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In the last few months I’ve received many calls from insureds/claimants who are attempting to manage their claims on their own. During the course of our conversations it becomes evident that, due to lack of information, they may have set themselves up for denied claims. Hence their calls to me when the bell begins to drop from the tower.

Insureds describe how they’ve been having verbal conversations with their reps, asking insurers for advice on what to do, writing long letters to the claims handlers, trusting information given to them, have not read their Plans or policies, and in general, describe how well their claims have gone, until they are about to be denied.

I also know that those who read my posts sometimes tell me how fearful my articles cause them to be. At the same time, I am contacted by many insureds for advice, (even when they have attorneys), because they know I provide accurate information and won’t just tell them what I think they want to hear.

“Information” is the most valuable tool insureds have to protect themselves from a complex, deceptive, adverse private disability system that provides no long-term financial security when they need it.

Please think about this! Before you even open the cover of your policies, these documents are adverse to you. You don’t have to file a claim, you don’t have to do anything, and yet, most people are totally unaware that benefits provided are subject to “conditions” that must be met, and insurers are permitted to use their discretion whether or not to pay you. You don’t have to DO anything and yet your policies are already working against you.

Imagine what could happen when you DO actually file a claim and attempt to move through the process. Today more than ever, insureds/claimants need to know how the process works and what to do, and not do, when filing claims and moving through the process.

There are over 1,300 articles on this blog containing valuable information insureds need to know. It occurred to me recently, after another very painful call from an insured, how limited in scope Lindanee’s Blog really is.

Therefore, I’m asking the 800 or so people who read this blog everyday to share Lindanee’s Blog with others particularly those who may have need to file claims in the future. This is not an attempt on my part to solicit more business, but rather to “get the information out there” to those who need it, before they begin working against themselves and handing insurers their claims on a silver platter.

I have no stake in the ground as people do on YouTube videos. This blog isn’t monetized, and I don’t have to compete with “Subscriptions, Likes” or “thumb’s up” to get higher ratings. My only concern is getting information out to the public to prevent them from making mistake upon mistake that won’t get them a successful claim.

Therefore, I’m asking my readers to let others know where the resources are and how important information and knowledge is with managing a disability claim before it’s too late. I know my posts are uploaded to CFS/ME and FMS chat groups and websites. Please help if you have a resource my information can be referenced on.

The information contained here on Lindanee’s Blog is free and available to everyone.

A word of caution to DCS clients who sign confidentiality statements with me. DCS, Inc’s proprietary information cannot be posted or shared without my permission, but you certainly can direct others to this blog.

Thank you.

 

 

 

 

Recently I was contacted by a reporter from the Baltimore Sun and gave an interview about Unum. Although I spent some time with the reporter, I knew that information I gave him would never make the paper. Unum’s long-reaching arms of protectionism usually prevent editors from exposing Unum to any great extent.

Sure enough when the article came out it contained one or two sentences about Unum’s tendency to deny claims, and that was all. But, the article did mention that Unum’s public relations department told the reporter that out of the 650,000 claims submitted to Unum each year, Unum paid 85% of them. What?

Reading such rubbish was like old home week reminding me of Unum’s ridiculous claim in 2002 when regulators were still conducting the conduct market examination that lead to the Multi-State Settlement Agreement. Back then, Unum alleged it paid 98% of claims, which was later debunked when regulators and attorneys asked for proof of the calculation.

Unum’s recent statement of paying 85% of claims should have been investigated by the Baltimore Sun reporter. Surely, he could have asked for “Proof” of how that statistic was calculated. In my opinion the allegation of paying 85% of claims is just as ridiculous as Unum’s prior statements that it paid 98%, and here’s why.

To my knowledge, nearly all disability insurers determine, and price premium based on a 60% liability payout rate (LAR). Premium for ERISA group plans and IDI polices are both underwritten assuming a 60% risk of payout. Therefore, if any insurer were to pay 85% of claims while costing out premium at 60%, doesn’t it make sense they would have lost their shirts by now?

I know this to be true since most claims managers and VPs go ballistic when unit LARs begin to exceed 60-70%. Unum’s claim VPs are well aware of the effects of pay out rates and opt to manage them at the 60% level by demanding claims handlers do their jobs better by denying more claims.

