Friday Q & A

Q&A ButtonWhy are my doctors so reluctant to sign my disability paperwork?

Although there are many, many physicians who go out of their way to advocate for their patients and spend hours filling out paperwork they generally don’t get paid for, there are also physicians who view disability certification as a waste of their valuable time. Here are some of the reasons.

  • Physicians are learning more and more that private disability insurance companies misrepresent medical information above and beyond what is officially recommended by them. A “they don’t listen to me anyway”, attitude is building to the point that physicians are reluctant to get involved at all.
  • Physicians spend up to 30% of their office time filling out disability paperwork of some kind – SSDI, Worker’s Compensation, and Private Disability. For most, they don’t get paid for their time and, in reality, physicians really don’t want to spend time doing it.
  • Not all physicians are willing to share with you that they really think you can work. Although most physicians want to be helpful, of course they would not want to be involved in certifying disability if they didn’t believe what they were signing. If your physician balks about signing paperwork it could be he/she is reluctant to sign-off on a medical condition he really hasn’t tested or diagnosed.
  • Physicians do not want to testify in court and when it becomes obvious they may have to, suggestions are made to find “another physician.”
  • Surgeons and pain management physicians are infamous for not filling out paperwork. They see their role as pre-op, surgery, post-op, and then send patients packing. As a general rule, claimants shouldn’t depend on surgeons for continued support of disability.
  • Physicians find themselves intimidated by insurance physicians who call on the phone, and/or claims representatives who continuously request the same information over and over again.

Although physicians have a very important and urgent role in the private disability claims process, as more and more insurers disregard logical medical assessments and recommendations, physicians are less likely to spend time on what appears to be a useless waste of time. Physicians who remain loyal to their patients and do their best to help them should be thanked with a box of Christmas cookies this year.

How likely is it that Unum is overturning denials on appeal?

Not likely at all. Word is out that Unum is not overturning denials on appeal very often. At this time of the year it’s not likely that any insurance company is willing to re-open financial reserves that offset profit figures. Appeals have the best chance after the first of the year. Other insurers are delaying appeal decisions beyond what is considered to be reasonable, and in my opinion, none of the insurers are meeting ERISA timelines at all. Insurers just don’t seem all that concerned anymore about meeting any type of deadlines in the claims or appeal process.

Can I resign and still collect disability?

No one should be resigning from their employment until they’ve read my post on resignations. Resignations say, “I quit”, and that’s not what disability claims are. Please read my post on resignations before you actually sign one.

Does Unum engage in wrongful termination?

“Wrongful termination” is a characteristic of Unum Group that it holds very carefully. A Unum employee can be terminated for any reason at any time, and has been known to engage in age, health, gender and social unattractiveness discrimination. Any Unum employee who can prove unfair termination should immediately contact an employment attorney and file a lawsuit. In the last decade Unum has been striving for a much younger workforce and has frequent firings to rid the company of older employees who think outside the box. Employees with health issues are also terminated on a regular basis.

Working for Unum is like walking a mine field.

Carrot and StickNo doubt about it….champion stick holder for 2015 is the Maine Assistant Attorney General who abused her office by allowing Unum Group to dictate terms regarding representation of insureds and claimants, but only for those consultants who assist insureds and claimants keep their benefits.

Ex-Unum executives in Maine running a business called Professional Disability Associates (“PDA”) have not been forced by the Maine AG to obtain Life & Health Licenses or stop the unauthorized practice of law as consultants without a license. PDA provides medical, vocational and file reviews to Unum and other insurers, therefore, it’s obvious the Maine AG only attacks claimant interests, but not those supportive of Unum, Prudential, RMS, Aetna etc. and other insurance companies that render aid to corporations who target and deny claims unfairly. The law should be applied fairly to all, not just those who provide assistance to insureds and claimants.

Although this consultant has the utmost respect for government, the Maine AG’s unfettered ability to restrain trade, censure Internet websites, prohibit “advocacy” if you’re not an attorney, and tread on constitutional rights to free speech is deserving of a Maine rotten log.

