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9/11 Victims and God Bless UnumProvident

From 1999-2001 UnumProvident operated well outside any reasonable or ethical standard set by the NAIC’s Model Acts or state insurance laws. Claims continued to be indiscriminately denied by newly appointed “Consultants” who also participated, along with Managers, in the company’s MICP (Management Incentive Compensation Program). It payed to support Unum’s profitability targets and management raked in thousands in annual bonuses. Claims handlers weren’t so lucky and received nothing except for Dave Gilbert’s gold chocolate coins and on-site performance awards.

The statement, “It’s hard to get people to do the right thing when their money depends on not doing it” rang true enough, and although the claims area continued in eternal chaos and backlog, many ERISA claimants were denied benefits for no other reason than the company didn’t want to pay. Mercilessly, no one seemed to care that the American middle class was deliberately deprived of money in the form of benefits they rightfully deserved.

Mary Fuller, the then VP of Claims told an entire department to, “Not inform claimants of their appeal rights on the phone since Unum’s appeal department was over run and couldn’t process any more appeals.” While assurances within the company suggested that employees hang on to their worthless stock options, many employees recognized the reality of devaluation and threw their hands up in disgust. I was actually lucky in recognizing the potential devaluation and exercised my shares as soon as they vested when Unum’s stock was still $55 per share. Others were not so lucky, and Mary Fuller was eventually fired.

STD and Life Waiver claims were reassigned to claims handlers who had no idea how to manage them. Shredders were strategically placed within each unit to “shred non-essential” documents, and boxes of documents were handed off to individuals presumably to take home. When I asked if I could take the box of documents I was told a stern “no.” In fact, the senior claims specialist wouldn’t even let me see what documents were in the box.

When Dave Gilbert’s feet hit the claims floor to replace Mary Fuller most claims handlers shook their heads in disbelief at his inexperience with claims. Dave’s greatest contribution as VP was giving out chocolate gold coins to claims personnel when they denied high reserve claims. The unit needed leadership, not a claims Easter Bunny bearing chocolate!

9/11

UnumProvident began managing 9/11 claims in “the American way” by waiving employment records and application forms normally submitted by victims. Since Unum sold policies to Morgan Stanley and The Mercantile, 9/11 victims had no records to submit and there was nothing to verify since all had been destroyed. On the surface UnumProvident appeared to be “the 9/11 Savior” of disability claimants were it not for the fact that the company used its position to pay 9/11 claims without verification as a marketing tool. “Look at us! We’re the good guys!”, Unum said to the American people but unfortunately it didn’t last long.

At the year anniversary of 9/11 Harold Chandler forced all employees company wide to gather in various conference rooms for a re-showing of the tapes of 9/11 including people jumping out of buildings and running through smoke and debris. Most employees in the Portland location attended in disgust, and some refused to watch the hour-long footage of one of the most horrible of American tragedies.

Still, during his concluding speech, Harold Chandler actually had the cajoles to say, “God Bless America and God Bless UnumProvident”

With that most of us hit the bathroom and literally puked.

In 2002 Unum’s managers in the psyche/cardiac unit attended a meeting wherein it was discussed that UnumProvident had been paying 9/11 claims long enough. Therefore, management “decided” that all 9/11 claims were to be presented at roundtable so that it could be figured out how to deny them. Although Dave Gilbert appeared to be leading the way, managers and consultants were equally elated since denying 9/11 claims would significantly bolster their progress toward profitability targets.

Unum frequently denies these allegations because there is nothing written to support what is discussed at unit meetings between managers and their direct reports. In fact, most of what claims handlers were (are) directed to do is discussed in weekly unit meetings and never documented. It doesn’t surprise me that Unum continues to deny various unfair claims practices because nothing is ever written down. But alas, I was there.

As a Lead Customer Care Specialist I had been managing 9/11 claims and was put off by the directive “to deny” as many 9/11 victims as I could. One claim involved a gentleman who was so near to one of the Towers when it collapsed that he was still pulling bits and pieces of the building out from underneath his skin. The building imploded so forcefully that it imbedded pieces of material into his body and was still making its way out a year later. My manager wanted that claim denied.

Another woman who made it down from the 15th floor was still emotionally disabled and refused to go outside of her home. Still, another claimant told me he now lived in New Jersey and couldn’t bring himself to cross the bridge into New York and return to work. Another claimant had been in a nearby store and climbed out on top of severed arms, legs, and other body parts after the Towers collapsed. He was still an emotional wreck and in counseling but my “consultant” told me to present the claim at roundtable so the managers could figure out how to close it.

