Unfair Medical Reviews Continue
Recent narrative letters from Unum’s physicians to treating docs seem to indicate Unum is still using Dr Alex Ursprung to review medical records and write reports favoring denial. I had previously thought the egregious “Dr. U” had retired, but apparently he hasn’t.
Dr. Ursprung is a well-known Unum “claims killer” psychologist who has a longstanding history of providing documentation that can be used to deny claims. I’ve seen his name on many internal review reports I’ve read over the years including when I was actually employed by the company. Typically his reports are overwhelmingly unfavorable to insureds.
Some time ago it was Dr. Ursprung who recommended that an opiate addicted anesthesiologist return to the surgical arena where exposure to drugs is readily available. Although Dr. U’s report placed not only the anesthesiologist’s patients at risk, but also the insured, Unum denied the claim alleging an addicted physician could return to work based on Ursprung’s report.
Unum’s medical reviews are not intended to be accurate assessments of functional capacity or measurements of disability, but rather deliberate misrepresentations that are prejudicial toward Unum’s business and profitability agenda.
There is now an overwhelming amount of public information available on the Internet and from other resources indicating that Unum’s internal medical reviews are biased, and literally bought and paid for by the insurance industry.
Let’s not forget that Unum’s physicians are paid yearly bonuses for supporting the company’s agenda to increase “shareholder value”, or profit.
I can’t say that I’m pleased to see Dr. Ursprung’s name on narratives to treating physicians. In my opinion, Dr. U. is nothing more than an old Unum hack from way back still assisting Unum to deny claims unfairly. Not good news for insureds.
Unum Suspends Benefits After Receiving A Request To Reschedule An IME
Unum’s recent trend toward “suspending” benefits continues simply because several of the company’s claims handlers feel mean enough to do it.
Remember the slinky comment one Unum manager wrote about on his Facebook Page?
“Insureds are like slinkies – they aren’t worth very much, but you like to see one fall down the stairs every now and then!”
Unum’s policies do not require insureds to “show up” for an IME whenever it says they have to show up. After all it is insureds who are ill, and in the past they were given considerable lead way to determine when they can make arrangements to attend the IME evaluation.
Recently, a Unum claims handler arbitrarily decided to “suspend” benefits because an insured requested a rescheduling of an IME. Although the IME was rescheduled, the Unum claims handler “suspended” benefits pending attendance on the new date – out of pure meanness.
I suspect the real motive behind the suspension action was that the claims handler was really ticked off since she had targeted a denial for month-end in April and now will miss her target. Therefore, she coded a suspension of benefits giving Unum some profitability hit anyway.
Unum’s “suspension” of benefits is an out-of-contract action that is in violation of ERISA after 30 days. Nevertheless, suspending benefits because an insured requested a rescheduling of an IME is an act of hostility toward insureds, and the claims handler in question should be fired.
If anyone is interested in knowing the name of this particular Unum rep, send me an email and I will give you her name.
Unum Estimates and Reduces Benefit for SSDI In Violation Of Plan Policies
Unum’s ERISA group Plans allows Unum to reduce benefits with an Estimate when (and only when) claimants refuse to apply or continue the process through the allowed appeals.
Recently, a case was brought to my attention that a Financial Department Rep coded an offset for March and April to reduce benefits even when the company was aware, and had been provided proof of application for SSI and SSDI.
Of course it makes perfect sense that Unum would code an offset on BAS to make sure the company realized a financial reserve gain just in time for 1st Qtr. profitability. However, Unum’s action, at the expense of the claimant cost her more than $5,000 and was in violation of her employer’s Plan.
The problem here is that Unum, as I’ve recently reported in prior posts, doesn’t give back estimated SSDI deductions even when in error, or the claimants aren’t awarded at all. Of course, if the claimant is awarded SSDI, Unum will reduce the amount owed back by the estimated amount, but that’s not the point.
Unum violated the terms of this claimant’s Plan by taking an estimated offset for SSDI when the claimant was in complete adherence with the Plan by applying and following through with the process.
Unum is also now insisting that claimants sign the Payment Option Form to prevent estimated benefits. This action can also be in violation of some Unum Plans.
If anyone is interested in the name of the financial rep who deliberately reduced this claimant’s benefits maliciously, please send me an email and I will give you his name.
Unum Conducts Surveillance – Wrong Person and Dog – Wrong Person Working
Other phone calls to DCS indicates Unum conducted surveillance on insured’s daughter while she was walking the family dog. Although the claim was denied on that basis, Unum remains unconvinced daughter is not insured even though the real dog-walker is only 15 years old.
Clearly seen on the surveillance DVD, the insured’s daughter is obviously much younger, in fact a good 20 years younger. Unum doesn’t seem to give any credibility to the fact that their vendor conducted surveillance on a 15-year-old teenager. Even more ridiculous, Unum denied claim based on the mistaken identity surveillance.
Second case – Unum snooped on the Internet and found recent work history for an individual with the same name as one of its insureds. The company sent the insured a very threatening letter demanding information concerning “her recent earnings and work history.”
That’s one thing about snooping on the Internet…..a lot of it is “fake news.” Still, one would think Unum would immediately reverse its decision and pay benefits. Unfortunately, it hasn’t done so yet.
There is no question but that Unum, in my opinion, is an unfair insurer. Unum’s medical reviews are prejudicial, information is literally “snatched” from patient notes and misrepresented, medical information favorable to insureds is ignored, benefits are suspended for no logical reason in violation of ERISA, claims handlers have become rude and contentious, the company is frequently in violation of contract or Plan.
Remember, it’s not just Linda Nee saying so either. Unum has a longstanding history of unfair claim review – the Internet is full of information, litigation records, and public records indicating the same.
In my opinion, group employers need to move away from Unum and seek to spend their benefit dollars elsewhere. Claimants should inform their former employers of the need to provide benefits with a more successful company.
Obviously, Unum is not the “Lighthouse logo” it used to be, but an “Outhouse” that needs to be emptied.