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Unum’s internal claims review strategies have received a great deal of criticism over the last decade causing many insureds and claimants to be cheated out of benefits they are legitimately entitled to.

Interestingly, Unum, and probably many other insurers, use strategies like those used in the past by professional boxers referred to as “Rope-A-Dope.” The term gained popularity after the infamous Foreman vs. Ali fight when Ali allowed himself to be hung up on the ropes and then “knocked out” and exhausted Foreman, the favored winner of the match.

“Rope-A-Dope” actually refers to a strategy wherein one boxer allows himself to get hung up on the ropes and allows the other to literally exhaust his energy before going in for the big knockout. Simply put, one player allows the other to become exhausted and then goes in for the kill (knockout).

Disability insurers use virtually the same strategies to wear claimants down before claims are denied. Consider.

  • Unum begins the claim with a 10-page set of application forms and then follows up with a  phone interview (not my clients), encouraging clients to talk and provide much more information than is necessary to investigate any claim.
  • Unum then proceeds with a process whereby multi-paged letters are sent out to insureds and claimants regurgitating policy provisions most people find confusing. These letters often arrive twice a month to begin with, then decrease to monthly, then every other month. The letters always say, “We are continuing our review of your claim; it is never really clear that Unum accepts liability for the claim.
  • After claims have been paid for more than 6 months, Unum hangs itself “on the ropes” and exhausts insureds with requests for field visits, forced applications for SSDI, IMEs, surveillance fears, multiple requests for medical information, and menacing phone calls.
  • After insureds are “exhausted” from all of the “risk management” activity, Unum goes for “the big knockout” and denies claims – a clear “Rope-A-Dope” process of exhausting your opponent then going in for the big knockout.

What most insureds and claimants fail to realize is that Unum’s strategies are planned, deliberate actions intended to gather information sufficient to deny more claims. Since the intent is deliberate such strategies could be described as “patterns of practice”, or in other terms “racketeering.”

It is also true that insurers who do this deliberately consider their insureds and claimants to be naive “dopes” unable to “figure it out.” According to Unum insiders the company is now training its claims handlers to immediately “suspect” new claims and engage in multiple risk management activities, an exhausting process of phone calls, letters, requests for information, surveillance, field visits and IMEs.

Those who are currently managing their own claims may recognize the process now that its been explained. How many times does Unum contact you? Ask you for additional information? Contact your treating physicians? Send you letters to the point you become fearful of the mail and opening anything from Unum? As a company, Unum is deliberately exhausting you sometimes to the point you will say anything to make them go away and get off the phone.

Clearly, these tactics encourage you to exhaust yourselves with fear and running around trying to meet Unum’s constant requests. DCS, Inc. is often contacted by those who have become exhausted of the claims process and ask for help.

The next time Unum hangs itself up on the ropes, don’t be its “Rope-A-Dope” and wait around for the knockout.

When it comes to defending disability claims, insureds can often come up with their own “right hooks.” Knowledge is power in the insurance industry and it’s time insureds and claimants recognize a “rope a dope” strategy when they see one.

Knowing what insurers do, particularly Unum Group, and why they do it is a big step toward defending any private disability claim.

The next time Unum hangs itself on the ropes waiting for you to exhaust yourself, just knock ’em out of the ring with fearless calm. Unum’s management hates that.

 

 

 

 

 

Friday Q & A

Is Unum Hospital Indemnity insurance a good deal?

Unum bolstered its group offerings with hospital indemnity and catastrophic insurance as riders to its group Plans. Employers offer the insurance, but often require employees to pay the additional premium. If Unum engages in bad faith and egregious claims practices for disability claims, doesn’t it make sense it would do the same for any other line of insurance it offers? As an example,  Unum’s Long-Term Care insurance was a disaster and that line of business was eventually dropped.

Insureds should consider the cost of any additional insurance Unum offers very carefully to determine whether the premium is worth the risk of not getting paid. What the company does to “not pay” claims for one line of business it can clearly do for all others.

What happens when I return to work after a period of disability?

If you return to work full-time with your same employer, but cannot remain on the job more than 6 months, you may go back on claim without having to meet another Elimination Period. Keep in mind, insurers will put you through an extensive investigation prior to reinstating your claim. This is why it is so important to make sure that once you return to work you are physically and mentally able to remain there.

If you return to work part-time with any employer under most Group Plans you qualify for the Work Incentive Benefit Program (WIB) for 12 months. You would actually qualify for “residual” benefits under the old group Plan while at the same time gaining eligibility under a new STD/LTD Plan for a new employer.

