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Unum sources report the company is looking to “outsource” a great deal of its business to outside vendors. Although other insurers often do the same thing, at least to some extent, it appears Unum is taking its internal inefficiency elsewhere.

In the true tradition of Sun Life Financial, Unum’s plans to hand-off business to specialized vendors, and/or offshore to India (IT Department), are indications the company isn’t functioning profitably using statutory employees. Recent incidences of “firings” further support Unum’s efforts to cut costs at all costs.

Last night I received a call from a claimant who received a letter from a company called “Lucens” (say this name out loud several times and you’ll get it), asking that she sign an SSDI Authorization to obtain her file.

The reason given was, “It is important that we verify this information to ensure that Unum continues to administer your benefits correctly.” This statement is a deliberate falsehood.

The only interest Unum has in SSDI information is to verify claimants have been approved, or denied SSDI benefits, as of what date, and how much was awarded. This information is indicated in the SSDI approval letter directly including how much was sent to an attorney for assistance.

What does Unum need an entire SSDI file for? Well, let’s see….Unum is looking to obtain Form 831 that contains the actual SSA “listings” used to award benefits, and the name of the DDS (Disability Determination Specialist) who reviewed the file.

Obviously, Unum is looking to see if any mental or nervous listing was used to award benefits and how they can contact the DDS whenever they want.

Lucens’ letter goes on to say, “The signed Authorization for the Social Security Administration to Release information will allow Unum or us as the designated representative authorized to obtain the needed information without any further action on your part.”

Yikes! Now, claimants are authorizing yet another entity to have access to SSDI information. Is this what you really want? Your SSDI file floating from one outside resource to Unum and back again?

Further, Lucens’ website states, “Lucens Group’s mission is to find mutually beneficial solutions between insurers and individuals receiving disability benefits.”  What does this mean exactly? Isn’t it obvious that if a situation needs a solution, that there’s a problem somewhere? What problem?

Unum has been operating a scam with its requests for SSDI files for some time. However, claimants have the right to say, “It is my request that the contents of my SSDI file remains private and confidential. If you need a copy of my SSDI status letters, please let me know and I will be happy to provide them to you.”

Unum’s group policies do not contain provisions forcing claimants to sign Authorizations allowing the release of SSDI files. Although Unum may persist in its demands, forcing SSDI file Authorizations down claimants’ throats is an out-of-Plan demand.

If Unum persists in its demands pick up the phone and call your federal Congressional Senators and let them know Unum is forcing you to give up confidential information it doesn’t need. Most people want to keep as much information as they can private and SSDI is no exception.

Remember the name, “Lucens” so that when you receive a letter from them you will know who they are. Do your own research on the Net for more information.

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.

 

Friday Q & A

Unum wants me to do a neuropsychological test. What can you tell me about this test beyond what you’ve already written on your blog?

Although neuropsyche tests are said to be “objective” in nature, in my opinion, that tag is not accurate. This test allows the insurance evaluator to choose a “battery of tests” that concentrates on issues of “somaticized”, or imaginary complaints, malingering, and other DSM-5 “cognitive” issues that in most cases have absolutely nothing to do with the insured’s actual diagnosis or evaluation.

In addition, the “raw data”, or actual tests are scored and are compared to common normative values existing in certain statistical categories; and then the evaluator writes a report giving his/her opinion as to what the standards means.

How can neuropsychological evaluations possibly be considered “objective evidence” when an evaluator who is not “independent” chooses the battery of tests and then write an opinionated report as to what the numbers mean?

If you ask 5 neuropsychologists to evaluate any particular report, you will most likely get 10 opinions. We’ve known for a long time that neuropsychology tests given to FMS patients are not accurate because the appropriate “battery of tests” aren’t administered.

A neuropsychological test is no more persuasive than any treating physician’s opinion based on clinical consultation alone. In fact, I would argue that at least treating physicians are using objective test results as diagnostic back-up for ongoing treatment.