In the future, this consultant supports having the Maine AG elected by the people (in lieu of legislative secret ballot) with an oversight committee as a safeguard against allowing “special interests” to dictate Maine law. If elected by the people, the Maine AG could be impeached for abuse of office and operating under “special interests.”

We want to thank Governor LePage’s special counsel and Senators Woodsome and Collins, and Representative Campbell who agree with DCS on these issues.

Second on the stick list is, of course, Unum Group who deliberately targets compensable legitimate claims for denial. The company has not changed its internal protocols away from deliberate targeting, denies claims paid 10, 15, sometimes 25 years, and conducts medical reviews that misrepresents medical impairment for the purpose of denying benefits. Although Unum Group is the the largest provider of STD/LTD in the world, the company is also known as the worst.

Reliance Standard comes in third on the list of stick holders for 2015 by reporting to me that it does not maintain a diary system and that activities on a claim are kept on file “through letters and correspondences” sent to insureds. The company took 4 months to find an IME doctor and actually wound up requesting two ad hoc IMEs on appeal. The appeal in now pending greater than 6 months. Reliance Standard is an awful company and well deserving of a DCS stick award.

MetLife is fourth on the list for a top 2015 stick award if we could find someone to give it to. DCS found MetLife’s Customer Service in 2015 to be non-existent. Several blog articles were written such as, “Raising the Dead” and “Is Anyone There?” MetLife as a company just doesn’t get that providing customer service is an important part of the claims process.

At the top of the list of DCS carrots is Mass Mutual and Northwestern Mutual for consistent claims investigation looking to “pay” rather than “deny.” Both companies provided good service to DCS clients in 2015 and are well deserving of our since thanks and the top 2015 carrot receipitents.

ComplaintsKimberly of Morrice, MI on Nov. 20, 2015

It has been 110 days today that my husband filed for his long-term disability benefits and we still do not have a determination! This company drags their feet and seems to be in no hurry to process his claim. It’s amazing how quickly they have processed taking his premium payments over the past 10 years out of his paycheck. When people are out of work, for an injury, illness, surgery etc, one would like to think that their disability insurance company would be there to help you, this is NOT the case with UNUM. This company has an average of 1 star and there is a reason for that! (Unum won’t be approving many claims before year end. It’s the same old game I’ve described several times on the blog involving manipulating claim financial reserve figures and the timing of claim decisions. Appeals probably won’t be overturned and paid either which keeps many insureds and claimants waiting for decisions that won’t come until after January 1st. Unum manipulates the financial reserves to show greater financial profit. The company will likely play dead until after the first of the year unless it’s to deny claims rather than pay them.)

Billie of Pocatello, ID on Nov. 2, 2015

I have filed all the correct paperwork, followed up as often as I could when provided new information, and I continue to have issues with this company. They informed me when I first filled out the paperwork at the beginning of my pregnancy that I would be getting 12 weeks of PAID maternity leave, only to be informed 2 days before I gave birth that I only would receive 6 weeks of paid maternity leave unless I had a medical reason to not go back to work. If I had a medical reason to be off for the additional 6 weeks, they would continue to pay me. I asked them why they told me I would get 12 weeks paid leave to begin with, and they told me that that’s what they tell everyone to make it easier to explain.

My doctor doesn’t do a postpartum check up until 8 weeks, so I sent the required information, and all the information the doctor had, to UNUM so that I could get the additional 2 weeks pay. When I got the letter that I wouldn’t be receiving the additional pay (due to my employer and their agreements, not UNUM), I called to figure out why. The man I spoke to was rude, and when I didn’t understand what he was trying to explain and told him I wasn’t understanding, he’d just repeat himself. I spent 10 minutes just trying to get him to explain it in a different way.

