i-need-a-jobNearly a year ago I phoned Met Life for one of my clients and reached a gentleman who could barely speak English. “That’s odd”, I thought, and asked him where he was calling from. “India”, he told me in broken English, “I’m in India. Can I help you?”

Recently, rumors Unum Group is considered sending American jobs off-shore circulated with a corresponding downgrade of the quality of claims review coming across my desk. Although not confirmed, it does cause one to wonder if Unum jobs are catching the boat headed for India, the Philippines, or Thailand.

Yesterday, I attempted to contact AON Hewitt, a third-party leave/disability Administrator for Amazon.com, and was told by the person I spoke to that, “we’re not in the United States.” When questioned further I was also told that the rep was not allowed to tell me exactly where he was. Clearly, he wasn’t in the United States either.

Over the years when I’ve tried to solve various problems (particularly with virus protection software), I was also transferred to off-shore customer service reps, most of whom I had to guess what they were telling me. My response was always the same, “is there someone I can speak to in the United States?” And, in  most instances there was.

Insurance claims reps make anywhere from $30,000-$60,000 per year. Insurers such as Unum Life (UnumProvident and now Unum Group) have systematically downgraded benefits to a bare minimum with employee contributions to keep costs down. The tendency is to maintain younger, and therefore healthier, employees also to cut the increasing labor costs of health insurance.

But, insurance costs are not always about employees; the increasing costs of utilities, new facility acquisitions, and debt often causes management to look to other means of financing, namely denying more and more claims.

I have no doubt but that insurance is only one of many industries that are finding it difficult to make reasonable profits. Here in Maine, Sears (bought out by K-Mart) has all but disappeared from Malls and retail locations. Textile mills, shoe manufacturers, rural sewing factories have also disappeared from the Maine countryside at the same time graduates from the University of Southern Maine have transitioned south to Boston and Hartford in an effort to find suitable employment.

So far, it appears to me that most insurers who have opted for offshore labor have only transitioned Customer Service and other clerical jobs. As a veteran of the claims process and insurance industry it does bother me that policies sold under the regulation of state authorities in the United States may not be managed in the United States. Wouldn’t you be concerned if someone from India who isn’t very proficient in English were making YOUR claims decision?

Finally, and I hesitate to bring this up particularly right before an election, but we have people in the United States who are looking for jobs, particularly our veterans. While some politicians support unlimited immigration, our industrial complex is sending jobs offshore in order to make more profit. Does this even make sense?

Unum used to be a major employer in the states where it maintained facilities – Portland, ME, Chattanooga, TN. Worcester, MA, and Glendale, CA. Sending jobs overseas clearly will affect these areas economically particularly on Unum “bonus day” when thousands of Unum employees spend approximately $2,000.

I can’t say that I’m very pleased that the insurance industry either has, or is considering sending claims management jobs offshore. Individuals who favor globalization, particularly those receiving disability benefits, may in fact get what they get even if it is a denial letter scripted from Bombay.

Friday Q & A

Q&A ButtonWhat is considered “doctor shopping?”

Both insureds and insurance companies can engage in the practice of “doctor shopping.” Insurance companies typically request multiple IMEs and FCEs to obtain adverse decisions they are looking for to deny more claims.

On those occasions when IME reports are not decisive victories for insurers, multiple IMEs allowed under the contract policy as “often as is reasonable” are requested. DMS is at the top of the list for “doctor shopping” adverse IME reports to deny claims. One insured was asked to attend as many as 10 IMEs before she decided to “settle out” her claim and be done with the process.

Likewise, insureds and claimants can also be guilty of engaging in doctor shopping by consulting multiple doctors to obtain support for disability, often for a particular impairment. Patterns of “doctor shopping” such as consulting one doctor after another in order to obtain physician support for disability are evident in the record and often treating physicians begin to “caution” each other about certain patients looking to document somaticized impairments.

To be clear, it is NOT “doctor shopping” for insureds to seek out qualified physicians in order to obtain appropriate treatment and consultation. Patients have a responsibility to obtain care and treatment that is necessary for the prevention of disease. This is NOT what I’m referring to as “doctor shopping.”

On the other hand, a good example of insured “doctor shopping” would be the individual who insists she has Lyme Disease even when her physicians have concluded she doesn’t. Subsequently, this same person continues to consult with multiple doctors hoping to get the diagnosis for “what she thinks she has.” This is doctor shopping.