In my opinion, Unum’s neuropsychological tests are nothing more than “battery test set-ups” culminating in opinions based on insurance conflict of interest.

I so desperately want to go back to work and I told my insurance company that. Now, they are harassing me. What do I do?

I advise insureds to be cautious about communicating an optimism about returning to work. There are several really good articles on Lindanee’s Blog that describe returning to work after a period of disability. When it comes to managing a disability claim insureds and claimants can only deal with the here and now.

Returning to work involves much more than just the ability to perform work tasks. It involves having to be somewhere every day and the ability to perform work in the context that any employer will expect the work to be done. It also involves regular driving to and from work, which for many people is problematic. Employers are not looking to hire individuals with work accommodations from the beginning.

The worst thing that can happen to insureds with disability claims is to attempt to return to work prematurely and not be able to stay there for any length of time.

In so far as a disability claim is concerned, expectations regarding returns to work shouldn’t be discussed beyond the medical restrictions and limitations given by physicians today. Truth is, insureds have no idea what the future holds for them and therefore communicating “I want to return to work” opens the door to harassment forevermore. Keep your optimism at bay and just deal with the “what is.”

Is Ohio National a good insurance company?

Ordinarily, I would say “No” because my experience with the company is that it does not consider outside treating physician medical information and refers all issues to  insurance attorneys who never want to resolve anything. Ohio National’s Attorneys refuse to provide copies of claim files upon denial and generally give insureds a very hard time.

Having said that, after posting a few negative posts about Ohio National, a representative from the company called me to ask for my feedback as to how to “fix” the claims process. She alleged that she had been assigned to try and improve Ohio National’s claims process. Whether she was able to do that or not I have no idea, but at least the company solicited input to change what wasn’t working – a novel idea for an insurance company

In my opinion, insureds with Ohio National disability claims should tread with caution while carrying a big stick!

 

Bill of Springfield, IL on Feb. 21, 2017

When they sold me this Unum critical heart and cancer insurance if I had cancer or if I had a heart attack or needed heart it would pay so I could use it for out-of-pocket expenses. Don’t waste your money on them. I had a rare surgery repositioning an artery which is found in about 5 percent of people. I had to have open heart to fix. Didn’t get a dime from them. Couldn’t even get their doctor to look at. Denied, denied. Don’t waste your money on them. You will be denied too.

(Unum began offering additional benefit riders such as hospital indemnity and critical care  insurance on their group Plans several years ago. Unfortunately, these additional Plans are contributory meaning claimants pay extra for them. I have never recommended that claimants spend the money for the additional benefits particularly when Unum “risk manages” them the same way they do its disability Plans.  For other insurers “indemnity insurance”, or insurance that pays a fixed daily rates for hospitalization or services paid directly to insureds, payments are not usually a big deal. However, like all Unum scams, the idea of risk managing “indemnity insurance” is profitable for them. I wouldn’t spend any money to buy Unum’s extra indemnity policies, as you can see they don’t pay out.)

Grace H. of Middletown, CT on Feb. 17, 2017

If I had NO disability insurance I would have been better off by far! They paid me 11,196.74 16 payments@$963.34/ea. Then took back $9,496.74 as a overpayment because they said that payments should have been only $100.00/mo — And demanded in a very threatening letter all the payback immediately. Why and who would overpay you $863.34 a month for 16 months without some kind of backhanded deal going on. You could never get real answers to questions. I won a disability case, I had a minor child, a retired husband and nowhere did I see “credits” for any of this or for the attorney’s fees either—It was a terrible time to be harassed and to be so very ill.

(No insurance company really cares about the people they sell policies to. Although this writer is unclear as to why a overpayment was due, “offsets” can only reduce benefits if the Plan or policy contract says the insurer can. Therefore, claimants need to have copies of their Certificate Booklet so they can determine what is a legitimate “offset” and what isn’t. Most of the time, though, deductions taken from benefits ARE contractual, but claimants are unaware of them. It it also very unfortunate that claimants have to deal with the issue of finances while ill and trying to manage their disability. Unum knows this, and usually takes advantage.)

