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The worst customer serviceWhile there is no doubt that all Unum insureds read letters from insurers word for word, it is also true that claims reps do not write the letters but have drop down menus of narrative to choose from. In short, much of Unum’s letters are “constructed” from templates.

Indeed, insurers do not trust claims handlers to cite exact policy provisions on their own, nor does management want claims handlers taking the time to actually type out all of the long letters sent to insureds and claimants.

Instead, most claims specialists do not sift through all of the templates and often include (and possibly exclude) appropriate policy provisions that pertain individually to each insured. Unum insureds should look at their letters carefully. It is easy to tell where the “template inserts” have been made because formats are “off” with too may spaces between paragraphs and other format errors.

I can’t tell you how many times I’ve investigated policy provisions cited in Unum’s letters that do not match provisions from policies and Plans for each individual. Short paragraphs actually written by claims handlers contain typing and grammatical errors – another reason why Unum may want their employees to use templates.

Some claims specialists throw in the “right to IME provisions”, many do not. Other claims reps insert most provisions in the policy into the letter whether it is relevant to the topic of the letter or not. Claims reps often think that the longer the letter the more “informative” it is, but the truth is that sending out multiple page letters regurgitating policy provisions is the least effective way to communicate.

Common sense would dictate that disabled persons might understand shorter and to-the-point communications rather than multiple page text regurgitation of policy provisions over and over again. Still, I suspect Unum will defend the repetitious citations as “we want to make sure claimants understand policy provisions and that we have a contractual right to do what we’re doing.”

Well, maybe. Unum often assumes its insureds and claimants are stupid. In many instances, Unum cites policy provisions in its written communications but then in other locations in the letter does, or requests just the opposite. Many denial letters actually document total disability by including favorable language from treating physicians, but then conclude at the end, “We’re not paying your claim.”

What is also interesting about Unum’s written communications is that the letters themselves are “validated” (approved by a manager before they are sent out). With all of the typing, spacing and grammatical errors it makes me wonder if managers “validate” format as well as content.

Of course, in any discussion of Unum, there are also anticipated fear mongering and intimidation effects. Longer, detailed, hard to understand letters create fear to the point that insureds will do anything even when Unum’s requests are unreasonable. Impossible to understand letters allows Unum loopholes to allege, “we informed you, but never had a response.”

Finally, arrogant Unum claims reps like to keep their “big sticks” handy in their written communications, so they can figuratively beat insureds over the head with misinterpreted policy or Plan provisions. I do not recommend trusting Unum’s policy or Plan citations as verbatim from Plans applicable to each insured or claimant.

Unum Group et al is by no means the only disability insurer sending out multi-page letters that force insureds to sift through policy narratives in order to find out what the insurer really wants. Prudential is also a big offender in sending out letters often 6 or 7 pages long, repeating policy provisions over and over again. (Also from templates.)

Most insureds might be tempted to say to Unum, or at least think of saying, “OK Unum, you’ve informed me once, I get it. After that, just tell me what you want.”

DCS recommends that insureds and claimants look for the one or two sentences in a Unum (or any insurer’s) letter that actually makes a request – the rest is pure buzz insureds have seen on multiple occasions.

Common sense tells us that disabled persons would appreciate short, clear and concise communications that are specific about what’s being requested. But, insurance companies are all about the paperwork and to the extent they can make it difficult, it can only be to their advantage if they do.

Don’t be intimidated or fearful of Unum’s lengthy letters – just search for, and underline the one sentence or paragraph that defines what the company wants. The rest is template “insertions” that may or may not pertain to your claim situation.

 

Getting FiredCalls and messages from Unum’s recently terminated employees seems to indicate the company launched again headlong into firing employees for minor infractions, some they didn’t even know about.

Didn’t record a flup? Took no action on a flup (follow-up)? Used cell phone? Can’t handle the block of claims and new business? Poor history of claim denials? Guess what? You’re gone!

It’s wishful thinking for any Unum employee to believe they have job security. Some employees who are suddenly terminated are those who received generous salary increases and spot performance awards months before terminations take place. Still, Unum alleges employees are “not able to maintain standards” and they are fired for “poor performance.”