Of course, it all depends what blocks of claims are thrown into the calculation mix to distort the outcome. Years ago I was an expert in a qui tam case involving Unum and social security. It was discovered at that time that Unum included Short-Term and Maternity claims into the statistical mix – a huge distortion. STD doesn’t have any financial reserve and is usually paid for 26 weeks, and nearly all Maternity claims are paid.

Public relations offices presume most reports are deaf and dumb on the subject of disability insurance and would be more likely to accept nonsensical statements such as, “we pay 85% of claims.” In reality, garbage-in equals garbage-out and any statistics given by Unum should be validated with proof of how the figure was derived. I’m guessing everything including the cafeteria was thrown into the mix on this one.

Let me also point out that if I were a Unum investor, and the company publicized it paid 98% of claims, I’d immediately sell my stock and run for cover. Insurance companies who continuously pay claims in excess of premium costs won’t stay in business very long. The fact that Unum remains a going-concern tells me it’s not telling the truth about paying 85% of claims.

The truth is that no disability insurance company can make a profit using a 60% payout rate to cost out premium. If Unum were to actually pay those claims that should be paid, and deny those claims that should be denied, the company would not be profitable. Therefore, Unum, like all other insurers must “risk manage” claims – devising strategies to deny legitimately payable claims in order to make a profit. The denied, legitimate claims make up the difference, and remain the path to profitability.

Insurers can’t increase premium or LAR percentages because they would price themselves out of the private disability market. Insurance is a very competitive industry. Therefore, all insurers cost premium conservatively, and make up the profitability difference by denying legitimately payable claims.  Make sense?

Unum’s mantra is to put out figures of payouts that are exorbitant, and untrue. Whenever you hear of a statistic like this, you might want to request verification of how the figure was derived, particularly if you are a regulator.

In my opinion, Unum’s pants are on fire most of time, but particularly when they allege a 85% payout. That’s just crazy!

 

 

 

 

Sources inside Unum continue to report to me that company treatment of employees continues to harass those who either challenge claims practices, or have had to go out on STD themselves. This is another subject I’ve written about extensively, but because I am aware Unum employees read my blog I’m going to address it again.

After a recent discussion with a Unum LTD DBS it occurred to me that neither its claims practices nor treatment of its employees changed in 16 years. Apparently, Sandy Rosen from HR is still covering Unum’s behind, and management harassment is at an all time high.

A Customer Service rep who is expecting to be fired shared that Unum’s treatment of cancer insureds is unfair and dishonest. Although he was told to keep his mouth shut, he was eventually offered around $4,000 to quit the “remote” program and leave.

Another claims employee out of work and receiving STD is receiving daily calls from her manager harassing her to come back to work. I also understand that several other employees have been harassed by managers who contact those on STD on a daily basis.

Listening to Unum’s current employees talk is like “old home week” for me. Most who call DCS, Inc. describe a claims process focusing on denials and meeting financial targets.  Although I have said many times, “Whatever Unum does to its insureds, it can also do to YOU”, it doesn’t make things any easier when “the targeters become the targets!”

Unum employees should realize they need to protect themselves from Unum’s violations of human rights in the workplace. My first suggestion is to keep a journal at home documenting what goes on at work. Daily records of 1/1 meetings, unit team meetings, internal memos of interest from Unum’s “Intranet”, and other management directives that don’t seem quite right to you.

Use your conscience as a guide to figure out what’s right and what isn’t. Keep your journal up to date with records and other information that could prove wrongful termination and deceptive claims practices. Come on. If you’re working in claims, you know how the process works. Document it!

One of the problems I ran in to from the DOL and Human Rights Commission was, “We believe you, but prove it.” Document your employment, your activities and management’s directives – if a wrongful termination occurs, you will have documentation to back you up.

Unum’s managers begin to pad personnel files long before most employees are aware of it. Do not keep your Unum journal anywhere near your office or office computer.

Unum terminated me off campus when I was taking HIA tests in South Portland – then it raided my office drawers, computer, shelves and confiscated all of my files. Another employee in Chattanooga’s desk was raided and her personal belongings were thrown to the curb in front of the building for her to pick up at 5 o’clock. That’s got to be pretty humiliating.

More claims or work seems to be coming your way, you are set up in projects in which you will fail, 1/1 meetings begin to be more critical and negative, and when managers finally have you where they want you, they put you on probation, or you are escorted out of the building.