Schon of Ashley, OH on Feb. 16, 2017

My former employer, Gateway Mortgage Group, offered short and long-term disability insurance with our benefits in 2016. After trying chiropractic care and physical therapy, my surgeon advised in July that I would need to have spinal fusion surgery on L5-S1 and I would also need to have metal rods inserted to stabilize the spine. Gateway advised me that there was nothing to worry about and I had the surgery in November. I knew that the first two weeks were unpaid and that the short-term disability would kick in at 60% of my pay thereafter.

From the first moment that I dealt with Unum, they were rude, dismissive, and disrespectful toward me. “What was I doing on my time off?” and “Your job is not that stressful, why can’t you work from home?” This started four weeks after surgery. It took them six weeks after my surgery to finally pay for four weeks of benefits. The following week, I received a letter from Unum stating that my claim would be denied unless I could provide further documentation stating that I was disabled. They took my doctor visit on December 12th and stated that since I was off of pain pills, there was nothing stopping me from going back to work. Being off of addictive painkillers was my choice but it does not mean that I was not in pain.

On January 4th, I told Unum that I would be seeking an attorney for an appeal to my case. I had my surgeon release me to go back (against his wishes) part-time from home on January 11th until my next visit with his office on February 6th. The attorney is still working on the case and I truly believe that Unum is one of the worst companies that I have ever dealt with. Later in January, I found a job with a better company. In my resignation letter to Gateway, I told them that they are ultimately responsible for their actions, the actions of their employees, and their third-party providers (Unum).

(The case described here is par for the Unum course. More and more reports are coming in to DCS describing rude and harsh treatment from claims handlers. I’m certainly glad that this claimant is fighting back and notified Gateway of Unum’s treatment. Unum couldn’t survive as a company without its Group LTD core products. All claimants should communicate with employers and let them know of Unum’s mistreatment.)

Michelle of Merrill, WI on Feb. 16, 2017

On November 9th of 2016 I went in for my 3rd Acl surgery. These were not work related. At that time Unum was ok with the short-term, constant phone calls and paperwork to get them to do their job, but it got done. I am a 50-year-old woman working in a factory job where I need to be lifting metal from a range of 20 lbs to 150 lbs. I worked there for 13 plus years. For 13 plus years I have paid for out of my own pocket for long-term, just in case. On Tuesday my doctor would only let me go back to work (this is after my 90 days of short-term) at light duty. My work place, which I knew this beforehand, after 90 days if I can’t make medium restrictions, cannot hold my job and at that time, let me go and issued long-term.

Today I get a phone call from a Unum representative, questioning me on my recovery and why I could not go back to work. I told her that it is not me, it is my doctor and my work, if they have nothing for me to do at light duty, so I cannot go back to work. So this very rude woman started to question me, she said, “Well we were checking out your Facebook and see that you are a very active person, and we seen you posted a picture of you zip lining on vacation.” I laughed and said, “Why yes, you did and if you are so smart to check out my pictures on Facebook you should have checked out the date and seen that picture was taken 4 years ago.”

Then she goes, “That I seen you took a vacation in January, and I seen that you were swimming.” First I said, “Well yes I did, it was a cruise, and if you look at the pictures you say you did, you will see a doctor issued brace that I wore, you also need to know it was not me so-called SWIMMING, take a better look, it is my daughter, daughter in law, son’s girlfriend, my sister-in-law and a close friend, who do you think took the pictures of them swimming?” She also questions hunting pictures that I had posted in my memories, from 2 to 3 years ago. She also question that I go to work out and questioned why I am not going to PT 3 times a week. I said that, “#1 my insurance reset at the first of the year and now it is out-of-pocket, so I cut it down to 1 time a week so I can afford it. #2, I go to work out because of me not doing PT 3 times a week, I need an Elliptical and a bike to use to get the strength back in my leg.”