You would need to notify SSA of your return to work either full or part-time. Under SSA’s work programs you may be able to keep your SSDI for a limited period of time depending on the number of hours worked up to certain earning limits. SSA’s Red Book for return to work is extremely helpful in describing return to work benefits under SSDI.

Most Group Plans offer an incentive for insureds to return  to work such as the WIB program that allows claimants to work and keep both earnings and monthly benefit for a period of 12 months. Although claimants must still have a 20% earnings loss, the program is intended to be an incentive to encourage people to return to work.

Will Unum deny my claim after I send them the overpayment for SSDI?

Yes. Unum does have a “pattern of practice” of doing that, but then again all other group insurers often do the same thing. In my opinion, this is one of the great legal estoppel associated with disability insurance.

Group insurers force claimants to apply for SSDI which has a “total disability from any occupation” definition. Then, once SSDI is approved, Unum (and other insurers) allege claimants can work and deny claims – the greatest estoppel that is never enforced!

In simple terms, an “estoppel” is something that can be used to benefit you, and then also used against you. Disability insurers force claimants to apply for SSDI to reduce their total liability for claims. First, insurers sell SSDI as a great benefit to insureds, and then once the overpayment is collected, SSDI is ignored and claims are denied.

Think about this. Insurers sell group and other disability Plans based on a 60% pay out rate on which premium is based. Then, the government allows companies like Unum to reduce total future and financial reserve values by SSDI received by claimants. Employers actually pay premium on one thing, and employees receive something else.

As I said, this contradiction between SSDI’s value to claimants and the fact that once overpayments are recovered insurers can deny claims is a great estoppel that is not legally challenged.

It is extremely unfair to claimants to allege they are totally disabled for one purpose and not disabled for another.

How do I win a claim for Guardian Berkshire?

Well, that’s the million dollar question these days isn’t it? Guardian’s paranoia when it comes to investigation is not producing a good public image of the company’s products. At one time Guardian was a fair reviewer, but in the last few years a distinct change occurred giving the public the impression that Guardian is more concerned with a person’s credibility than whether they meet the definition of disability or not. If there’s dirt and smut out there about insureds, Guardian is sure to find it.

In addition, I’ve found that Guardian has strange ideas about interpreting its policy provisions. Payment is not always consistent with “residual” definitions written into  actual policies. Insureds would do well to be very familiar with their contractual policy provisions and be ready to defend them.

Winning a claim with Guardian/Berkshire is unreasonable and untimely, a fact that, in my opinion, should be considered very carefully by potential buyers of Guardian’s products. The company’s investigation of claims is way over the top and exceeds what would normally be considered necessary for disability claims.

 

As an addendum to yesterday’s post (below), recent information also indicates Unum [Lucens] is now requesting claimants to submit 1099s they received from SSDI going back many years. This should give every Unum claimant a head’s up that Unum is pursuing “re-calculations” of offsets going back, if possible, a decade or more.

Claimants who refuse to sign the Lucens Authorization to obtain financial information directly from SSA are subsequently asked to submit 1099s, which by the way, do not break out gross benefit from COLA and adjustments for additional earnings.

Therefore, Lucens could potentially calculate overpayments based on COLA additions that Unum does not have the contractual authority to offset. Why Lucens/Unum is requesting the 1099s is beyond me.

It’s reasonable to understand that SSDI recipients may not want their file information distributed to yet another outside party. Although Lucens’ letters communicate they protect confidentiality, there is no recourse for release of information if they don’t. Besides, Unum’s Plans do not require claimants to release SSDI information as proof of claim.

What is so ridiculous about Unum’s initiatives to “re-calculate” everything is that they have already been provided with SSDI award letters giving Unum all the information it needs to offset benefits. Of course, Unum is interested in SSDI increase adjustments for additional earnings, information they may not have access to as well as correcting all of their previous claim errors.

Here are a few facts Unum claimants and some insureds should think about.

  • If by re-calculation Unum/Lucens were to find that they owed YOU money, would they inform you accordingly and pay with interest? There is no guarantee of that.
  • How many of you have verified (in accordance with the definition of MONTHLY EARNINGS in your Plans), your pre-disability earnings on which the 60% of benefit is figured? Are you sure Unum figured it correctly?
  • How do you know Unum calculated “indexed pre-disability” earnings correctly if you are working part-time, or an any occupation investigation was recently completed? Have you verified that calculation? $1 can sometimes make the difference between gainful benefits or no benefits after 24 months.
  • Does Unum owe YOU money? Have you checked and verified?
  • Does Unum owe you COLA or Income Revenue Protection contributions (TIAA-CREF funds) the company conveniently forgot? Are the calculations accurate? Have you checked?