In addition, Unum’s managers often segregate you from your unit peers and attempt to obtain additional adverse information from them. For example, your manager may ask some of your peers to send you emails asking how you are, so they can get more information about you. My personnel file was padded with statements from my peers even AFTER I’d left the company.

(You may recall that Unum suspected me of being a whistle blower at the time of 60 Minutes and NBC Dateline shows in 2001.)

I know this to be true because Unum’s attorneys threatened my best Unum friend to give up personal emails I sent to her home the day I was terminated. These same emails plagued me for several years when I gave depositions. It is definitely NOT a good idea to respond to peer emails when you are on STD or expecting to be terminated.

Human Resources is not a Unum department to contact since they are not advocates for employees, but for Unum. I mentioned Sandy Rosen, an HR person who has, in my opinion, done more to destroy Unum-employee relations than any other personnel tool. As an employee, this is not a person you want to trust to help you get a fair shake.

When I write articles like this, my insured readers ask, “Why are you so concerned about Unum employees?” It’s pretty simple, really, Unum employees keep me informed, and as a person whose been there, I can tell them that getting fired by Unum is the best thing that  will ever happen to them!

Unum employees need to constantly “watch their six”. For those who don’t understand this phrase, it simply means that everyone who works for Unum must keep a close eye on their behind, and cover it from those who wish to do them harm.

If you find yourself on Unum’s or some manager’s poop list please feel free to give me a call. Unum can’t control who you speak to, or who you contact, and I just might be the  right person who can relate.

And, keep reading the blog….I know you’re out there.

 

 

One of the most egregious misrepresentations  continuing to plague insureds/claimants are the allegations made by insurers that certain physical diseases are in fact mental and should be only paid for 24 months.

The new/old strategies to classify impairments as “behavioral health” in order to reduce claim liability, is as popular as ever. In so far as private disability is concerned, any mention of depression, even if it is secondary to physical disease, is presumed to be the sole cause of disability and limits benefits to 24 months.

Recently, two companies have emerged as the top offenders of behavioral health claim abuse, not surprisingly Unum Group and The Hartford. Most people are unaware that The Hartford’s management originates from Unum’s old Duncanson & Holt, and its claims strategies are primarily the same with one exception. In my opinion, The Hartford places more nickels in the surveillance-investigation bucket than Unum does.

Nevertheless, the financial reserve conflicts of interest involved in limiting benefits to 24 are so obvious, the practice is no longer “secret”. I think most people understand very clearly that mention of depression could be trouble.

Unum’s “big thing” these days is to classify “migraine impairments” as mental and nervous. While insureds scurry to obtain proof of claim from their neurologists, Unum insists “migraines” are “self-reported” and any evidence submitted is subjective.

The Hartford doesn’t even wait for final investigations to be completed. The company literally “jumps in” with both feet by having medical reviews done by a company called MCN (which you can look up on the Internet), inaccurately supporting a false narrative that there is no “objective evidence ” to support a physical disability.

Neither company’s Plans or policies require “an objective evidence standard”, a fact left unmentioned in its citations and writings. Some Unum ERISA Plans limit “self-reported” impairments to 24 months, but then again it’s Unum that decides what is and isn’t “self-reported.”

The misuse of Plan and policy provisions opens the door to increased profitability for insurers, but causes periods of unsecured financial support to those who are physically impaired and cannot return to work. Therefore, there is harm being done to insureds by corporations seeking increased profits at their expense.

It seems as though fibromyalgia, chronic fatigue, secondary depression, migraines, chronic pain, and many other impairments are “positioned” to look like mental disorders when they are clearly not. Even Lyme disease, an old impairment from the past is often classified as “mental” in order to avoid paying claims to age 65.

Insureds in this situation have 24 months to submit evidence that they are in fact “physically disabled” and not mentally disturbed. In fact, it amazes me that Unum, for example, can allege a behavioral claim when the insureds has never received therapy, and is not now in consultation with a mental health provider. How is that possible?

Still, Unum’s old abuse of the Mental and Nervous provisions of the policy remains rampant and is harming insureds and claimants as it always has.

In my opinion, all states should outlaw limitations for mental illness, that should take care of the problem. In the meantime, this is an awful situation for insureds to be in.