She was rude and downright demeaning, I told her before I ended the call that, “It is NOT me, NOT wanting to go back to work, its work not having anything to fit my restrictions.” Maybe she needs to be calling them and asking them why? I am a very active person and life does not stop. I knew that this would be happening and was proactive and have job interviews for jobs that I can do with my restrictions. I am just amazed at how they treat people, not everyone in this world is out to screw them. It makes me wonder, because there are people worse off than me, with worse health conditions and this is how they treat people. Wow.

(Sometimes I think readers believe I’m over the top when I recommend that everyone on disability pull out of social media, Twitter, Facebook in particular. This is a very typical story about the fact that Unum actively accesses social media and uses it against their insureds and claimants whenever they can. If you have an active Facebook account please change the status to “Private” and only allow those you know about to access it. I actually recommend shutting it down entirely. And, by the way, it doesn’t make sense to me that anyone on disability would be publicizing activities on the Internet where it can be viewed, reported on, or hacked at any time by the international owners of the Internet. Be smart, and think twice about what you write on the Internet. You may as well be writing a letter directly to Unum when you do that.)

 

There seems to be some confusion of late between the terms “gain occupation” and “gainful employment.” Although both terms seem to mean the same thing the issue is further complicated by the fact that claims handlers (and attorneys in litigation) don’t seem to know the difference either.

Both of these terms relate to ERISA Group Plans but are used to describe significantly different contractual situations. Although Unum’s attorneys like to use the terms in ways favorable to the company, the terms are not inter-changeable within the context of when they are used in Unum’s Plans.

“Gainful Occupation” is used in Unum and other insurer Plans to describe whether or not the claimants own “occupation”, or any other occupation (as defined in the national economy), is gainful or not.  It is presumed when used in this context that insurers have the right to do “any occupation investigations” to identify alternative gainful occupations.

Although there are many versions of what constitute “gainful”, the most common is “60% of pre-disability earnings.” If insurers can identify two or more occupations (as defined in the national economy) that are “gainful” group claims can be denied on that basis.

Therefore, “gainful occupations” describe occupations (not jobs) that pay claimants at least 60% of pre-disability earnings. It is brought up most often in Group Plans to describe occupations that meet the definition of “gainful” in any Plan.

On the other hand “gainful employment” is a capstone phrase used in a general sense to describe claim situations when claimants are actually working.  The phrase doesn’t relate to any specific “occupation” at all, but instead describes situations when claimant are actually working part-time when, at some point in the future will earn “gainful employment” and claims can be closed.

For example, claimants who return to work part-time, and after a period of employment, begin to earn greater than 80% of pre-disability earnings, or “gainful employment.”

The more. you think about these two terms the more they begin to merge together as one definition, yet they are used to describe entirely different situations.

A simple way of remembering the difference is that “gainful occupation(s)” refer to “alternative gainful occupations”, or the claimants own occupation as part of an “any occupation investigation.”

“Gainful employment” refers to situations when claimants are working part-time and are receiving part-time earnings eventually arriving at greater than 80% of pre-disability earnings.

 

 

One of Unum’s most popular CXC loophole-fixes was to add definitions for “regular and appropriate care.” In retrospect we see that many claimants received denial letters because medical resources inside Unum alleged they were in violation of “regular and appropriate care.”

Although it would appear that Unum is very clever to include these provisions it should be noted that the Plan wording does NOT give contractual authority for Unum to decide what “regular and appropriate care is”, only to enforce it.

“Regular care” requires claimants to consult their treating physicians as often as any prudent person would normally visit a physician for any claimed impairment. The most persuasive evidence of regular care accepted as proof of claim are patient treatment notes, which is why insurers are so fond of chasing these records.