Unum’s “you owe us money” scheme is a two-way street and DCS, Inc. has already begun our own initiatives to assist our clients in validating payments. If Unum owes my clients money we’ll be requesting repayment with interest. DCS, Inc.’s client recalculations include calculation of Elimination Periods, WIB and PPL benefits, and any other Plan calculations that are appropriate.

Also, if you are one of the unlucky claimants Unum informs that money is owed, immediately request verification by asking for a complete spreadsheet of Unum’s calculations – month by month.

If any other company informed you you owed thousands of dollars wouldn’t you want to see verification that it was really owed? Ask Unum to prove their alleged overpayments by providing you with a copy of its complete month-by-month re-calculation before benefits are reduced to $0 to recover. Do you really want to take Unum’s word for it that you owe money and need to pay it back?

Isn’t it pretty convenient that Unum/Lucens performs the re-calculations, but never discloses actual calculations, or proves the money is really owed before it stops benefits to recover? Wouldn’t you want proof from Unum that the money is really owed first?

Personally, I’d want disclosure of all monthly calculations relied upon in claiming I owe Unum money. Do you really want to repay only on Unum’s say-so? Given Unum’s track record for dishonesty, I would think claimants would want more verification than just a letter telling you what you owe.

You can also ask for an ERISA appeal of Unum’s calculations and alleged overpayments including full disclosure of communications between Unum/Lucens and all financial data relied upon in claiming monies are owed.

Unum really should be providing claimants copies of its re-calculations prior to reducing benefits to $0. ERISA appeal opportunities should also be disclosed allowing claimants the opportunity to challenge Unum’s so-called overpayments and obtain disclosures.

Don’t allow Unum/Lucens to cheat you out of benefits you legitimately should be paid. Truth be known, it’s entirely possible Unum could owe claimants more than the company alleges claimants owe them. Check it out.

 

 

Recent news from inside Unum seems to indicate employees are given management directives to “do as much harm as you can.” Although some higher level employees are having pangs of conscience over Unum’s new “go get’em” strategies, most are content to harm insureds and claimants for a paycheck.

I don’t think I’ve ever heard of a disability insurance company that deliberately devises  outhouse strategies to “harm” insureds and claimants, but it doesn’t surprise me that Unum finally crossed that line. For years the company has been scamming its insureds by demanding repayment of imaginary overpayments suddenly turning up as a result of one re-calculation after another.

Robert C, [not his real name] was suddenly informed by Unum he owed over $250,000 because Unum made a mistake in calculation 12 years ago. Unprepared to repay such a large amount Robert probably won’t be paid a benefit for the duration of his claim. Unum eventually agreed to only collect 24 months of the new overpayments or $40,000, but Robert still won’t see a benefit for quite some time.

Of course, these focus initiatives are in addition to other unfair schemes within the claims review process such as multi-level medical reviews, rude claims handlers, and misrepresentation of information favorable to payment of claims. Recent information also suggests that management is training U-numbie newbies to presume all claims are fraudulent and investigate them as much as possible.

I think every Unum insured and claimant should stop and think about this for a moment. Not only does Unum want to deliberately do you harm,  the company teaches its employees to presuppose you are dishonest and treat you like a criminal. Your employer has definitely not done you any favors by providing you with group STD/LTD insurance you may never be able to honestly apply for, or receive.

As a former college educator and consultant I’ve tried to inform readers not to depend on disability insurance long-term. Although this is particularly true of Unum, other companies such as The Hartford, Prudential, CIGNA, Guardian and Mass Mutual have lowered their standards to meet Unum Group in the deception corner of the ring.

Disability benefits are no longer reliable as part of a financial planning portfolio. This is especially true of highly paid professionals who purchase IDI policies thinking Unum or Guardian will pay out on a $10,000-$15,000/month benefit without a fight.

What can you be thinking? Wealthy claims represent between 2-5M dollar financial reserves [contributions to profit if denied] and your claim will NEVER get off the “target” list.  Guardian and Mass Mutual are quickly following Unum’s unconscionable claims practices.

For now, in my opinion, Unum is causing its own insureds and claimants a great deal of harm. At least we now know what the big Lucens push for SSDI financial information was all about. In the last month DCS, Inc. received more than 10 calls about “fictitious overpayments” due to various Unum alleged “identification of errors.”

