There’s been some question raised recently about just “who is responsible at Unum Group” for the “bad faith” claims process and unjustified denials. Well, let’s take a snapshot of what we know about Unum’s claims process and see if we can pinpoint responsibility.
The CEO and Senior Executive Officers sign responsibility statements as part of Unum Group’s financial statements. In brief, the CEO and/or Senior VP’s sign a short statement that they are responsible for making sure the financial statements were prepared in accordance with generally accepted accounting principles, and that in general, they can account for what the numbers mean. This alludes to the fact that if Unum, as a company, was under reserved the top brass would know about it.
An oversimplification of corporate responsibility directs that if the corporation does anything to “cook the books”, the CEO could be held responsible. Unum’s CEO also certifies he knows what went into the making of those figures. Is the Unum CEO responsible for the over all financial reporting of Unum Group? You better believe it, even though Unum’s CEO positions himself an arm’s length away from actual claims practices and doesn’t get involved in complaints.
So, who can we blame? As an employee I once sent an email note to Tim Arnold, the then Vice President of Claims, and basically told him “you either are not aware of the poor claims process, or if you are aware, are covering it up, or you have lost control of the claims process.” In hindsight it appears Tim Arnold was aware of the poor claims process, but had lost control of it all together.
Either way, as Vice President of Claims Mr. Arnold was in a position along with Ralph Mohney to develop the claims process into a system of fair review, or as it turned out, to an unfair one according to multi-state settlement commissioners, Georgia and the state of California.
Although my experiences with Tim Arnold indicated he was generally fair regarding claims, he did terminate managers and other staff who disagreed with him, or failed to meet projected targets. Although there was no question of Arnold’s being a “good ol’ boy” cohort of Harold Chandler, the claims process at Unum degraded into a big mess at the time.
Therefore, any Vice President involved in the claims process at Unum Group has the authority to devise and implement strategy within the claims process itself. Claims Vice Presidents attend Multi Disciplinary Roundtables on occasion, and can approve denials for business reasons. Vice Presidents can order Managers, Directors and Claims Handlers to terminate claims, or “step up” review procedures to produce increased denials.
Claim directors and managers set the tone of the claims environment within the workplace at Unum. They can either make it a nice place to work, or the worst hell on earth if claims handlers aren’t living up to their unit quota of claims denials. Claim managers have the accountability to “roll in” Unum’s projected profitability targets and therefore they also have authority to do whatever is necessary to make it happen.
Are claims directors aware of what “bad faith” is? Yes, they are. Do they try to implement the claims process in “good faith?” Not when the “powers that be” demand increased denials in any given financial accounting period and continue to expect managers to roll in unattainable profit targets. The job of a claims director or manager at Unum is an impossible trek toward higher and higher unattainable expectations. As a result, it makes people do what they ordinarily wouldn’t do to keep their jobs.
In my opinion, anytime an executive is in a position to create, implement, and evaluate performance of any process or action THEY ARE RESPONSIBLE for the outcome. At Unum Group this would include any supervisory position above claims handlers who are ultimately the lowest rung of the claims review process and nothing more than glorified administrative assistants.
Also, responsibility reaches to Unum lawyers who attend roundtables and who are a part of Unum’s bad faith not just defenders of it. Unum employs long lists of defense attorneys all over the country who have knowledge of Unum’s criminal actions and defend bad faith. These lawyers are also responsible to the people and should be held accountable for their participation in wrongful denial of disability claims.
Are Unum claims handlers responsible then? Yes, they are, but from a different perspective. Since they do not have the authority to create, implement and devise strategy, their responsibility is limited to that of a moral and ethical one.
Certainly we would all agree that Unum employees should report wrong doing at any time. But, ethics is relative—not everyone has the same moral sense of ethical conduct, nor does every “Joe six pack” have the wherewithal to give up a yearly salary and walk away from bad faith. Most claims handlers at Unum need their jobs and do what they have to do to keep them.
Furthermore,, Unum claims handlers are brainwashed by the company into believing they are doing the right thing particularly when awarded bonuses for doing it. It takes a long time in this type of environment to really understand what is going on and come to a consensus that targeting and denying payable claims is wrong. It takes guts to report wrong doing within this company, since when you do, your personnel file begins to get papered and subsequently you’re escorted to the door by security. Unum does not tolerate dissent, or thinking outside the box.
So, who IS responsible at Unum Group? The answer: EVERYONE IS. The CEO, and VPs certainly are from a legal point of view. And, managers, consultants, customer service reps, and claim specialists are from a moral and ethical perspective.
There are those who look back at Unum Life, UnumProvident and now Unum Group and comment that the company should have gone the route of Enron many years ago. Many of UnumProvident’s management probably should have gone to jail, but alas the company was salvaged; and the same people who created and implemented strategies to deny compensable claims were promoted and are running Unum’s claims process today. A bit scary isn’t it?
When the public takes a look at Unum Group it doesn’t see quality claims management or “good faith and fair dealing.” What it hears about overwhelmingly is Unum’s denial of legitimate payable claims for profit. And, every employee at Unum is responsible for that image.
Therefore, on those days when you’re looking for someone to blame at Unum Group, start at the top and work your way down the chain of command to the claims handler’s conscience. It’s the only conscience you’re going to find in the entire company.