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StupidityWhat kind of common sense does it take for Unum’s management to realize insureds and claimants cannot provide 10-15 years worth of tax returns when the IRS destroys the information by law after 6 years? One would think a company like Unum would have qualified financial people who are well aware of the rules pertaining to the IRS and destruction of records.

My research on the Internet indicates the IRS keeps copies of all versions of tax Form 1040 for up to six years. After that time, according to law, it destroys the records. In addition, the IRS recommends that citizens keep up to three years of tax returns, the period of time the IRS may conduct an audit.

In my practice, I’ve encountered at least two occasions when Unum’s claims handlers absolutely insist that claimants provide over ten years worth of business and tax returns. The company insists on obtaining these returns to verify (or not) alleged income. When Unum is told the returns do not exist, it still won’t pay benefits and insists that insureds sign IRS Form 4506 to obtain copies of returns that were destroyed by the IRS.

My clients were actually forced to provide Unum with IRS Form 4506. Not surprisingly, the IRS responded they destroyed the records according to law and they did not exist. The level of general stupidity of Unum and its claims handlers is astounding. Insureds can’t provide Unum with what no longer exists, and neither can the IRS provide what it has destroyed. Ya think?

I cannot believe the levels of stupidity that are coming across from Unum in recent months. CF, a notable claims killer Unum specialist, is refusing to reinstate “suspended” benefits demanding submission of tax returns going all the way back to 2005 – 12 years of tax returns! His actions represent a stupidity that could be easily corrected by consulting with his Financial CPAs to determine if the insured can obtain copies of his tax returns beyond 6 years.

These types of requests are indications of Unum’s abuse of discretionary authority and conduct of bad faith.

Neither insureds nor the IRS cannot provide what doesn’t exist, and although it isn’t rocket science, it sure is Unum stupidity. Unum’s bread dough never seems to rise to the top.

Self Reported symptomsUnum’s claims process appears to be in a chaotic mess! More and more insureds are reporting Unum’s claims handlers are NOT reading the files and are NOT familiar with the facts of claims before sending out threatening letters for the same information over and over again.

All indictions point to Unum’s managers losing control of the claims process when insureds begin to see numerous mistakes in administratively managing claims, such as sending out incomplete letters way beyond the date they were written.

Although claims specialists are required to have read all of the claims in their blocks, it’s obvious they no longer have the time to do that. Pushed, and stressed out by claims managers to “touch” claims, it appears specialists are sending out requests without “thinking things through.” These types of mistakes are unnerving to insureds, but I would think are also not efficient use of time from a claims management perspective.

Of course, this kind of administrative chaos may be indicative of why Unum is considering handing off some business or India or, perhaps the company has finally terminated enough employees to make the claims process impossible to administer with the employees it has left.

Either way, claims handlers are not reading the files and there is every indication they aren’t even familiar with the facts of claims before sending out requests for information.

As if Unum’s chaos isn’t confusing enough, the letters I’ve read from Unum specialists threaten termination of claims, or benefit “suspension” for non-response when the information requested has long been included in the claim files.

This would not be the first time Unum’s claims process “lost it.” Shortly after the UnumProvident merger, the company was again in chaos, with enormous backlogs, STD and Life Waiver claims unmanaged. If this current chaos is anything like the post merger one, insureds will find managing claims very challenging.

Company management is so used to “micromanaging” the process that in the absence of knowledgeable direct control, Unum’s review process falls into a bottomless pit with claims handlers a few french fries short of a Happy Meal.

Unum insureds who are receiving threatening letters requesting information already provided, or who are threatened with benefit suspension for non-compliance, are experiencing evidences of Unum’s claims review chaos – very confusing to muster through.

 

Insurance Bias – Aetna

biasInsurance claims handlers, and their managers, often demonstrate prejudice toward groups of insureds due to sexual orientation, and or for other reasons.