If Unum Group were an honest disability insurer I would report that too, however, that’s not the case. As a company Unum deliberately works against those it collects premium from. Insureds, claimants and their employers need to think about that. After all how often should you pay for the privilege of suddenly having no income because Unum alleges you owe THEM money and reduces benefits to $0?

I think it’s time for all Unum insureds and claimants to consider what’s at stake when a company deliberately investigates claims for the purpose of NOT paying, rather than paying claims.

Claimants and insureds are not without recourse in this matter. Claimants can contact their employers and let them know what Unum’s up to. Ask employers to make better choices by spending employee benefit dollars in more positive and reliable ways. Unum’s can’t stay in business long if the company can’t give away its STD/LTD Group Plans.

It’s easy for insureds – just don’t buy Unum IDI policies (if they are still selling them). If you have an old Paul Revere or Provident policy and need to file for disability, pay attention to policy provisions and force Unum to abide by the contract policy.

Obviously, Unum is out of control and thousands of claimants and insureds are at risk of losing benefits everyday. It’s own employees are calling the company out in negative ways because of its new policies of “going directly for the consumer jugular.”

In my opinion Unum Group is bad news for just about everyone.

 

 

 

Social media is now used by all major disability insurers to gather information it can use to deny private disability claims. “Social media” by definition is for the purpose of communication. It makes sense to me that the insurance industry finally reached a point where “hacking” and “snoop dogging” is normal practice to avoid paying claims.

Although I’ve written many articles about insureds not having an Internet presence, I haven’t been all that successful in convincing insureds and claimants to remain off of Facebook, LinkedIn, Twitter, and club chat rooms.

Yep! I’ve been talking to the wind I think. Still, I’m going to use a real live case in this article to help me drive home the point that social media is hazardous to disability claims.

Stephanie A.’s (not her true name) ERISA claim with Prudential was denied. In reviewing the Administrative Record (her file) I found that insurance investigators (probably MES) not only got into her Facebook account, but that of her children, mother and father, and friends, of friends, of their friends etc. There were pictures of pet dogs, bicycling, and most importantly conversation messages and chats discussing activities.

Apparently Stephanie A. was a volunteer leader of a junior baseball club and often participated in club events to earn money, a fact that was discussed extensively on Facebook and among friends. Also contained within the file were Prudential referrals and recommendations to investigators that they call the baseball club, find out the date of the next meeting and invade the meeting to observe Stephanie A.’s activities.

Investigators also found out from other Net sources that Stephanie was listed as secretary of another club. The extent of Prudential’s investigation is unprecedented and went on and on, digging deeper and deeper until there was enough evidence to deny future benefits. Prudential’s investigators were able to dig up enough evidence to show Stephanie had work capacity – not necessarily because she said it, but because her Facebook friends and family communicated it.

Unfortunately, Stephanie’s doctor also documented in a patient note that she and her family took a vacation to California where she felt well, but then got sick again when she came home. Prudential took this to mean that Stephanie’s complaints were somaticized (made up), but clearly not when she was on vacation.

An Internet presence anywhere is a hazardous risk to receiving future disability benefits. I hope my readers are really getting this, because if you continue to have Facebook accounts you probably won’t have your disability claim very much longer. Insurers have advanced their investigations to the point that they WILL find you, HACK into your accounts, and find enough information to separate you from your disability income.

Yes, I hear all the old hat excuses people tell me, “I security protect my account so they can’t get in (this is hog wash!), or, “I never discuss my activities on my Facebook page.” No? Prudential found information about Stephanie on her grandmother’s FB page. Imagine that!

As a disability consultant, I defend the contractual rights of private disability insureds everyday, but I have to say that insureds and claimants need to smarten up too. If you know it’s a risk to have a presence on the Internet why do it?

Truth is, you shouldn’t do it, you can’t do it, and still have benefits coming every month. There’s too much risk involved in using social media and DCS, Inc. recommends against it.

Please, get off the Net, and stay off the Net while you are receiving disability benefits. There are much more important things in life than tweets written by twits, and comments on FB that go global.

 

This is just a reminder that September is the end of third-quarter profitability results for insurance companies.  After the 15th of August, most insurers, particularly Unum Group will begin to find new claim targets to manipulate and plan for terminations.

If you begin to receive increased requests for information, notice surveillance, are notified by your physicians that insurers are harassing for patient records, receive field visit requests etc., your claim is on the target list for third-quarter profitability results.