Whether or not the job infractions warrant “termination” is usually determined by claims managers who “want to get rid of” direct reports who aren’t holding up their commitment to processing denials.

Employees who have been on the job for more than 20 years and are “getting of age” are also targeted as quick hit terminations, again for poor performance. Employees with “Meets” performance ratings are  suddenly terminated making one wonder whether anyone in the company is actually performing well.

Although any employer can terminate an employee for little to no reason, Unum actually works very hard at it. It spends time padding the employee’s file with probations, and negative reports for minor things such as “not bolding certain contractual words in policy citations”, or failing to record a flub as completed, etc.

Managers discuss “poor performance” issues with peers to create “hate groups” within the unit that ostracize employees making work environments unbearable.  I’ve often wondered whether other employees realize the extent to which Unum uses them against their peer workers.

Although I have never criticized any Unum claims rep for doing what is necessary to keep their job, it has become increasingly clear in the last year that not only are Unum’s employees complicit with Unum’s unfair practices, but actively seek to deny claims in order to receive annual bonuses held over their heads by management.

Although Unum’s bonuses may appear to be significant, the amount of each individual bonus to claims handlers is probably less than $3,000. What would you be willing to do for $3,000?

My message to Unum claims handlers is to consider that whatever the company can do to its insureds and claimants, it can just as easily do to you, and it does.

And, by the way, Unum can’t control what you do, or who you talk to after it walks you to the door. In some instances via letters Unum tries to tell you not to speak to anyone about the company if you want to get your “severance” money. Once Unum terminates your employment it cannot dictate what you do or who you speak to. You do not have to be afraid.

Believe it or not, there IS life after Unum. You may be hurt and angry at having been fired but in the long run, not working for Unum is preferable to cutting off someone’s legitimate benefits you know should have been paid.

There are many employers who treat their employees with respect by providing leadership and opportunities for advancement. Unum is not one of them – instead, the company sends you to Disneyland to “aspire” more indoctrination and assumes adult employees want a hug from Mickey Mouse.

Sometimes getting fired opens more doors than it closes. I am always available to terminated Unum employees who need someone to talk to. DCS refers Unum employees to good employment attorneys to determine if they are getting what they are entitled to such as unemployment, severance, and/or retirement.

Employment termination by a company scorned by the public with a history of unfair claims review can’t be such a bad thing. Sometimes it’s the best thing that ever happened to you!

Controlling SpouseWhile there is no question that family primary care givers have difficult jobs, there often occurs disability claim situations when the non-disabled spouse literally takes control over the claim, or inflicts so much harassment and abuse upon the disabled partner that life becomes even more difficult for the person who is ill.

By far, most spouses of disabled partners are loving and provide much-needed support for the betterment of the family. In my experience I have come across some of the most caring partners of insureds and claimants who give much of themselves to keep things going.

Full time care giving is not an easy job and always requires an unselfish spouse willing to give up his/her time to help loved ones regardless of the severity of the disability. My thanks go out to all of the special spouses who care for those they love and stand by them.

Technically, spouses are not parties to disability contracts and should have no involvement with the management of claims unless their partners are proved to be mentally incompetent and a legal power of attorney exists for that reason.

Spouses who “take over” the claim of a partner by signing letters and frequently contacting insurers are viewed and documented as “controlling the direction of the claim.” This creates internal red flags within the insurance review process and makes the administrative management of a disability claim all the more difficult. Some spouses are relentless in managing partners’ claims to the point that they actually do more harm than good.

Interestingly, spouses who take over the management of a partner’s disability claim also “inherit” the claimed disability and can become obsessed, sometimes more so than the disabled spouse. Long letters are faithfully written, Internet research is done, patient notes are scrutinized, corrected and nearly every aspect of the claim itself is under the control of a non-disabled spouse.

As a consultant, I have always recommended a bit of caution to spouses who feel it is necessary to “take over” and speak for their disabled partners. First of all, those who are disabled believe they have lost their own “personal power”; they feel guilty because they can’t work and provide for the family the way they used to; often feel rejected by family when they aren’t included in family decisions anymore; and, most importantly, often isolate themselves from “business as usual” because they feel insignificant and unworthy.

