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Lindanee’s Blog is once again open for comments. Your ideas, not necessarily about your claim, but ideas to support one another during periods of disability will be helpful.

I also found comments to be extremely helpful to me when they forward pertinent new information of value to everyone such as websites, new cases and really good ideas.

Therefore, I activated the comments section again and I look forward to your comments!

 

 

I always feel honored when my clients take the time to write good things about me and my consulting practice. Although I don’t always keep the Blog up to date, I wanted to share a few comments that mean so much.
Unum Disability 2017
The first thing anyone who is contemplating filing a disability claim should do is contact Linda Nee.  Linda has been invaluable to me as my consultant.   She has  many years’ experience as a claims manager and expert witness.  Contact Linda before you contact your insurance company.   The application process can be inscrutable and baffling.  Linda will probably save you weeks and perhaps months of confusion, stress, aggravation and heartache.  Call Linda.  You’ll be glad you did.
Unum Disability 2016

Linda, I contacted you a few years ago in 2012 regarding UNUM & a field visit & their unfair practices.  In hindsight I wish I would have used your services as i realize now how I let them beat me down, but not only that the so called brain lesion that was part of the claim that they they would be MS is malignant brain tumor so the symptoms that called self reported make perfect sense now…tumor headaches, vision problems.  I became permanently disabled when I unexpectedly in September of 2011 had a major back surgery with a 3 level fusion at L3/4, 4/5 & S1 with a nerve treating away. My surgeon was awesome & I received permanent disability on my first attempt SS also considered the neurology as secondary…no mental illness.

I even saw UNUM’s IME who was a highly respected doctor in Houston, no one in San Antonio would see me because of who my treating doctor is…Dr Gilbert Meadows is highly respected spine surgeon…He told me didn’t know why UNUM sent me there even reviewing what they sent it was obvious I was permanently disabled (I took all my files just in case).  He said the report he sent back would indicate just that.  UNUM terminated my file because I wasn’t bedridden…

I know there is nothing I can do now & thank God I don’t have to live with UNUM’s harassment of calls & surveillance.  Please keep my name & contact information if ever I can help out in stopping UNUM’s Bad FAITH plans or if there is another major lawsuit against them. I don’t want anything for myself but to help others.  I worked in HR  I was a Benefits Specialist I encouraged people to buy disability policies thinking they would be there to help them in their time of need, I was horrified to learn how I had mislead people as used the plan.  I understood benefits, my doctor said I was disabled & did his part, SS approved me the first time…this shouldn’t have been a nightmare.  Now that I’m disabled I educate my HR friends & tell them to research their policies & give them your site. I educate individuals on their plans as much as I can I don’t want them to be fooled.  I’m not sorry when I tell people a UNUM policy is a waste of money in my eyes when I tell them how UNUM treated me it horrifies them as it should.

With your help I was ready for that field rep & IME, which I was honest, I had nothing to hide but I knew what they were doing I was prepared.  The field rep was so rattled that day when I told him I was recoding him & out my recorder in the table. I started pulling out my sheets that you  told me to have ready..I showed him my file & told him UNUM had it all.  I told him they called weekly.  He apologized & said  they were a horrible company & that he would tell them to leave me alone. After that I told them to notify me in writing for all requests.

I have kept all my records, should they ever be needed.

Thank you for what you do, most of all for having integrity & standing up against these companies!!

Unum insureds and claimants who have been harassed by Lucens and Unum for financial information resulting in alleged overpayments should contact the law firm below with your story.

It is my understanding this firm is preparing a class action lawsuit against Unum for alleging overpayments and several other issues.

Marcus A. Castillo, Esquire
Haas & Castillo, P.A.
Attorneys At Law
19321-C U.S. Hwy 19 N, Ste. 401
Clearwater, Florida 33764
(727) 535-4544 telephone
(727) 535-1855 facsimile

If you’ve received notification from Unum that you owe an overpayment after many years, please contact Attorney Castillo to lend your support.

Class action lawsuits can be a bit tricky, but please give your support to this law firm and his team who is willing to do something to stop Unum’s atrocities.

Thanks!

While I’m sure there many attorneys who do NOT charge back/forward fees, there are many more who receive fees far in excess in exchange for what they actually do, or provide to insureds.