When it came to checks: I received my first check, and second check in a timely fashion (as timely as the mail allowed). I faxed in the information they needed for direct deposit after learning that I could have my checks direct deposited. However, after receiving my second check, I failed to receive another for almost 3 weeks, even though they are supposed to be issued weekly. When the check finally was issued, it wasn’t direct deposited to my account like it was supposed to be (it had been almost 3 weeks since I had sent in the information, and it was confirmed they had the bank information on file and that it should have been deposited). The woman I spoke with the last time was very helpful, and even though there was nothing she could do, at least she was thorough and polite.
It has been nothing but a headache (and late bill payment because my checks haven’t been sent every week like they should have been). (During the holidays Unum’s claims handlers take PTO time and, frankly, forget to approve claim payments before they leave, STD in particular. Still, it’s hard to know what’s going on with Unum’s STD because we’re privy to quite a few complaints about late payments and failures to pay on time. The last time Unum’s STD department was so negligent a merger had just taken place and 80% of Unum’s trained staff left the company. DCS will be keeping an eye on Unum’s STD process that is apparently slipping in terms of timely efficiency. I feel really awful for the people who do not get paid regularly as they should.)

Take care of yourselfThis past week I’ve spoken to so many people who are scared, stressed and feel overburdened with managing their disability claims. It reminded me that I haven’t written very much lately about how disability claims contribute additional illness rather than contributing to a sense of wellness and healthful living.

Anyone who says that having regular monthly disability income helps insureds feel more secure about their financial futures never had a disability claim. Disability insurers develop strategies that keep insureds on the edge – letter, letter, phone call, physician records request, phone call, letter, letter, letter, update, questionnaires, field visit requests, surveillance, etc……well, you get the picture.

Ultimately, insurers deliberately create claim review systems that suggest the “ever watchful eye of the insurance industry is upon you”, and as a result, insureds and claimants react to the need to “buffer” themselves from the endless harassment that is payback for filing disability claims. Insurers aren’t stupid and concluded a long time ago that fearful/stressed individuals say and do things they normally wouldn’t do, a reality that can only be used to bolster corporate profits with more and more non-compensable claims.

First, insureds and claimants are not at ease with the fact that they have left themselves no other financial support option other than (ERISA) group disability provided by employers. I understand this because by far the majority of people I’ve spoken to have little understanding of how unreliable group STD/LTD is. The typical ERISA policy is filled with adverse provisions that claimants only find out about AFTER a disability occurs and claims are filed. IDI insureds fare no better since policies sold in the 80’s referred to as “better than sliced bread”, may not put a loaf of bread on the table at all.

In addition, we live in an economy where spending money is more beneficial than saving it. With money market interest rates at 1% or less, more benefit/value is derived by putting on that much waited-for addition, or buying the adjacent property, than saving money for a rainy day. In other words home improvements (and other investments) add greater value to tangible assets than saving money.

As a result, Americans aren’t saving money, and when the disability “fireball in the night rings” there’s no option for financial support other than employer-provided group STD/LTD, or old IDI policies that are rarely paid. Middle class Americans live paycheck to paycheck and there is little expendable income to save for the rainy day medical disability.

Depending on American corporations for daily sustenance is scary, yet thousands of insureds and claimants find themselves in this very position. Fear and stress quickly becomes the “new normal” and life as a disabled person escalates into a downward spiral to depression and hopelessness. Reality quickly sets in that insurance harassment will be a thing of the future for a long as disability benefits are paid.

Claimants often internalize “claim hopelessness” and move on with less than a desire to achieve the qualities of life they deserve. I’m often asked, “Should I accept this treatment if it will help my claim?”, and my answer always is, “Your health and well-being is the primary reason for accepting recommended treatments, not a disability claim.”

Sometimes, insureds forget that the objective of disability is either the medical management of permanent impairment, or the progression of wellness through appropriate treatment back to baseline of working to one’s own maximum potential. Isn’t this what disability is all about?

On those occasions, when disability claim stress and fear is added to the mix, managing medical conditions and achieving maximum potential are near impossible even though it is essential for insureds to set their own health as a priority.