Therefore, it seems reasonable to me that spouses who interject themselves into the claims process enable the above emotions often contributing to the “bad feelings” that are so often part of a disabled person’s thinking.

It is so important for the disabled spouse to continue to be actively involved, and heard from when a disability claim is filed. All good intentions aside, non-disabled spouses should take a step back and allow the disabled partner to participate in the claims process as much as he/she is able.

At least once this past week I had to remind a caller that she was not a party to her husband’s policy, the claim was not hers, and the appeal process belonged to her husband. Again, while there are many good intentioned spouses who provide support, occasionally there are also situations when a spouse inappropriately interjects themselves into the process.

Unfortunately, there are often spousal situations when either a wife or husband beats their partners over the head (figuratively) because “There’s no money”, “What are you going to do now?”, “Why don’t you get an attorney?” “Don’t listen to that person.”, “There’s never any money to do anything.” . “We can’t live like this.” etc.

Or, a non-disabled spouse continually threatens divorce or desertion if the partner fails to return to work because of pain he/she doesn’t see or understand. Abusive spouses can often influence children away from the disabled partner – often a very hurtful situation to someone who is ill and helpless to defend their own rights to their children.

Behavior such as this is abusive and should not be tolerated by the disabled spouse. I’ve had to deal with a few very abusive spouses, both male and female, in my 23 years of managing disability claims, and if it was unpleasant for me, imagine how the disabled spouse felt.

Supportive spouses are a god send to those who are disabled and are a much-needed blessing to the family. However, it’s been my observation that although some spouses are good intentioned they often regard disabled partners as “not being able to handle anything” and feel obligated to step right in even though they may not have a clue as to how to handle or manage a disability claim at all.

Spouses who verbally abuse disabled partners should not be tolerated. Unfortunately, some disabled spouses feel so bad about themselves they actually think they “deserve” the verbal abuse and do not report it.

In Maine, care providers are required to ask those over 60 , “Is anyone hurting you at home?” This is a perfect place for disabled partners to discuss spousal abuse – with their treating physicians.

In my opinion, it is extremely important for both spouses to recognize their individual roles in the disability claims process and define those roles in accordance with the severity of the spouse’s disability while also considering any emotional impact “absolute control” and/or verbal nagging can have on someone who is ill.

“Disabled” does not mean “helpless”, and disabled spouses should remain an integral part of their disability claim in so far as they are able. Nagging and verbal abuse should always be reported to a healthcare professional.

Friday Q & A

Q&A pointerHow do I find work with a medical restriction?

Unfortunately, we live in a society that discriminates against the disabled and elderly. Unlike other countries that provide opportunities and work options for disabled workers, employers in the United States hire only the young, gym-healthy, good-looking, thin, and  highly educated.

The fact that Wal-Mart hires the disabled doesn’t speak well for the company either. Disabled workers are taken advantage of with low pay, limited benefits, not to mention that most people joke about “being a greeter at Wal-Mart.” In the end, Wal-Mart targets disabled and uneducated workers because they are more apt to settle for low pay and nonexistent benefits. I cringe every time I see the very elderly reduced to bagging groceries at my supermarket.

Corporate employers target young, beautiful people. Although the corporate executive who told HR “not to hire uglies or fatties” received public criticism for his comments, the reality is that in America those who are less than perfect have a hard time getting jobs.

However, medical restrictions, unless physically obvious, need not be disclosed to future employers, if the restrictions can be managed outside of work. For example, some restrictions limiting numbers of hours worked, can be resolved simply by applying for part-time work instead of full-time.

Keep in mind those applying for jobs are expected to be truthful on applications, and if specifically asked should disclose certain physical conditions that require employer accommodations, or other work limitations such as lifting, carrying, traveling and social interaction.

Bottom line, disabled workers have a hard time in America finding employers who are willing to hire them. The Americans with Disabilities Act (ADA) is no more than lawful lip service from a law that gives deference to employers, not employees. Very few ADA lawsuits are actually won.

Social Security has a trial work period with rehabilitation if disabled workers want to go that route. Many state agencies have resources available to assist the disabled in finding work. In some respects, “where there is a will, there is a way.”