Finally, one of my claimants who had been pregnant at the time, and who had escaped from the 57th floor, delivered her baby but refused to care for it. Her claim was also denied.

Unum’s management did in fact roundtable all of the psyche/cardiac 9/11 claims and denied the majority of them. Most of my claimants telephoned to say, “How can Unum do this? I’m still not well.” In fact, when my Consultant forced me to call one of my clients and demand immediate medical update information under threat of denying the claim that very day, the claimants husband got on the phone and called me every nasty name he could think of. He wasn’t wrong, but later he complained to my manager, and I took a hit for the company.

Unum’s treatment of 9/11 victims signifies the extent to which the company capitalized on initially doing the right thing, followed by doing exactly the wrong thing to rid the company of an expensive block of claims. After the Chandler “God Bless UnumProvident” speech, most employees settled silently into complacency to keep their jobs. Not too many people liked the company anymore and began looking for other opportunities.

It was really a very sad environment to work in, and although I continued to go up the chain of command attempting to change UnumProvident’s unfair claims practices my complaints were consistently met with, “Shut up! Stop criticizing claim protocols! There’s nothing we can do about it and you’re complaining isn’t helping. Be quiet….be quiet…..be quiet…..”

Some employees, however, began looking for ways to blow the whistle. outside the company. Although I wasn’t involved initially in blowing the whistle on Unum, once the 60 Minutes and NBC Dateline exposes aired, I quickly found the biggest whistle I could find.

Stay tuned for part IV – “Busted”

UnumProvident Eliminates Extravagance and Hobos Employees

Harold Chandler descended on HO III in Portland, Maine surrounded by mafioso-looking bodyguards in black sedans and limousines. After clearing the parking lot of any obvious employees, Chandler appearing very much like a John Godi figurehead to those watching, was rushed into the building by presumed protective bodyguards we referred to as “wise guys.” Employees watched from cubicle windows as the new UnumProvident CEO suspiciously made his way into the Executive Offices to pave the way for the most abusive and egregious disability claims process in existence at that time.

Soon it became obvious just how much cheese Ralph Mohney and his cohorts gobbled from Unum Life to form a new corporation including the repositioning of Unum claims employees from the top of the employment pyramid to the bottom rung of presumed ignorant and unqualified personnel. Within months, female managers and VPs nearing 50 years of age were either offered voluntary retirement or were terminated for poor performance. Cleaning house took on an entirely new meaning as upper management did away with tenured jobs and faithful employees.

The mass exodus of other qualified employees, no doubt prompted by the realization that their stock options were worthless, left the new company with less than 20% of its qualified claims staff remaining. Keeping popular VPs such as Elaine Rosen and John Roberts did nothing to prevent the dust trail of former employees who left the company in disgust. The claims process was chaotic and entirely run by managers charged with saving the company by reorganizing from a department to an impairment based claims organization.

The good l’boys from Chattanooga swiftly rid the company of female contenders for key positions and replaced them with old hard-nosed seasoned VPs and managers from Paul Revere and Provident. Female employees in general were terminated in droves precipitating brief interest by local attorneys in gender and age discrimination class actions. Non-contributory employee HMOs were replaced with expensive PPO health plans and most subsidies and employee incentives bit the dust.

The newly formed UnumProvident began to show itself as a no-nonsense profit oriented company with no mercy philosophies toward those it sold polices to. The powers that be clearly intended to hurt insureds by denying as many claims as possible.

New philosophies emerged as Tim Arnold’s emails communicated that all claims decisions would be made based solely on internal medical reviews and that a “consensus of medical opinion” would no longer be required to make claims decisions. In fact, the new directive required all Unum claims to be re-reviewed under the “no-consensus-needed rule” and thousands of claims were denied as a result. The first group of claims designated to be re-reviewed were those from First Unum as management identified the product policies as backlogged and poorly managed.

Just prior to the merger a “Consultant” from Paul Revere told me, “You guys up here in Portland pay too many claims and we’re here to stop that.” While it looked as though the new onslaught of Chattanooga Consultants were out for blood the newly formed organization consisted of employees who hated to be there but needed the job, and those who feared being kicked to the curb because of their gender and age.