Unum’s “hungry vulture” will be looking for vulnerable claims and will be engaging in unfair practices such as alleging physical impairments are mental and nervous limited to 24 months. Other insurers such as The Hartford, Reliance Standard, Lincoln National, Liberty Mutual, CIGNA, Aetna etc. generally engage in the same practices.

Insurers will be asking for increased Independent Medical Evaluations while they still have time to get the results back by the end of September.

Please feel free to give me a call to discuss your claim if you notice increased requests that should be managed to avoid the “hungry vulture” for third quarter!

One of the things I hear most often from insureds and claimants is that they spoke with insurance representatives on the phone and suddenly they either begin to receive outlandish requests for information or their claims are denied.

Although I’ve been writing and posting for years that it’s not a good idea to speak with insurance reps on the phone, many people still take the risk of doing just that. Insureds are either so scared they think they have to, or sincerely believe if they don’t their claims won’t get paid. Neither one of these are true.

In the interest of trying to explain [again] why it’s not a good idea to speak with insurance reps on the phone, please note the following:

  • Insurance reps are trained to document what you say through “filtered listening” techniques. Anything you say to reps is not documented the way it is said, but is “translated” in adverse ways.  Insurance reps can never “tell a straight story” and aren’t encouraged by management to do so either.
  • If disability insurance were any other kind of business insureds would be falling over themselves to get “it” in writing. All insureds should request to have all communications in writing so that they will have a permanent written record of all of their dealings with the insurance company.
  • Today, insurance reps like to speak to insureds to obtain additional family and social information that can be used by investigators to “hunt down” children and “friends” from Facebook. I’m seeing more and more denial letters containing information from Facebook “friends” about descriptions about outings and other activities.
  • Attitudes of, “I have nothing to hide” often encourages insureds to share more information than is necessary to investigate any disability claim. Not having anything to hide is NOT the point, and it won’t stop insurers from “interpreting information in their own favor.” This is also true of surveillance when insureds are cavalier and say, “I have nothing to hide.” Once you are observed engaging in activity with “nothing to hide” it quickly turns into “work capacity”. Please remember this.
  • Claims handlers can’t harass or abuse you in written letters that become part of the record. If you have a rude claims rep why do you spend the effort to listen to that kind of exchange? You won’t be abused verbally if you insist on everything in writing.
  • Anyone taking opiate or other pain or depression medications should not be speaking to any insurance reps on the phone. In my opinion, those taking certain medications are not able to respond accurately to questions asked simultaneously. At least responding in writing allows insureds to actually “think” about what their responses should be. Claims handlers know “you’re fuzzy” and take advantage.
  • Although my impression is that most insurers are NOT recording conversations, some still do. If you are unaware and say something detrimental to your claim, it can be discoverable in a court of law. Written communications are a matter of record and pretty much say themselves.
  • Claims handlers are given standard templates of information to ask about you, your activities and family. Much of the information is subject to interpretation and can be used against you. How many times have you said to your claims handler, “I never said that”, or, “that’s not what I meant?” What you actually said is never documented.
  • Insurance companies cannot use against you what you do not say.
  • Once something is said to an insurance company, you can’t take it back.

Another way of getting your goose cooked is to have an Internet presence. Recommendations to insureds and claimants – No Facebook, no LinkedIn, no Twitter, no website leftovers – nothing. The whole purpose to Facebook is “socializing” and the worst thing you can do is communicate and share photos and give the insurance company names of your friends, children and family.

Let’s not underestimate the hackers, they can get into any Internet media and use information against you. In fact, many insurers of auto and life insurance also hack social media for underwriting information. Insureds and claimants need to be “off the Net” entirely for the period of time benefits are payable.

Stay away from emails and insurance website portals. Emails are not a good way to communicate. Some insurers do not allow communication by email, others encourage it. The problem with emails is that they may or may not be added to the official record. Insurance website portals have tracking software attached to it that tracks insureds all over the Internet.

Although I’ve been writing articles about communications with insurance companies for many years, not everyone adopts my best practice suggestions and continues to speak with insurers on the phone. I really don’t know how I can more clearly communicate the dangers of verbally communicating with reps who do not accurately report what you say other than provide you with the above information. The above are “best practices” in claims management from the perspective of insureds and claimants.

If you are looking to cook a goose today, please make sure it is not your own disability claim. There are many ways for insurers to use your own words and statements against you. I recommend all communications in writing in order to accumulate a complete written record of all dealings with any insurance company.

Please feel free to give me a call to find out how DCS, Inc. assists insureds and claimants with managing communications with insurers.

 

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