Although “taking care of oneself” is a disability priority, many insureds become obsessed with the management of claims to the point that living with the fear of losing benefits takes precedence over seeking medical treatment, taking care of activities of daily living, and making sure as disabled persons there is a balance of medical support, and social and support group interaction.

Those with disability claims shouldn’t be thinking about their claims the majority of every day, nor should they be checking insurance website portals 20 times a day for reassurance. Health, happiness, and achieving a quality of life you want to live is the real priority and these qualities should be given the time and priority they deserve.

Here are a few ways to “take care of yourself” while receiving private disability benefits:

  • Make sure you have a reasonable expectation of what private disability insurance is all about and what provisions in your policies are not favorable to you. There should be no expectation of future surprises.
  • Re-direct your thinking to more positive aspects of your life and disability. “What is best for me today?”, should be a question asked every morning. “What do I need to do for myself that will make me feel better and be happy today?”
  • Understand clearly that insurance letters are not specifically written to target and attack you personally. Most insurance correspondences are merely templates and all insureds receive basically the same language. An update request, is just simply an update request, nothing more.
  • Do not organize your medical care around a disability claim; but choose health care and treatment that is reasonable to help you get better. Claim requirements will then fall into place automatically.
  • Consider yourself a priority first. Only you and your physicians know what is best to manage your disability and help you care for yourself. Insurance companies should never be allowed to dictate medical care or treatment.
  • Consciously decide everyday to be happy. Knowledge about the claims process gives you the power to take conflicts in stride and know you will be OK regardless of what happens. Insureds should always give some thought as to what they would do if their claims were denied. Have a Plan B waiting.
  • Accept the fact that you cannot control what any disability insurer does; but you CAN control what YOU do. Say and do the right things when dealing with claim issues with a calm mind and after careful thought.

Although it is often very easy to forget about yourself and your own needs while receiving disability benefits it is also important to remember yourself as a person first, and as a person with a disability claim last.

BuzzmeterSeveral new insureds phoned yesterday to tell me that either their claim was denied or Unum denied their appeal. Both individuals asked for help although I had to respond that indeed it was too late for me to assist them. Unfortunately, once disability claims are denied the value of experienced consultants in the claims management process disappears.

There are very few options for the ERISA folks with denied claims and/or appeals and the following should be considered:

  1. Although Prudential and perhaps one other insurer allows more than one appeal, once final decisions are made the only option is to convince an attorney to take the case for the purpose of suing.
  2. ERISA litigation does NOT favor claimants. ERISA law, originally intended to prevent discrimination, has been so changed by the courts to favor insurers that there is a higher probability of not winning than winning. This is why there are very few ERISA litigators out there. Those who accept ERISA cases pick and choose the ones they want and the rest of the ERISA denied are thrown under the literal bus.
  3. Attorneys only accept “wealthy” ERISA claims (benefits in excess of $3,000+/mo.) and expect you to sign back/future contingency agreements taking as much as 40% of future benefits to age 65. Most claimants do not realize that giving up 40% of future benefits is the same as reducing benefits actually received to less than 30% of pre-disability earnings. It is NOT better sometimes to get something rather than nothing.
  4. There are now attorney “settlement mills” emerging on YouTube and other media encouraging those with denied claims to contact them. Fees for claim settlement range from 40-60% of the agreed settlement amount. This is your money going down “the tube” (pun intended) for a few attorney lunches and phone calls.

Most claimants I speak to want to continue to receive benefits. In fact, it’s the primary goal of most individuals who receive disability benefits and find they are unable to return to work. Secondly, those who are physically or mentally unable to return to work, can’t work. Just because an insurance company says, “we think you can work” doesn’t necessarily mean individuals are actually able to go back to work 8 hours per day, 40 hours per week.