UnumProvident’s newly declared war on disability claims led the company to adopt claims practices and internal strategies focusing on ERISA group STD/LTD claims. A memo written by a UnumProvident Executive explaining how millions of dollars were to be had by denying ERISA claims was discovered during the multi-state investigations. The infamous “Ralph Mohney memo” was circulated among attorneys just after the 60 Minutes and NBC Dateline exposes.

Stripped of their annual bonuses and extravagant benefits, Unum employees quickly descended into the Unum bottomless pit. No more than unthinking robots, employees were expected to obey Unum’s cultish rules like the word of God. Most did and some didn’t. Thankful for greatly reduced salaries employees continued to deny claims at the direction of Consultants working exclusively to assist managers in reducing financial reserves for increased profitability. UnumProvident was a new company with a new mantra of bad faith.

Clearly, group STD/LTD became new targets of profitability as executives garnered millions off the backs of American employees who depended on benefits provided by employers. Many claims were deliberately denied without proper review to support profitability of a prematurely reorganized company top-heavy with aggressive Paul Revere male leadership. Most of the claims denied between 1998 and 2002 became part of the claim reassessment process required by the multi-state settlement.

One consultant who “ordered me” to deny several claims without medical reviews and appropriate investigation was told a swift “no”, while my manager sanitized claim files in my office when a subpoena was received from an insured’s attorney. It was all in a day’s work at UnumProvident and some where in some state someone received the bad news of a claim denial that was deliberate, targeted and extremely unfair.

Within a year, Unum Life had been transformed from Jim Orr’s “Lighthouse to the world” logo and slogan of “We see farther” to Chandler’s “the Provident Outhouse” and “We see nothing at all.” And it got extremely worse.

Consultants, Chaos, Backlogs and Expected Recovery Dates

Provident’s solution to “paying as few claims as possible” rested with the creation of a new prestigious level of employee called a “Consultant” whose major focus was to “validate” claims decisions made by glorified administrative assistants renamed “Customer Care Specialists.” The autonomy to make claims decisions alone was immediately removed from CCS’ as was access to claim financial reserve information. “Consultants” reported directly to Claims Managers who miraculously  escaped UnumProvident’s previous firings, and Harold Chandler’s new dawn and a new day resulted in thousands of claim denials.

The new “Consultants” had access, as did managers, to OMAR spreadsheets listing assigned claims, benefit amounts and financial claim reserves. (Yes, these are the same reserve figures Unum later alleged didn’t exist!) In fact, I still have the paperwork of my performance listing financial reserve gains I contributed to the organization.

Validating claims in combination with an impairment based claims review structure was one of the worst mistakes ever made by UnumProvident. Slowing down the claims review process while at the same time eliminating the autonomy of claims handlers to make their own decisions created an uncontrolled backlog of ACM (actively managed claims), viewed as an untapped source of profitability.

Chaotic, disorganized and managed entirely at the whim of mostly male profit seekers, UnumProvident assigned STD, Life Waiver and AD&D claims to untrained and unqualified employees who hadn’t a clue what to do. Group LT claims were inaccurately managed , backlogged by “Consultants” whose responsibility it was to “validate” claim recommendations from claims handlers in consideration of unit profit targets.

My discovery at the time was that many LTD claims were not paid COLA or Revenue Income Protection benefits that should have been recorded as additional income to claimants. My manager just shrugged and said, “Can’t you ever find a project in OUR favor instead of one that costs money?” Although she didn’t want me to do anything about it, I researched numbers of claims on BAS (Unum’s payment system) and discovered in nearly every case Revenue Protection Benefits were not being paid to those with contractual provisions requiring Unum contributions.

Revenue Income Protection benefit provisions were common at the time requiring Unum to contribute into a TIA/CREFF or Retirement Plan when claimants became disabled. Most Plans with RIP included University or School Districts and represented a considerable liability to Unum. In addition, COLA benefits were not coded into BAS and many insureds were underpaid as a result.

Mary Fuller once asked me why I didn’t want to be a Consultant. My response was, “Because they do bad things.” True enough, the Consultant in my unit was relatively unfamiliar with the management of claims. When I explained that not only was Unum committed to bringing retirement contributions up to date, but that Unum would  be held accountable for any compounded lost interest that also would have been paid into the plans, I was told to “just leave it along.”My Consultant told me to inform claimants that we would bring the TIA/CREF payments up to date, but to NOT mention anything about interest. “Let’s count on the claimant’s ignorance about the interest so that they wouldn’t even question it.” And, so it was done. As I said, “Consultants do bad things.”