Therefore, it is very important for the disabled and elderly to be persistent and insist that they be given consideration for jobs. Admittedly though, it’s a hard place to be since finding employers who hire “less than perfect” individuals may take some time. Unfortunately, jobs in America are also competitive as well.

How long do I need to go back to work before going back out on disability?

First of all, if you think you will need to “go back out on disability” then you shouldn’t go back to work in the first place. One of the worst things claimants can do is repeatedly go back to work and then back out again. I’m not really supportive of people who actually “plan” disability claims either.

However, employees who go back to work with the same employer will still be covered by their group LTD Plan as long as the “minimum number of hours worked provision is met.” For example, if a claimant returns to work 20 hours per week part-time but the minimum hours worked provision requires 30 hours to remain covered under LTD, then the LTD coverage stops, and no future claim will be covered.

Employers often do not inform employees they don’t have their group LTD coverage anymore – something to be very careful about when returning to work part-time.

Claimants who return to work full-time with the same employer are subject to the “recurrent provision” in their policies. This means if they are unable to continue working for 6  months, they are permitted to go back on claim without having to meet another Elimination Period. Of course, insurers will make you wish you had not done this by requiring a preponderance of “proof of claim” in order to pay benefits again.

When claimants return to work with another employer, they are of course, subject to a new Waiting Period and Pre-existing Condition provisions. Most group policies have a 3/12 pre-existing condition provision requiring employees to work for 12 months prior to filing any disability claim. Even then, there is a 3-month look-back from the Effective Date of Coverage to determine if there was any treatment, prescriptions etc. for the claimed disability.

Therefore, it’s likely that even with a new employer if a claimant was treated for a disability in the past, the claim could be considered pre-existing if claims are filed sooner than 12 months after the Effective Date of Coverage. There are other versions of pre-existing provisions, so it is always a good idea to check Plan provisions before “planning” a disability.

When I file a complaint against Unum with the EBSA can I also file a complaint against my employer?

Yes, you can, but you should keep in mind the limited jurisdiction of the Department of Labor. The DOL may choose to deal with fiduciary issues and ERISA requirements, but has no jurisdiction over EEOC or Human Rights employment complaints. There are a few exceptions such as wage and hour violations, omission of job postings etc., but in general the DOL deals only with federal requirements and laws in the workplace. Upon inspection, most complaints filed against employers have to do with issues more pertinent to EEOC and state Human Rights Commissions issues.

Employees do not have forever to file EEOC or Human Rights complaints, so it’s always a good idea to file a complaint as quickly as possible.

I live in California. Can Unum reduce my benefit for SSDI or dependent coverage when I haven’t even been approved yet?

No they can’t. California does not permit insurance companies to offset SSDI benefits until you actually receive them, assuming of course, that you are cooperating with the process of applying and appealing as required by the Plan.

UnfairWhen claimants honor their agreements and do the right thing by repaying all that is owed for SSDI overpayments they should be rewarded, not penalized.  Apparently, The Hartford has an internal “lockbox” system that literally locks out benefit payments until overpayments are recorded as received.

Just how long this takes is another question. Overpayments received aren’t recorded right away and therefore it’s likely claimant benefit checks will be withheld indefinitely until the lockbox system records overpayments as received.

In addition, The Hartford does NOT give credit for up to $6,000 in attorney fees until all of the overpayment is received. Claimants need to “pay it all back” before they get credit for the attorney fees. One claimant actually received a letter from The Hartford stating that she still owed $6,000 of overpayment when she did not.

As I’ve posted previously The Hartford is a paranoid company and it seems as though this trend threads through its entire claims process. Claimants who payback their SSDI overpayments in a timely way shouldn’t have to wait to receive their next benefit check.

The Hartford’s inability to get it together and record overpayments received promptly is unfair to claimants who look to receive their benefit checks on time.

Hartford’s lock box system takes the approval and release of benefit checks out of the hands of claims specialists, therefore in situations when the claims specialist admits benefit checks are late, he/she can’t do anything about it. What good is that?

If claimants can give back to The Hartford all of their SSDI overpayment money promptly, then the least the company can do is pay benefits owed, when owed. In my opinion, The Hartford is quickly becoming a company that needs a major over haul of its philosophy and internal administration.

Clearly, the processing of SSDI overpayments is archaic and punitive to claimants.