Doesn’t an insured have the “right” to be left alone?

Actually, no. Keep in mind that a “right” to something must be given either by law or contract or agreement. No where in any disability contract or Plan does it say that insureds or claimants have the right to be left alone.

Having said this, there is a line that can be crossed by insurers called harassment, defined by DCS as “a deliberate series of actions taken by insurers for the purpose of causing fear, intimidation, and mental duress upon insureds in the disability process for profitability purposes.”

Unfortunately, when any person expects to be paid benefits by an insurance company, there is no expectation of “being left alone”, and increasingly – no expectation of privacy either. Since the NSA has access to all phone calls and emails, and the UN owns the Internet now it’s unlikely insureds and claimants have any expectation to privacy about anything.

I got hurt doing a Functional Capacity Evaluation. Now what?

Did you insist on your insurer obtaining a written prescription from your treating physician beforehand? Most insurance companies are well aware that a written prescription should be obtained from a treating physician before requesting a FCE. In many cases, particularly insureds with back and neck problems, injury can occur as a result of the rigorous physical activity insureds are asked to perform.

Insureds should insist that their physicians “buy into” such a physical evaluation by writing a prescription, or providing documentation that to participate in such an activity risks additional injury.

Reliance Standard once refused to cancel a FCE when the claimant’s physician refused to sign off on the physically demanding test. Instead, Reliance had their own physician on the line during the FCE who gave continual parameters and instructions –basically, a real biased deal.

DCS recommends to insureds who are injured during a FCE to immediately request that an ambulance be called so that a patient record of the injury can be obtained. The bill for the ambulance and ER treatment should be sent to the insurance company if the FCE was not authorized by a treating physician.

Then….you get yourself a very good personal injury attorney.

Are there any recent Department of Insurance lawsuits against Unum?

First of all, Departments of Insurance do not bring lawsuits against insurance companies. DOIs perform “Conduct Market Examinations” and if it is found insurers engaged in unfair/unlawful claims practices,  they can be fined sometimes in the millions.

State Attorney Generals can bring criminal charges against insurers. Elliot Spitzer, ex-Attorney General of New York brought criminal charges against UnumProvident only to throw in the towel along with the 48-state regulators and the Multi-State Settlement Agreement.

As you might guess, most state insurance departments are now under the influence of large, expensive lobby influence and rarely hold insurers accountable for anything. Multi-State regulators could do another Market Conduct Examination of Unum, and if found to be unfair (again), could levy considerable additional fines. Although it’s clear Unum remains in violation of the Multi-State Settlement Agreement, no subsequent actions have ever been taken.

Americans should no longer be surprised that our state and federal agencies have been bought and paid for particularly in light of events going on in our country today.


Disability Claims Solutions, Inc. is a fee based, national consulting organization that provides expert claims management services to those with private insurance. I offer free initial consultation. 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 can also be viewed on this website by clicking the Tabs at the top of Lindanee’s blog Home Page.

StupidityIt has been reported to DCS that Unum Group seems to be communicating information to insureds that is inaccurate particularly when it comes to what is payable via DI policy contracts. With Unum’s history of deliberate bad faith and targeting claims for profitability it’s often difficult to determine whether the company began new strategies to pay less claims, or has “dumbed down” its staff to the point of ignorance.

For example, a growing trend with the company is for claims handlers NOT to read entire files and as a result  claims handlers communicate false information or keep asking for the same information over and over again. More disturbing is that it appears DI claims handlers have no training in adjudicating DI policies and come to conclusions that are , well…….just wrong.

A case in point is the Unum insured who paid additional premium for an Own Occupation Lifetime Rider that pays Lifetime benefits if he is disabled prior to age 65. The “Scheduled Benefits” page in the policy clearly shows a Lifetime Rider, and the Rider was attached to the policy that Unum provided to the insured. Still, the insured received a letter from the claims handler stating benefits are to be paid to age 65.

What happened? I suspect the claims handler’s eyes zeroed in on the Scheduled Benefits page that listed Sickness to age 65 and didn’t look further down the page that included the Lifetime Rider. This is the kind of review stupidity that only takes place when you have unqualified people reviewing DI policies. I did notice that the Unum rep’s title was “Lead Specialist” which on the face it means the person should have known better.