If you ever wanted to know about the adverse affects of surveillance, please read this interesting case submitted by a reader of this blog.
I’ve been advocating for years that insureds not exceed their restrictions and limitations. Now, you can see what could happen if you do. This document contains pictures of the surveillance.

Leaving work due to a medical disability is a traumatic event. For most, it’s a “fire bell in the night” – unexpected, undesired and financially harming to the extent that it often causes insureds and claimants to feel “off their mark”, fettered, confused and helpless.

In addition to managing impairment, insureds are expected to keep up with a very challenging private disability claims process that often results in secondary diagnoses of anxiety and depression, I call “Disability Claims Syndrome or DCS (pun intended.)

In combination, medical disability plus filing a private disability claim can push most people to a dark place of negativity, pessimism, and fearful living. I’m here to tell you that it doesn’t have to be that way.

Like many other phenomena in life, “attitude and knowledge” can make all the difference often requiring skills that replace the expected negative behaviors with more positive perspectives of what it means to be disabled. Although I’m certainly not the guru of coping skills, I feel qualified to offer a few suggestions that could help  insureds while   receiving disability benefits and managing a disability claim.

To begin, there are two basic realities that most insureds should think about and accept when going out on disability.

  1. There must be a recognition of the reality that the mechanism used to receive benefits, your Plan or contract policy, is deliberately designed to be adverse to your receiving benefits legitimately due to you. Sitting in your family safe, your policy is already a negative to the process of receiving disability benefits.
  2. Although unexpected, your disability precluding you from working,  is an uncertain aspect of your life that can only be determined day by day. No one can project disability in the future, and doing so can be a constant source of negative thinking.

Once insureds fully accept that ERISA group STD/LTD and IDI policies do not represent “entitlements”, or presumed benefits, “knowledge is power” takes over and the process is less frightening. Insureds are more capable of defending their Plans and policies when there is basic recognition of the realities of the claims process and what it entails.

Although the Internet offers little in terms of positive reinforcement to those on disability, filing a disability claim need not be a horrific experience. As the above graphic suggests, life is not over because of disability, only that insureds may need to adjust their thinking to daily activities in search of the quality of life they want and deserve.

Here is my first coping skill:

Using “Insured’s Alone Time Wisely”

Most insureds work at least 40 hours per week, and for some occupations even more. Those who are out of work generally have 40 hours that now requires some activity to keep them involved. I’m guessing that medical and impairment management will take up at least 50% of the non-working hours; activities such as doctor appointments, picking up prescriptions, medical objective evaluation, and performing basic Activities of Daily Living are real tasks that take up time.

Let’s overestimate medical management and say that leaves about 10 hours per week for what I call the “Insured’s Alone Time” or IAT. One of the best disability coping skills I can think of involve filling idle time with positive activity at levels tolerated by each individual’s impairment and medical condition.

While there are no specific recommendations of WHAT to fill the time with, reading, walking, drawing or painting, allowed exercise, taking a course online, learning new languages, doing a minor household chore, or even dancing around the kitchen to an oldie but goodie tune, even putting a puzzle together with a grandchild, are great fillers of time. Engagement in fun, pleasurable activities, whatever they are, is a means to using non-working time in a positive way.

What should be avoided at all costs is using non-working hours to “just sitting and thinking”, a predominately negative probability. After a few minutes, “sitting and thinking” becomes a focus on how sick you are, or how much you are in pain, or how fatigued you’ve become. Thinking about pain worsens pain; inactivity breeds inactivity; and, unfortunately focusing on negativity often produces negative results. Negative thinking becomes a powerful habit.

Finally, your thinking switches from your medical symptoms to your disability claim producing even more stress, fear and anxiety.

Those who use their time just “sitting and thinking” about their disability claim usually become extremely paranoid and negative about “what’s probably going to happen to my benefits in the future.” “Is Unum going to continue to pay me? What are the odds?” “Why is MetLife doing this? What deceptive motives do they have?” And on and on……

These negative thoughts cause insureds to do things they shouldn’t do such as frequently calling their claims reps, or visiting the website portal 10 times a day. Still, insureds often  do anything to relieve themselves of the stress of “sitting and thinking” about their claims, even to the point of risking denials.

