. 

The problem remains, however, that whether Unum renders one or four medical internal opinions to back-up claim denials, ALL opinions are still Unum’s. It is very easy to render adverse decisions when the only opinions considered are Unum’s.

Therefore, we know by virtue of the omission of consideration and weight of any outside medical points of view that Unum is engaging in deliberate deception to deny claims by creating the illusion of credibility through multiple physician reviews that “stack the deck” against fully qualified treating physicians and their patients. The attorney looking to file RICO charges may point to this evidence at some point in the future.

Reliable Inside Information

Occasionally employees victimized by rounds of Unum’s age or gender related firings contact me and describe the company’s internal process as prejudicial and biased. One Unum employee described management as those “consultants” who in lieu of going to jail in 2004 were promoted as Directors and Managers and continue to force handlers to engage in unfair practices.

Not surprisingly, this is isn’t the first time I’ve heard of the corruption of Unum’s middle claims management who seems to pressure employees to deny everything in sight. Not long ago, one employee also shared that “Quality Compliance” audits and control over claim documentation kept the rank and file in check by making sure no information got into claim files that was adverse to Unum.

Finally, we also know from reliable sources that Unum’s settlement area was also directed to “risk manage” claims for denial when it becomes apparent they can do so. Phone conversations, and other investigatory means are used in the settlement department to obtain information to support denials in lieu of “providing insureds with available options of settlement.” We also know Unum manipulates present value calculations when claims have been under reserved as was pointed out last year to one of my clients.

IMT sheets and the “Rule of Threes” was also reported to DCS in 2012 although it’s unclear whether Unum still utilizes the practice. IMT sheets were allegedly provided to claims handlers containing names of insureds selected by management and QC to terminate as “the biggest bang for the buck.” IMT sheets were clear evidence of “targeting” specific claims for denial.

The “Rule of Threes” was a process whereby Unum claims handlers worked to obtain return to work releases and other reports not supporting restrictions and limitations. When they had three sources of denial support, claims were terminated.

Clearly, there are strategies and internal claims review processes that former employees report as unfair and discriminatory.

SSDI – Deliberate Interference

During the last several years Unum has systematically created a strategy of interfering with a federal agency and an entitlement paid for by the American people. The following has gradually taken place in plain sight.

  1. Unum obtained permission from the SSA to use its own File Authorization Request Form in lieu of Federal Form-3288. Unum’s version of the Authorization to obtain SSDI files adds permission to release Federal Form 831 that contains diagnosis codes and the name of the DDS who made the approval decision. Unum’s version also provides that the form is valid for 2 years. Occasionally under threat of termination, Unum sells obtaining SSDI files as “we want to give your claim every possible consideration.”
  2. Unum changed its Payment Option Form to include giving the company voluntary liens over all insureds’ assets if they do not pay back the retroactive overpayment.
  3. Unum begins to send out denial letters stating that the company does not need “to consider” SSDI decisions because it was able to obtain more current information SSA didn’t have when they made a decision to approve claims. Unum “suggests” insureds are no longer qualified for SSDI.
  4. Evidence indicates Unum obtains SSDI files on a hunt for mental and nervous listings it can use to limit claims to 24 months even when it’s clear the primary cause of disability is physical, not mental.
  5. Claimants who receive Unum denials are reporting that they receive “SSDI Review” forms shortly thereafter even when the initial SSA approval does not mention timely SSA reviews. (Is Unum forwarding their own opinions back to SSA?)
  6. Unum appears before the US House Ways and Means Committee offering its assistance in the identification of fraud.

What is more egregious is that the SSDI process at Unum now looks like this:

  1. Forcing all insureds and claimants to apply for SSDI under threat of reducing benefits if application is not made.
  2. Coercing claimants to sign the new POF form under threat of termination of claim even though the form is asking claimants to agree to something potentially adverse to them.
  3. Coercing claimants to sign CL-1155, Unum’s own Authorization form to obtain SSDI files requesting Form 831 and validating the authorization for two years.
  4. Once SSDI files are obtained, claims may be limited to 24 months if mental and nervous listing are used by SSA to award benefits.
  5. Unum alleges that it is excluded from considering SSDI decisions when making its own because it obtained more current information SSA didn’t have at the time of the approval and claimants may not be entitled to SSDI at all.
  6. Once SSDI is approved Unum uses the threat of the new POF form to re-coop overpayments, and then denies claims using multiple internal reviews to support claimants can work.

Clearly, the attorney seeking cause for RICO against Unum will be taking a long and hard look at the above. The evidence is out there, all the attorneys need to do is gather it.

The above points made in this post are only the tip of the iceberg. Regardless of which side of the fence attorneys comfortably settle on, it is clear that Unum is not operating in “good faith and fair dealing.” Are other insurance company’s doing the same things? In my opinion, not quite.

It is also my opinion that since Unum’s demutualization in the mid-80’s the company has never been able to devise ways to pay claims fairly AND make a profit at the same. I doubt Unum’s profitability picture would be in the black if the company were stripped of its deceptive claims practices.

However, given the above information (a mere mention given all of Unum’s strategies), YOU decide for yourself what Unum’s up to and which attorney you would throw in your towel with.

 

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