Another astonishing case involves a DI insured with a Business Overhead Policy (BOE) who wasn’t paid anything under the policy because her expenses exceeded the maximum amount allowed. Again, this is pure ignorance since BOE reimbursement for expenses each month is payable to the maximum monthly amount even when the gross expenses exceed what’s payable. Unum’s claims rep assumed that since monthly expenses exceeded the allowable reimbursement, nothing was payable. What?

Some BOE policies allow for a carry forward of BOE reimbursement until the maximum amount allowable under the policy is reached. What the heck is going on at Unum? Are the DI claims handlers trained at all?

I am also finding there are other more deliberate inaccurate communications taking place such as responding to insureds there are no medical restrictions and limitations when new medical forms clearly list them. Information is delayed, decisions are untimely, and Unum doesn’t seem to “get it.”

Clearly, there is something going on internally that has “dumbed” the company down to the point of ignorance. Unfortunately, Unum insureds need to be on top of their game to nip Unum’s incompetence in the bud.


Disability Claims Solutions, Inc. is a fee based, national consulting organization that provides expert claims management services to those with private insurance. I offer free initial consultation. 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 can also be viewed on this website by clicking the Tabs at the top of Lindanee’s blog Home Page.

Start the complaint processAfter posting the DCS carrot award naming Northwestern Mutual a top line insurer, I received a call from an insured who informed me NWM provided his physician with a report of his recent neuropsychological IME, but demanded his doctor not show him the report. The issue eventually went all the way to the head of the medical department who also refused to provide a copy of the report to the insured.

The important question here is “by what authority?” If NWM didn’t want the insured to see the neuropsychology report it shouldn’t have sent it to the treating physician. However, once the report is receiving by a treating physician it becomes part of the patient file and under HIPAA the insured has the right see his file.

While I do understand that some psychological patient notes and testing would be harmful if the insured were to have access, in this case the insured’s physician told him, “I can tell you what the report said, but I can’t give you the report.”

One also has to wonder at the ethical standards of a treating physician who actually listens to the orders of an insurance company. One of my first thoughts was that this physician was no longer advocating for the insured, or that he was basically “spooked” by NWM and was under the impression he had to do everything it said – like many insureds these days. Truthfully, many treating physicians won’t give insurance companies the time of day!

In this instance most treating physicians would come to the conclusion themselves whether the neuropsychological report was harmful to their patient, and if it wasn’t, would probably tell NWM to “stick it.” This physician did not. In addition, after speaking with NWM, the treating physician completely reversed his attitude toward the insured to the point that the insured now wonders if his physician is still advocating for him.

I keep coming back to my original point, “by what authority?” NWM has no authority, neither contractual, legally, or in any other way to command a treating physician to withhold patient file information from a patient. In fact, in my opinion to do so would be a HIPAA violation. The insured in this case should file a HIPAA complaint and ask for assistance in obtaining a copy of the IME report from his patient file.

Again, if NWM didn’t want the insured to have access to the report, it should not have given it to the insured’s treating physician. I’m not arguing that NWM doesn’t have a right not to disclose the report, only that once it is released to a medical treatment provider it then becomes a part of the patient’s file to which the insured IS entitled to.

Finally, the fact that a treating physician refused to release the report based on NWM’s direction not to do so (without authority mind you), indicates it’s time to start looking for another physician who is not under the control of the insurance industry. The insured has a right to file a HIPAA complaint for disclosure of the report. He also should be looking for another doctor.

Until such time as NWM can provide a legal authority for a treating physician to withhold an IME report that has become part of a patient file, it should be assumed treating physicians can in fact tell NWM to “stick it”. If, in the opinion of the treating physician the report does not have the potential of harming his patient, he can give the report to his patient regardless of NWM’s command not to do so.

While I’m not ready to remove NWM from the “carrot” category quite yet, I find the above practice to be dishonest and contrary to HIPAA law and insureds’ disclosure rights.


Disability Claims Solutions, Inc. is a fee based, national consulting organization that provides expert claims management services to those with private insurance. I offer free initial consultation. 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 can also be viewed on this website by clicking the Tabs at the top of Lindanee’s blog Home Page.

Carrot and StickIn September, Northwestern Mutual is our “carrot award choice” for fair and equitable claims review. Although several of my clients and I worked through patient records requests, and updates, NWM remains , in my opinion, the best disability insurer for disability insurance.

Every claims specialist at NWM I’ve communicated with has been professional, cooperative and helpful. Although I generally do not give “thumb’s up”  lightly, I’ve never really had a bad experience in dealing with the company. Thanks to Northwestern’s management for creating a review process that seeks to PAY claims rather than deny them!