Start the complaint processIt seems as though more and more ERISA claimants are being denied legitimate benefits particularly those with Unum, CIGNA, The Hartford and Prudential. Internal complaints never seem to resolve anything and are generally a waste of time.

Claimants are recommended to send written complaints to their Regional EBSA Offices, the U.S. Department of Labor. In recent months there has been renewed interest from the DOL to assist claimants with complaints against disability insurers who do not conduct fair and equitable reviews.

Although the EBSA may not seem to pay much attention to each individual claim the numbers of complaints do count. The DOL won’t get involved if claims are denied and attorneys have been retained. Therefore, it is very important to file complaints whenever claimants begin to suspect insurers are not acting in accordance with the Plan document.

The following link will provide you with the address of your EBSA Regional Office.

https://www.dol.gov/agencies/ebsa/about-ebsa/about-us/organization-chart

Although ERISA claims have a federal jurisdiction, numbers of complaints are also maintained at the state level.  ERISA claimants may also contact their state departments of insurance with written letters of complaint. Again, state DOIs may not act upon the complaint but they do keep track of the numbers of complaints received. When the number of complaints becomes significant, state authorities will do a Conduct Market Examination.

DI insureds are recommended to contact their state departments of insurance with formal complaints. Again, numbers do count.

NCDI_Logo_colorRemember NCDI is the National Coalition of Disability Insureds, the sister non-profit organization of Disability Claims Solutions,Inc. NCDI continues to recommend both federal and state complaint procedures.

NCDI continues to be an organization available to insureds and claimants who want to participate publicly in bringing fairness to the disability claims process.

Daily Buzz

Check is in the mailA Word About Late Checks

DCS has been receiving quite a few calls about late checks. Please note that no insured or claimant is ever guaranteed their checks will be sent out at the same time each month. But invariably, and probably due to the fear of being denied, most insureds push the panic button when checks are not received on exactly the same day each month.

I understand how scary it must be, or that perhaps insureds are living from one benefit check to the next, but 99% of the time delayed checks, particularly at this time of year, are due to internal administrative errors. Claims handlers go out on vacation, forget to approve checks going forward, or internally there is a glitch.

All claimants have what is called a “benefit payment period” and to the extent there is no glitch, checks can come at the same time each month, and most of them do. However, there is no guarantee that anyone will receive checks promptly and before the benefit payment period. EFT direct deposits are more reliable, but even then errors are made and checks may not arrive on time.

Although technically, insurers owe benefits for the benefit period in question, there is no assurance that all checks will be received “on time.” Insureds and claimants should plan accordingly cash wise, and anticipate that at times checks will be late.

If there are no outstanding issues pending with your claim, there is no reason to get into a panic when checks are late. The appropriate thing to do is call (yes, CALL) the claims handler and ask, “When can I expect to receive my check?” Once you find out your check is late due to an administrative error, you can calm down and stop worrying.

No news is good newsNo Answers To Positive Outcomes

Most insureds and claimants tend to feel that they should get letters from the insurance company informing them of positive outcomes when in truth insurers do not respond to positive outcomes on a regular basis. In my experience, “everything is OK” letters only occur when the claims handler has time to send them out. In general, though, insurance companies do not respond or provide answers to positives.

For example, if the insurance company sends you what I call a “response demanded letter” asking questions, or attempting to resolve an issue, and you respond to them, the company will not send you back anything saying, “thank you, your claim is now secure.”

I am aware that the “omission” of informing of good news seems somewhat rude, but the truth is disability insurers are only concerned about documenting negatives, or sending threats of termination for some reason. If there is no reason to threaten insureds, then generally there are no letters sent.

The only exception to communicating good news is extending benefits beyond 24 months after an any occupation investigation. Unum will send out letters, “your benefits have been approved beyond 24 months”, but then again, not always. The other exception, is of course, initial approval letters which are good news to insureds.

Therefore, when it comes to disability insurers, “No News Is Good News” and there is no reason to wait for written confirmation that “all is well” with your claim. It’s always been my experience in managing private disability that “all is good news, until it isn’t.”

This is why insureds need to be proactive and manage claims well to ensure there are no issues or problems.

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