I have been an opponent of back/forward attorney fees for many years writing, “attorneys are often part of the problem, not the solution.” Hopefully, this article will give you something to think about.

Let’s assume your pre-disability monthly earnings were $4,500 just prior to your date of disability. Therefore, as written into your LTD Plan your monthly disability benefit is 60% or $2,700 per month. Notice you have already lost 40% of your pre-disability earnings, and if you are awarded SSDI, it will be an additional reduction from your benefit.

After two years Unum denied your claim and you found an ERISA attorney who was willing to take your case. Your $2,700 in monthly benefit is borderline for attorneys to accept for reasons that I’ll make clear in a moment. The attorney in question asked you to sign a contingency agreement giving him 30% of any past or prior benefits he recovers and 40% of future benefits to age 65. You are 41 years old.

After being convinced that “something is better than nothing”, you sign the attorney fee agreement.  After 6 months of appeal and 3 additional months for Unum to overturn and pay, Unum provides your attorney with a check in the amount of $24,300 for past benefits not previously paid. He keeps $7,290 and sends you the remainder, or $17,010 representing 42% of your pre-disability earnings. Hum…you’ve lost another 8% just on back benefits.

Unum puts you back on claim and pays your attorney your monthly benefit in the amount of $2,700, but he now keeps $1,080 for himself each month and sends you $1,620/month.  This represents 36% of your pre-disability earnings to age 65. Can you live on that? Just looking at this very simple example, in total your attorney received $7,290 plus potentially $311,040 for a total of $318,330 to age 65!

It shouldn’t cost you six figures to receive 30% of your pre-disability earnings. You will never be able to recover over time the other 30%.

Also, consider if you have an IDI policy with a handsome COLA, your attorney gets a yearly raise the same time you do. Forty percent of total benefit is 40% of total benefit. If your case is actually litigated and the judge awards attorney fees, your attorney is not obligated to credit what you owe him with the court awarded fees.

The only thing the attorney need do moving forward is receive Unum’s letters and perhaps once a year manage your paperwork, which he just tells you to fill out and obtain from your physician. Most people could buy a house with the money they pay attorneys to look at forms several times a year.

Since you are 41 years old and have potentially 288 additional months, or 24 years to age 65, your attorney will be receiving a whopping $311,040 to look at your annual paperwork once a year, assuming of course, there are no other Unum issues! Even if the attorney responded to Unum’s tactics on occasion, he’s still overpaid for what he does. If he charged a per hour fee of say $300 per hour, he would be more reasonably paid.

On those occasions when I write about the unfairness of attorney forward fees I’m contacted by irate attorneys who say, “I don’t do that.” My response is, “That’s good, because I’m NOT talking about you.” I realize there are a few attorneys who charge reasonably, but they are definitely in the minority.

The tendency today is for insureds to run to an attorney for claims management even when the cost far exceeds the protected value. For example, a Boston attorney charges $600 per hour to manage disability files and I understand from those who hired him that he just says, “go ahead and do what Unum says, they’ll deny your claim anyway.” What?

Also consider that attorneys are not great disability claim managers. Some attorneys who attempt to manage disability claims actually have experience in personal injury law, an entirely different area of practice. Other attorneys accept your claim, ask you to sign contingency agreements and then “just sit there” and allow the claim to be denied, which is where the money really is. Doing nothing to protect your benefits isn’t worth up to 40% of future benefits. Think about it.

Attorneys do have their place in the disability claims process because good ERISA litigators are always needed. DCS refers out appeals and settlement negotiations to tested attorneys with excellent track records. Insureds and claimants who request help with claims management are never referred out to attorneys because they aren’t good at it!

For those who need to consider carefully future sources of income, I hope that you take a pencil to paper and figure out exactly what you’re paying your attorney over time, and the percentage of pre-disability earnings you’ve actually lost.

Who is it that is receiving the majority of your benefit?  You, or your attorney?

 

 

 

 

 

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

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

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

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

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

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

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

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

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

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

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

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

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

 

 

 

 

 

Friday Q & A

Is Unum Hospital Indemnity insurance a good deal?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

How do I win a claim for Guardian Berkshire?

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

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

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

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

 

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