Replacing idle time with re-directed time brings new perspectives and often opportunities to being disabled. Alone time can be planned and looked forward to every day. Being disabled and on claim does not mean you have to act like a wounded soldier with grandma’s comforter pulled up to your nose.

Filling your “Alone Time” with joy is a major step to managing any disability. Where before you were used to working 40 hours per week, you now are forced to manage your  health and well-being with perhaps some time to spare. This time can either be used to produce stress, or it can be filled with activities you choose to better your life.

Therefore, the first coping skill to disability is replacing the habit of just “sitting and thinking” with activities you enjoy and can look forward to. Life isn’t all about your medical condition, and clearly it isn’t all about your disability claim. Negative thinking produces negative results!

It’s about YOU and the people and things you love. It could also be said that using “Alone Time” wisely is not just a disability skill, but a life skill for everyone.

In any event, thinking positively about your claim is the first coping skill to successful outcomes.

 

I’ve been in the private disability claim business for over 25 years, and in that time one subject I have consistently stressed for successful claims is not communicating with insurance companies on the phone.

Despite the many articles on this blog explaining in detail why it isn’t a good idea to share verbally with claims handlers, insureds continue to call and  begin with, “…when I spoke to Unum….or, when I spoke to my claims handler.” Obviously, I’m not getting through.

If disability insurance were any other type of business, insureds would insist on having everything in writing. Would you really sell a used car without a bill of sale?  As adults, we are all well aware of the “he said, she said” impossibilities of attempting to resolve differences, and yet when it comes to managing claims insureds are more inclined to “spill the beans”, or, “give away the farm”, than recognize the importance of prudence and restraint.

Private disability insurers train their specialists to use “selective documentation” when it comes to conversations with them. This means, diary records document only what is favorable to insurers (or, that which progresses the credibility plan of denial), at the expense of all else said that favors insureds. A Unum claims specialist who is rude and says, “So why aren’t you going back to work?” clearly isn’t documenting what he/she said, only your response.

Those who are taking opioids or other depression and pain medications shouldn’t be speaking to any insurance representative on the phone. Perception and reaction can be distorted and therefore responses cannot be relied upon to be accurate or in proper balance to questions asked.

When I ask callers why they speak to their insurance reps on the phone I hear, “Because I thought I had to.”

OK. Let’s be clear. No group ERISA Plan or IDI policy contains provisions requiring insureds and claimants to communicate with insurers on the phone. Disability contract documents may contain provisions requiring you to cooperate, but certainly insureds can be very cooperative with written communications. “In writing only” is the only way insureds can accumulate complete records of all of their dealings with any insurance company.

Insurance specialists know that if they can reach you on the phone and get you talking, you may just give yourself work capacity – a great outcome for a claims specialist whose performance reviews are based on how many claims they deny.

As I said I’ve been giving the same advice about requesting all communications in writing for 25 years; and, insureds may be reading, but some are clearly not listening.

Contrary to verbal communications my advice and recommendations concerning insurance website portals is fairly new due to the advance of technologies that allow Internet interactions. It didn’t surprise me to find out that insurance website portals present the perfect façade for tracking Trojans, and documentation to allege insureds have work capacity. Accessing insurance portals could be said to be another method of covert surveillance…along with social media.

One recent Unum denial letter cited an insured’s use of its website portal as evidence of work capacity and denied the claim on that basis. Although Unum recommends using its website portal, it uses the fact that you go there to deny claims. As a result, I’ve never recommended that any insured receive emails or communicate with insurers through any website portal. Still, people keep going there to receive communications knowing full well that they are risking benefits.

So, why do you think insureds and claimants deliberately go against best advice and practices? I’m not a psychologist by any means, but it seems to me that because the claims process is stressful, worrisome, and frustrating, the only way insureds can “feel better” is to subject themselves to verbal or direct contact to obtain reassurance. Literally, insureds “take a breath” and feel calm about their claims after a “good chat” with the claims handler. Oh my……..

In other words, a phone conversation or website contact “calms the nerves.”

As a consultant I can only make the recommendations and communicate best advice; it’s up to insureds and claimants to listen and follow through.

I don’t really mind being ignored, but I do mind when I hear about claim denials that should never have been allowed to occur. I can only point you in the direction of success, but it is up to you actually implement the expert’s advice.

 

 

 

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