Although there are many other egregious UnumProvident wrongdoings I could mention, one of the worst was sanitizing (removing data) from claim files to prevent inside diary notes and claim support from being read or discovered even with a subpoena. As a claim trainee I was taught to do this in CBA by a ruthless manager who basically didn’t want anything to be left in the claim file that was “discoverable.”

File plans, diary notes records of referrals to other departments -it all went into the trash can. Protecting UnumProvident was the most important thing and claim file copies were sent out incomplete with most tell-tale information missing. Sanitizing claim files was treated as a learned skill and the ability to do it properly was performance managed.

Another innovation of UnumProvident was the addition of Expected Recovery Dates or ERDs into the claims process. Although shrouded in secrecy  at the time it was later found that the coding of ERDs on BAS (payment system) “adjusted” or reduced financial reserves. The connection between BAS and ERDs wasn’t a well kept secret for long particularly when employees had to seek permission from Consultants and Managers to change ERDs to more realistic denial dates based on impairments.

Manipulation of ERDs was just another tactic on the part of unit managers to “roll in” financial reserve gains for various profitability reporting periods. The name “Expected Recovery Dates” is really a misnomer meaning “Expected Denial Dates”. Expected targeted non-compensable claims could be easily “planned” and “managed” over the course of a month using ERDs. UnumProvident’s use of ERDs caused claims to be prematurely or unfairly denied so that profitability figures were bolstered. In combination with Med MD, a software computer generated recovery system, ERDs wrecked havoc with UnumProvident’s overall financial reserves.

Three-stage mandatory round tables were placed within the claims process whereby management had an opportunity to direct plans to terminate even more claims. Eventually, the process turned into a circus using mock-roundtables to sell Unum’s “fair evaluation of claims” and dog-and-pony shows put on by claims handlers complete with presentations and overheads.

Claims handlers were forced to sign “Customer Service Guarantees and Pledges” even though the statements were impossible to deliver given the chaotic state of the claims process at the time. Wouldn’t it be awful as a employee to be asked to “Pledge” to something you knew was impossible to deliver?

In retrospect, Unum Life Insurance ceased to exist. Five geographical divisions were swiftly done away with: NYRB (First Unum); MARB (Mid-Atlantic Regional Benefits Chicago; SRB (Southern Regional Benefits-Atlanta); WRB (Western Regional Benefits – Glendale); and NERB (Northeast Regional Benefits – Portland, ME). Duncanson & Holt was eliminated, many of the employees transitioning to The Hartford in Connecticut.

Unum Enterprise and Unum America also dissolved leaving confusion about the role of these two companies in the first place. (I worked for Unum Enterprise, was paid by Unum America, and managed claims for Unum Life Insurance. Who knew?)

The new game in town was run by Harold Chandler, Ralph Mohney and Tim Arnold – who transformed Unum Life Insurance Company of America into the most egregious unfair insurance company in the world called UnumProvident.

It was somewhat comforting when in late 2001 60 Minutes and NBC Dateline blew the whistle on UnumProvident. Still, Unum’s executives didn’t go to jail, but they probably should have.

Addendum:

Anyone who doubts the validity of any part of “Corrupt by Design” may want to watch the following videos that validate my story. I personally spoke with 60 Minutes producer Dave Gelber and Lynne Dale to confirm what witnesses had already told them concerning UnumProvident. I strongly suggest that you listen carefully to the following videos.

https://www.youtube.com/watch?v=gknSNvGoX-c

https://vimeo.com/39805945

https://www.youtube.com/watch?v=9jtlPFeK0Ng

Please stay tuned for Part III

PROLOGUE

It was told to me very early on that a person’s importance as an Unum employee was indicated by the size of his/her office, and whether or not they were allowed to have a table, one or two chairs and in particular, a vase. This fact was indeed verified by me in looking at my supervisor’s office, rightfully set up for a Vice President with a round table, two chairs and a milk glass vase with nothing in it.

After several years I realized that those who were allowed to have a vase on the table rode the cusp of illegality in deliberately devising strategies to deny more claims than they paid on behalf of an American disability corporation. Amidst the background of what appeared to be diligence and propriety, Unum VPs and claims managers attended yearly week-long expensive off-sites and secretly concocted the next set of million dollar strategies to deny claims of unsuspecting disabled insureds and claimants – the most vulnerable group in our society.