Insurance companies deny claims based on conflicts of interest, not because there is sound medical proof that claimants can actually work (although they would have you, AND regulators, thinking the opposite.) It seems logical to me that the better choice claimants have rests in those who are knowledgeable and experienced with the disability claims process and who can advise and assist with the complex administrative paperwork so that claims are well-supported and paid.

I do understand that perhaps claimants may try to save money while claims are paid, and only look for attorneys when it’s clear money must be spent. However, 40% of future benefits to age 65 is an unrecoverable loss of 5 or 6 figures depending on how old you are. It makes more sense to retain the qualified help to PREVENT denials and KEEP benefits rather than giving up a significant benefit amount to get them back.

We all know that there are no guarantees when it comes to disability claim benefits — insurers are far too dishonest for anyone to give probabilities of success or denial. But, the percentages of successful benefits are significantly increased when expert assistance is obtained early in the claims process.

I’m sorry to have to tell those who ask for help after claims or appeals are denied that I can’t help them. It really is too late at that point and the disabled person who deserves and needs the benefits probably won’t get the majority of them.

When people tell me, “I’m sorry I didn’t find you sooner, Linda”, the only thing I can say is, “I wish you did too.” But, the truth is, once claims or appeals are denied the only options left are to seek out attorneys who may or may not take the case, or if they do, insist upon 40% or more of future benefits to litigate cases in courts of law that favor insurers, not claimants.

Claimants should reconsider the thought, “something is better than nothing” and begin thinking, “an ounce of prevention is worth a pound of cure.”


Evil SantaWhile thousands of disabled Americans are dreaming of roasted turkey, pumpkin pie and thanksgiving for the meager blessings they have, disability insurers are deliberately planning to terminate increasing numbers of claims in order to bolster year-end profits.

Already, insurers have been focusing on claim targets to investigate with surveillance, field visits, medical and occupational reviews and increased demands for more and more records “stacking the deck” against those who are most vulnerable in our country – the disabled. For many, there will be no holiday spirit when the eventual December termination letters arrive in the mail.

In 2015 companies such as Reliance Standard, Prudential, Guardian, CIGNA and Unum have continued to “risk manage” and investigate claims to a fault, presuming fraud, malingering and secondary gain at every juncture. While some claims are approved and paid, other claims are deliberately targeted and denied even in the face of logic and reason that these same claims should be paid.

American middle class workers depend on benefits they are entitled to as participants in employer group Plans, and yet insurers continue to target ERISA claims because they are easy to deny and harder to litigate. I am still receiving calls from ERISA folks who once had faith in a system that didn’t work out for them.

Reliance Standard refused to pay a mental health claim for 24 months even though proof of disability was made reasonably clear. Although the company informed me “it did not keep diary notes”, written communications from the company have been inappropriate and attacking. Although a relatively small disability insurer, Reliance Standard does not appear to have any standards at all, and took nearly 4 months to find an IME physician on appeal. How quickly insurers forget sometimes that unreasonable time delays means no money, and no food on someone’s table.

Prudential makes a mockery of mental health records “snatching” every personal and private notation favorable to them at the expense of everything else in the record. The company allows unqualified Registered Nurses to write medical opinions on which denials are based. Although Prudential denies claims because “it couldn’t obtain psychotherapy notes”, its policies do not contain any provision requiring actual psychotherapy notes as “proof of claim.” In my opinion, Prudential operates “out-of-contract” most of the time.

While Prudential’s misrepresentations of mental health records contributes greatly to profitability, Guardian’s over-the-top investigations cause unreasonable delays, and non-payment of legitimate benefits. At one time Guardian ranked third behind Northwestern Mutual and Principal, but today struggles against a growing unpopularity with the public. “Investigation, surveillance and harassment of peers and neighbors” isn’t the tell-all in investigating claims, it’s just that Guardian doesn’t know it yet.

CIGNA’s claims process remains as bad as it ever was even though a 2012 multi-state settlement agreement compelled the company to change its claims practices. Of course, it didn’t and the company continues to operate outside of the agreement much like Unum Group. In my opinion, CIGNA does exactly what it wants to do and doesn’t give a damn whether it’s violating the settlement agreement or not. (Much like Unum, I might add.)