“Appropriate care” requires claimants to be in regular care with physicians who are credentialed in the specialty related to the claimed disability. For example, a claimant diagnosed with depression severe enough to cause cessation of work, shouldn’t be treated or prescribed medication by a family physician. Regular and appropriate care for diagnosed depression and anxiety is weekly therapy or counseling with a qualified psychologist, psychiatrist or both.

Therefore, “regular care” refers to the frequency of treatment while “appropriate care refers more to the quality of treatment received.

No insurance company has, or ever should have, the authority to determine what regular and appropriate care is for any claimant. Of course there are exceptions.

As a former Unum claims handler nearly 17 years ago now, I had a Texas client with a severe cardiac condition living somewhere along the border with Mexico. When questioned about his treating physician he stated that he had a “shaman witch doctor” in Mexico he was seeing who was actually treating him very well. Of course, I suggested to him that he seek out a cardiologist stateside to treat him.

This example represents a severe case, but in general, insurers can only tell you what the standards of medical treatment are and hold you to those standards. Insurers CANNOT, however, hold any claimant to a particular standard of care determined by internal medical resources or individual claims handlers. There is a difference.

Although regular and appropriate care should only be determined by primary care physicians and mental health providers, there are standards of medical care established by medical authorities that makes sense.

Lately, I’ve heard that Unum is enforcing “regular and appropriate care” as it pertains to Fibromyalgia. Seventeen years ago, the standard regular and appropriate care for treatment of FMS was at least bi-monthly counseling in addition to monthly  consultations with a Rheumatologist.

It has long been recognized that FMS has both a “mental” and a “physical” component. The “somaticized”, or “all in your head” aspect of FMS was further emphasized with the publication of the new DSM-5 that also classifies FMS as having a specific mental component that requires treatment. Again, this isn’t something new, but it is now supported and emphasized by the DSM-5. This also includes CFS and many other “syndromes.”

It’s very likely that Unum is pulling the “regular and appropriate care” card out of its scalp belt and holding claimants accountable to receive both therapy AND physical treatment for FMS claims.

For some claimants, regular and appropriate care is the least of it because they drop out of care altogether. “My doctor said there was nothing more he could do for me, so I stopped going”, said one claimant. Wrong. You still need to remain in regular care.

While it might be true your physician exhausted his treatment plan, claimants are still expected to remain in “regular and appropriate” care in order to receive benefits. Without evidence of regular care, there is no disability claim.

From time to time Unum has some very strange ideas as to what “regular and appropriate care” is and how it should be defined. Remember, no insurance medical resource can dictate treatment or care, but  it can enforce generally accepted medical recommendations that are reasonable within the industry.

In the 26 years I’ve been managing disability claims I have never encountered a claim situation where any insurer demanded claimants enter into “unreasonable regular and appropriate care.”

For example, one claimant told me on the phone, “I see my doctor twice a year and that’s enough!” As it turned out, this claimant was taking a cocktail of prescribed opiates – dangerous combinations I might add. Regular and appropriate care would more reasonably be determined to be at least monthly visits with a pain management MD, for no other reason than to manage the opiate dosages.

Finally, some claimants get themselves into trouble when they relocate to other areas and drop out of regular care. While moving isn’t a big deal for private disability, not maintaining regular office visits and care is. It’s always important to find new doctors and begin care as soon as possible after moving to a new location.

“Regular and appropriate care” is something I help DCS clients manage so that it’s not usually a problem for my clients. For those who are unfamiliar with the Plan provisions, it could become quite problematic.

Also, not all of Unum’s Group Plans contain “regular and appropriate care” provisions, so it’s very important to check the Glossary of your Plan if Unum is threatening to remove benefits.

Other insurer policies and Plans usually do not contain “regular and appropriate care” provisions, but instead insist on licensed psychologists and psychiatrists for mental health claims. This eliminates LCSWs from providing therapy, and I have known other insurers to threaten to deny claims if mental health providers do not meet certain qualifications.