Mass Mutual continues to receive our “stick” award, although I’m tempted to redefine the “stick” and just call it a “beet.” DCS recently had a great experience with a Mass Mutual claims handler who was cooperative and made a claims decision in record time. On the other hand, I’m currently dealing with another Mass Mutual specialist who is the absolute worst.

In the last year, I’ve posted that Mass Mutual seems to be dropping to Unum’s level in claims management and that I couldn’t continue my good recommendations for the company. Reported variations in the company’s claims review process leads me to believe management has lost control over their own claims process.

In any event, Mass Mutual continues (according to reports I receive from insureds), to leave claimants hanging with unreasonable delays. I’m saddened by the fact that a company I gave kudos to in the past, is now engaging in bad faith practices including unreasonable delays.

Our final “stick” award goes to The Hartford, the company of paranoid surveillance. DCS learned that The Hartford’s claims specialist aren’t always honest about their investigations and lead claimants on right up to the point when claims are denied out of the blue.

I’ve also found that The Hartford is a no-nonsense company when it comes to chasing and harassing claimants about SSDI overpayments. Letters threaten referral to credit reporting and collection agencies even when claimants have made it clear they fully intend to pay back the money they received.

The Hartford is so aggressive with overpayment collection that they do not credit attorneys fees until all of the SSDI overpayment is returned – a very strange way of doing things. It also appeared that the company has an automated system of not releasing benefits at all, called a “lockbox” until overpayments are paid back in full.

The Hartford clearly deserves a DCS stick and a DCS “Whack Down” for their insidious claims practices.

Great JobI want to take this opportunity to thank all of my blog readers for your continued support in 2016. Here are the stats for DCS’ current success rates.

Lindanee’s Blog receives between 400 and 800 reads per day.  There are 210 blog and 207 comment followers who often contact me with many additional questions and claim issues.

This blog contains 1,514 posts within 112 separate categories. Insureds look to Lindanee’s blog for information of importance to them.

The most common read article is “Resignations – A Disability Claim No-No” and “Returning to Work After Disability.” These two posts are read at least once everyday. From January to September 30, 2016 DCS received over 200 phone calls and 139 emails from insureds and claimants.

Disability Claims Solutions, Inc. currently has 92 clients insured by all major insurance companies in the US and Canada. All of my current clients have successful claims and continue to receive policy and claim advice as well as access to electronic forms, books and claim materials. We referred 5 clients in 2016 to attorneys for successful lump sum settlements and 4 clients were referred for appeals based on phone calls we received.

I continue to work for several attorneys on a regular basis providing reports, recommendations, and file reviews when requested to do so.

The most problematic issue for DCS is receiving calls from insureds and claimants who have already retained attorneys, or from insureds who are looking for additional information to keep their own attorneys informed. Although I wish I could help everyone who contacts me, my responsibility remains with those clients who have actually retained my services.

Lindanee’s Blog continues to be read by insureds and claimants, attorneys, IME physicians, insurance agents and brokers, vocational experts, and of course, insurance companies and large numbers of their employees. All are welcome!

I hold all insurance companies accountable for their claims practices as issues and matters are reported to me, or that I personally observe from letters, file copies and other insurance data. After all, since insurers are publicly held corporations the public has a right to know the same information insurers use to evaluate claims.

Again, thank you for your continued support and I look forward to very successful 2016-2017 year. Those who read Lindanee’s Blog are the best people in the world and I couldn’t do what I do without all of you.


Disability Claims Solutions, Inc. is a fee based, national consulting organization that provides expert claims management services to those with private insurance. I offer free initial consultation. 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 can also be viewed on this website by clicking the Tabs at the top of Lindanee’s blog Home Page.

Pin itI think we’ve all known for quite some time how “influenced” state DOIs really are. Now, we know for sure.

It’s common knowledge that state DOIs are in the pocket of the insurance industry. In Maine, the Attorney General is also in bed with Unum and basically does what Unum tells the office of the attorney general to do.

Although the Maine DOI (Department of Insurance) was one of the three regulators involved in the Unum Settlement Agreement, the department refuses to enforce it and render additional fines.

With everything else that’s going on in government these days, it makes me wonder if anything is really on the up and up anymore.

Here’s a good article submitted by a DCS client. Thanks!



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