And, speaking of Unum…..Much of the evidence and reports from terminated employees in 2015 indicate the company continues to deliberately target legitimate, payable claims to deny in order to bolster profitability. Employees report human rights violations, discrimination due to age, health and gender, as well as sudden, unfair terminations for little to no reason.

Unum’s insureds and claimants continue to report misrepresentation and complete ignorance of medical information submitted in support of claim from any outside source such as treating physicians. Clearly, Unum’s internal protocols continue to seek out vulnerable claims and deny them including claims paid for 10, 15, even 20 years. Denying claims paid for 25 years gives an entirely new meaning to “arbitrary and capricious”, with a little bad faith thrown in for good measure.

Accelerating the search for deniable claims for year-end profitability isn’t new – it’s been going on for many years. Today, Scrooges of the insurance industry are all too willing to “Ba Humbug” compensable claims in order to bolster profitability they have already manipulated by using financial reserve gains to paint profitability pictures that are no more than Aesop’s Fables.

Personally, I think Lou Lou Who from the Grinch Who Stole Christmas got it right:

“You can’t hurt Christmas, Mr. Mayor, because it isn’t about the… the gifts or the contest or the fancy lights. That’s what Cindy’s been trying to tell everyone… and me. I don’t need anything more for Christmas than this right here: my family.”

Although insureds and claimants should always exercise due diligence during the holiday season it should also be noted that insurance companies also DO pay claims. In fact, most insurance companies pay about 60% of them.

It’s the Scrooge in them that gives insurers a really bad name around the holidays!

Friday Q & A

Q&A2(Just a reminder that Friday Q & A posts derive from real questions submitted to the blog. Although I can’t answer all of them, and some questions are repeated, I try to provide as many answers as I can. If there are topics you would like to see addressed on the blog, please send me a private email. If you have a question it’s likely many others have the same one.)

Does Unum ever act in an honest way when reviewing claims?

Of course it is on occasion.

But, insureds and claimants need to realize that policy provisions, intent, administration of the claims process, investigation, and decision-making are stacked against insureds allowing insurers to make more money. No insurance company wants to pay more claims than it sells; this is called “risk management.” From the beginning there is a “conflict of interest” because insurers are both reviewers and payers of claims not to mention that “discretionary authority” allows insurance companies to deny claims on their own say-so.

Unum Group is the largest disability insurer in the world, AND it is the most egregious. That’s not by accident, nor is it just Linda Nee saying so. The company has a long history of foul play for which it has been sued and fined by regulators. And yet, employers and insureds continue to buy its policies from which thousands of middle class employees suffer losses of benefits unfairly. What does that tell you?

How many people would actually pay money for a dog they knew would bite them everyday? I think Hillary Clinton once said, “You can’t invite snakes into your back yard and expect them to only bite your neighbors.” Eventually, the dog or snake is going to bite you.

What is Unum’s “proportionate benefit”?

Claimants who can work part-time are paid a Work Incentive Benefit (WIB) for the first 12 months. (I’ve described this elsewhere on the blog in detail.) After 12 months claimants are compensated using a Proportionate Loss (PPL) formula that compensates claimants for the actual percentage of pre-disability earnings lost.

Indexed Monthly Earnings – Work Earnings/Indexed Monthly Earnings = Percentage of Lost Earnings

Monthly Benefit x Percentage of Lost Earnings = Monthly Payable Benefit

This formula is cited in most group LTD policies. Remember, monthly earnings may not exceed 80% of indexed pre-disability earnings since claims will be denied unless there remains at least a 20% earnings loss. Also, most Disability Income Replacement policies use PPL to calculate residual earnings as well.

Are there any good court cases won against Unum for fibromyalgia?

Please check out:

Mondolo v. Unum Life Ins. Co. of Amer., C- 11-07435 CAS.



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