Remember the comment from one of Unum’s managers on his Facebook page? “Insureds are like slinkys, they aren’t worth all that much but we like to see one tumble down the steps every now and then.”

Sometimes that same bias extends towards sexual orientation. Here is an article provided to me by a client.

https://www.bna.com/aetna-dodges-erisa-n73014449922/

 

 

fake-newsI’ve been asked several times lately about the role of “fake news” in the disability insurance industry and it’s impact on those who continue to buy coverage.

Although the question might be difficult to explain without political connotation, it’s clear to me that there are perhaps as many definitions of “fake news” as people, or insureds in the United States.

This blog has always been dedicated to providing knowledge and information, and I’d like to take a stab at continuing that trend. To that end, I’ve coined all of the definitions below that seem reasonable to me, but I leave it up to my readers to decide for themselves what “fake news” really is and how it relates to disability insurance.

To me, “fake news” can be defined as, “information publicly communicated without the benefit of corroboration, validation, or research (largely circumstantial) that is deliberately given for the intended purpose of indoctrination or persuasion of a people, nation, or group to a collective political regime, corporation, government or state.  “Fake news” presumes the directed audience is not capable, (too stupid), to make rational decisions that support the recommended platform of the entity, and therefore communicates persuasive, but untrue information to gather support for methods and ideas that may be adverse to the public at large.

On the other hand, “truth news” is that which is communicated only after it has been objectively verified by corroboration, and for which evidence of proof exists that the information is more true than not true; or, publicly communicated information that by video, verified emails, eyewitness and three-source journalistic rules is proven to be accurate. “Truth news” presumes that the receiving audience is smart enough to hear the information reported objectively and unbiased and decide for themselves its value.

“Conspiracy theory” is the deliberate intent of a collective of entities or individuals who create a series of unproven hypotheses, based on conjecture and opinion, for the sole purpose of implicating, as guilty, individuals or entities of largely negative events and circumstances. True “conspiracy theory” seeks to suggest guilt without substantial proof or verifiable evidence.

The insurance industry, in my opinion, does not engage in any of the above three, but does openly act upon what is referred to as “misrepresentation” and “misinformation.” Misrepresentation is the “deliberate misinterpretation of writings for the purpose of receiving favorable or profitable results from a set of reported facts based on opinion in lieu of what such documents actually say.

Imparting “misinformation” is simply “the imparting of information that is deliberately made to appear true when it is not upon investigation or closer examination.”

Disability insurers have always avoided informing prospective insurers about the possible consequences of “claim terminations.” In other words, while insurance agents are well equipped to say that disability insurance is” better than sliced bread”, marketing materials fail to inform prospective insureds of the “internal risk management” processes that actually pays only 50% of claims. One might refer to this as “false advertising by omission.”

Some insurers use “discretionary authority” to misinterpret policy Plan provisions to their advantage. Of course, the intended purpose is to profit, and profit greatly. Misrepresentation of policy provisions is quite common in the insurance industry.

Therefore, while the world seems to have gone crazy putting names to age-old communication strategies, insurance is largely an industry of using “risk” as an excuse to misrepresent information for profit.

Betting on the fact that the majority of insureds “won’t know the difference” the insurance industry remains at the top of the heap when it comes to deliberately “pulling the wool over insurers’ eyes.” Risk is risk, and any product involving risk isn’t foolproof -but most buyers don’t know that.

Since we now live in a society where information comes to us in various forms, it is important to be able to distinguish what the differences are in what we hear, read and watch.

I leave it up to you to decide for yourself what to believe, however, the insurance industry is more the master of “misrepresentation” and “stacking the deck” than “fake news”, or even “truth news.”

The real culprit is “risk” and the ability (or inability) of the insurance industry to manage its own profitability.

mind-you-own-businessA client called me this morning to report that he left work one day to have a cardiac work-up evaluation because it was suspected there was a blockage in one of his arteries. This client had been working as a part-time physician for nearly a year and is paid by Unum “residually.”