Remember, “no regular care”, no disability claim. Although insurers can’t dictate what care you should have, they can certainly enforce medical standards of treatment if standards aren’t being met.


DCS is a national consulting organization that provides expert claims management services to those with private insurance. I offer free initial consultation.  Please contact me about how you can become a client.

If you are interested in becoming a DCS client, please feel free to visit my website at: http://www.disabilityclaimssolutions.com

Telephone: (207) 793-4593

Fax: (207) 274-2331

Detailed information about DCS, Inc. can also be viewed on this blog by clicking the “Consulting Services” Tab from the Lindanee’s Blog Home Page. You do not need to go through the complicated maze of disability claim management alone. I am here to help.

The amazing thing about southern Maine is that I’m surrounded by people who are working, or who have worked for Unum in the past. In fact, most people in Maine either worked for Unum at one time, or know someone who does. The rests are Unum wannabes.

Friendly conversations with receptionists, data intake clerks, and even those waiting in line at the coffee shop often pin point Unum’s dirty laundry in the wake of recent firings and the typical unfair claims practices that makes Unum publicly infamous as an egregious and unfair disability claims insurer.

In the past, stories about Unum have always been the same – Unum denies claims unfairly, produces trumped-up medical reviews, refuses to overturn denials on appeal, treats their employees and insureds like crap etc.

Yet recent information emerging from within the company tends to suggest that Unum’s primary Group STD/LTD base is diminishing as employers throw in the towel on service contracts the company isn’t abiding by. Other employers are simply moving on, giving their employee benefit dollars to companies with better public perceptions and reputations.

“Service contracts” set standards of compliance for Unum to follow through with. If conditions set by the employer are not met, employers can reduce premium payments accordingly or move to other Plan providers.

It doesn’t surprise me that ERISA Plan employers have finally had it with Unum Group and its unfair claims strategies to deny more claims. In the last several years Unum’s strategies have included procedures and reviews to allege significant overpayments, deceptions to obtain SSDI files to include Form 831, “suspension” of benefits for any reason, misrepresentations of policy provisions, abuse of mental and nervous limitations and self-supported impairments, and finally continued “snatching” of medical information to support denials regardless of other information contained in the patient records.

Despite Unum’s 2008 attempt to re-brand itself after the multi-state reassessment was over, the company hasn’t “walked the talk” sending insureds and claimants back to employers demanding more realistic disability claims benefits. Employers have responded by taking their business elsewhere.

No doubt Unum’s recent round of firings including several Vice Presidents from Portland and Worcester, is in response to the public’s negative attitudes, plus rumors of unprofessional ethical behaviors associated with claims. In my opinion, I believe Unum’s woe’s are more the result of internal chaos because management has lost control of the claims process.

Over coffee today, a data reception clerk and former Unum STD employee, shared with me the fact that each claims handler is required to manage a block of claims between 200-275 claims. As a former Unum employee myself, this fact alone indicates Unum may be attempting to operate with a significant backlog of claims because there is no way one claims specialist can handle that many claims and not “grow their block.”

Other information obtained from the company’s insureds and claimants seems to also indicate Unum’s claims handlers have become rude, contentious, uncaring and uncooperative – in other words, really awful customer service. I’ve noticed Unum’s recent tendency is to lose paperwork, and be unresponsive.

Unum cannot survive as a company without its base related to its core product, namely Group STD/LTD. If the information is true that Unum is losing its employer account base, the company is headed for a fall.

It is also important to note that Unum employees are talking. Information about internal processes is being leaked to outsiders. In the past, 60 Minutes and NBC Dateline exposed Unum, “when employees began to talk.”

I admit the stream of information coming from Unum gives “waiting and seeing” a whole new focus of anticipation. For now, the word from inside Unum, is not good.

 

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