When he submitted his payroll stub, Unum noticed that 1 day of work was noted as “Time Off”. The client then received a call from Unum asking whether the “Time Off” notation was for sickness, or was it for personal time.

I had to ask myself why Unum would be asking a question like this. Most DI and Plan polices have formula calculations to determine residual disability that compare current amounts earned with pre-disability earnings or PMI (Prior Monthly Earnings).

It seems likely that my client was paid for “Time Off” and therefore the day’s earnings would have been included in the calculation. Whether the employee is paid for the time or not, a “total earnings” figure is listed on the payroll stub clearly indicating the amount paid and the appropriate calculations can be made. Why the insured was not at work is none of Unum’s business.

It seems more likely to  me that Unum may have wanted to know why the employee was taking off for “Personal Time”, something the company has no contractual reason to ask, or know.

A second example is that of a client who is a writer and journalist. His disability was approved and has been paid for about a year. Suddenly, he receives a letter from Unum asking about “royalties”, which is an appropriate question. However, the letter also asks, “Will you be writing again?” Of course the obvious answer to that question is, “We’ll let you know when I’ve made any money at it.”

Occasionally, insurance companies ask questions that are outside the authority of the contract. Insureds should not be afraid to ask, “What do you need to know that for?”, or “What does that question have to do with my policy, or disability for that matter?” Claims handlers often try to trick insureds into admissions that have nothing to do with claims.

Unum claims specialists in particular seem to have a particular knack in soliciting answers to questions that invade personal privacy and space. The questions cause insureds to feel vulnerable, and helpless, often coming across as threatening, “If you don’t answer me I’m going to deny your benefits.”

Other questions that invade privacy are:

  • Do you intend to have another baby?
  • How often do you have sex?
  • What is your (domestic) partner’s name?
  • Are you seeking fertility treatments?
  • Do you attend Church and how often?
  • How often do you go out to eat? Or, to a movie?

In my opinion, insureds have the right to keep Unum focused on information that IS relevant to the claim by saying, “This question has nothing to do with my policy; do you have a question that is?”

Keep in mind DCS still isn’t recommending verbal communications with any insurer on the phone, but privacy issue questions posed in writing can be ignored or responded to in the same way.

Don’t allow Unum or any other insurance company to invade your privacy with questions that have nothing to do with your policy contract.

It’s very easy to allow Unum’s control over your money to slip into controlling your personal life as well. It’s up to you not to let that happen.

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consultingDisability 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 about DCS, Inc. can also be viewed on this blog by clicking the “Consulting Services” Tab from the Lindanee’s Blog Home Page.

Unum Moving IT To India

indiaThe articles below appear to suggest that Unum is very serious about moving its IT divisions to India causing the loss of up to 350 employees, possibly more, in Portland and Chattanooga.

While Unum scrambles to find cheaper ways of managing its claims process, it’s obvious to insureds and claimants that Unum is inefficient, chaotic, and extremely disorganized. Now we know why.

As I’ve posted in several other blogs Unum Group downsized over the last several years while engaging in frequent “firings” of employees, most those nearing 50 years of age, or those who found it necessary to use STD and LTD. Although the cause of terminations given was “poor performance”, let-go employees report minor infractions and “trumped-up” allegations to remove them from the company.

In 2002 it was a Unum cardinal sin to ask for “work at home” but shortly thereafter Unum also began allowing employees, most notably Administrative Assistants to work at home. Thus began the re-vamping of Unum Group from a terrible company to one that shouldn’t exist.

In my opinion, Unum should just die the slow death of being taken over by another, more successful company. Unum Life Insurance, UnumProvident and now Unum Group never appeared to recover from Union Mutual’s demutualization in 1987.

While in 1987 operating as a publicly traded company under the guidance of CEO Jim Orr III seemed promising, the 1999 merger with Paul Revere and the Provident companies was disastrous and destroyed the public’s perception of Unum Group as ever becoming a fair and equitable claim reviewer.

Although Unum can attempt to delay the inevitable by shipping IT business to India, the fall of the last domino will occur as the company scrambles to keep as few claims specialists as it can. Providing worsening customer service to those who have no other choice but to depend on ERISA Plans is not indicative of business growth and prosperity.

Please read the attached articles and come to your own conclusions about the company. The links below were provided by an interested client. Thank you!

http://www.chattanoogan.com/2016/12/22/338487/Unum-Ramping-Up-For-More-Outsourcing.aspx

http://www.pressherald.com/2016/06/16/sources-unum-in-talks-to-outsource-hundreds-of-jobs/

 

knowledge-is-powerIn the last several months I’ve learned that there are many individuals who do not completely understand that private disability policies are double-edged swords. Not only does the definition of disability require medical certification, but that restrictions and limitations must relate to ones inability to work in some way.

The tendency today is for insureds to continuously submit medical “proof of claim” without connecting the dots between medical impairment and the inability to work. One without the other does not make a successful disability claim. Both criteria contained within the definition of disability must be addressed before most insurance companies will pay claims.

I have to admit that although there are some savvy physicians who know the private disability logo, and can write excellent restrictions and limitations for their patients, most are not adept at providing successful restrictions that link R&Ls to work capacity.

For example, one physician wrote (keeping this very simple), “This patient is permanently restricted from lifting > than 10 lbs.” Although technically, this is a medical restriction, it leaves out “occupational incapacity.”

Rephrased, it should read, “I’ve reviewed this patient’s job description requiring him to lift up to 20 lbs. frequently. Based on recent MRIs and the patient’s ten-year history, treatment and consultation with me, he is permanently restricted from lifting greater than 10 lbs. and is therefore not able to perform his material occupational duties. This restriction is permanent and is not likely to change in the long-term.”

The above phrasing is probably one of the best documentations of a medical “restriction” that links “medical cause and effect” to “occupational incapacity.” The unfortunate thing, however, is that most physicians will not take the time to write such a lengthy restriction even if he/she was aware of the dual requirement needed for private disability.

The key here is that physicians must ALWAYS link medical restrictions to key material and substantial duties that would preclude patients from working in any capacity. For some reason, the “occupational” definition of disability is often disregarded resulting in adverse claim decisions. This is particularly true when insureds attempt to manage their own claims.

Private disability is NOT determined by persuasive medical information alone, but also by documenting occupational requirements insureds and claimants can no longer meet. In the absence of “connecting the dots”, insurance companies keep going back to treating physicians in what appears as harassment in order to get answers to the question, “Why can’t this patient work?”, and “What parts of their jobs or occupations can’t they do?”

When I review IME reports (and I have reviewed thousands), questions posed to IME physicians are always the same: “What restrictions and limitations prevent this insured from working at his/her occupation?” “Would this person be able to work as a  ——–full-time?”

Insurance companies always want to know if insureds and claimants can work. Most of the other risk management activities such as surveillance, field visits etc. are also wrapped around finding out why insureds can’t work for medical reasons.

In theory, insureds must meet both criteria of the definition of disability before benefits can be paid. In reality, most insurance companies pay claims for medical certification only, and then spend the entire history of the claim searching for the connection between medical restrictions and inability to work. This is why the claims process appears to be burdensome and vexatious since claims issues never seem to be resolved in any way.

Finally, insurance paper reviews are not all that persuasive representing only presumption, opinion, and circumstantial evidence. If treating physicians actually took the time to write good restrictions and limitations, most internal paper reviews would be disregarded since they do not represent “fact” or provide accurate assessments of work capacity.

BOTH medical restriction and occupational incapacity should be documented as “proof of claim.” One without the other could prove to be a very costly omission.

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consultingConsulting ServicesDisability 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 about DCS, Inc. can also be viewed on this blog by clicking the “Consulting Services” Tab from the Lindanee’s Blog Home Page.

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