At some point it must have occurred to me that what Unum was doing was wrong and probably illegal. Suddenly, one day a light bulb went off and I finally got it. Unum wasn’t about quality claims management as I had originally thought when I applied for a job in claims, but the company made its money by denying claims it targeted to deliberately deprive insureds and claimants of benefits they were entitled to. Alas! Unum’s expertise was in denying claims for profitability sake, not paying them.

From there I eventually concluded that Unum’s management, namely the table, chair and vase crowd, should probably be looking through bars of a federal prison.

Here is my story.

UNUM Enterprise and the Royal Management Aristocracy

Although there are those who would say UnumProvident deserved the fate of Enron in October 2001, it is doubtful that even the highest officials at the time had any idea of the scope of Unum’s unfair practices to deprive insureds of benefits for profit. According to Harold Chandler UnumProvident lost $50 million when whistle blowers exposed Enron’s corruption and wrong doing. Although Unum’s fate never matched that of its fellow corporation, it should have.

In 1994 as a newly hired employee of Unum Enterprise, a subsidiary of Unum America, I had opportunities to be aware of, participate in, and observe Unum Life’s highest executives complete with golden parachutes, and opportune ability to engage in insider trading of stock options at various points in time.

It is interesting to me that Unum’s attorneys never once questioned me at deposition about my role as a Compensation Specialist working in Jim’s Orr’s office acting as a go between Unum ‘s executive staff and Smith Barney transacting the trading and sale of stock options on behalf of the powers that be at Unum.

It may also be that Unum’s legal resources hoped to avoid any public disclosures of insider trading in and around the time of the merger with Paul Revere and the Provident Companies. Nothing has ever been asked or answered about the sudden disappearance of “The 1998 People Goals”, and the deliberate granting of employee stock options valued at nearly $60 per share that became worthless at $5 per share after the 1999 merger took place, possibly with the full knowledge of management.

There’s a great deal Unum has never answered for and it’s curious that no resource has ever asked me to go on record about the sales of stock options when executives got wind of a pending merger. I was the one who executed all stock option sales and finally contacted Unum’s legal department to enforce the 6 month waiting period required by the SEC for insider trading.

In 1994, Unum’s top 26 Vice Presidents, including the CEO operated at the highest levels of extravagance complete with corporate jet, nannies, free financial advisors, dog walkers,  company paid rental cars, employee lunches, and bagels, coffee and sodas at every staff meeting. Golden parachutes included company paid for life insurance policies, stock options, valet and car services and as many other company paid incentives including deferred compensation packages.

While Unum’s female executives took advantage of free babysitting and nanny services (presumably to take care of adopted infants and young children) employees also received the best health and life insurance, subsidized dinners and lunches as well as an entire list of welfare cafeteria plans including domestic partner projects.

A going away party for a member of HR consisted of $500 shrimp and lobster platters complete with party favors and french pastries. Unum Life excelled in excess and extravagance to which the Unum “royals” responded to quite favorably.

At one time Unum also hosted golf tournaments on the Pro Tour and financially supported America’s Cup trials. It was reported that Unum also employed a fleet of bicycle messengers to carry communications from one Portland facility to another. Living high on the corporate hog suited Unum Life Insurance executives who seemed to have a language all its own with “paradigms, silver threads” and “placing stakes in the ground” alongside “benchmarks” in support of corporate ideologies.

It’s clear the Unum aristocracy had it made. Not only did Unum’s top VPs enjoy free traveling on the corporate Jet, but received a host of “chute” benefits including free financial advising services to help them manage their money, benefits, severance packages, life insurances, stock options and deferred compensation.

In many respects Unum’s executives took full advantage of royalty status by causing other middle management VPs’ knees to shake. My boss, the VP of Compensation was so scared of the VP of Marketing that he made sure he took her out to lunch every month. (Probably reimbursed by the company.)

At one time it was said that Steve Center, a former Unum President actually stood all of the female employees against the wall so he could check their pantyhose for runs and heels for imperfections prior to meetings.

Although I’m sure no Unum exec could get away with inspecting for pantyhose runs today, I know as an employee in the executive offices myself I kept plenty of extra shoes and pantyhose in my desk just in case. Although I could never bring myself to wear huge imitation pearl choke necklaces, most of the female executives looked like Unum Stepford wives about to be strangled by their own accessorized images.

Unum’s Enterprise also had its share of sex scandals when a member of HR was discovered in the process of a “Monica Lewinsky” with one of Unum’s executive vice presidents in a conference room. Although an embarrassed Jim Orr reassigned both executives to Unum’s “communication center” in Columbia, SC, most employees laughed to themselves at the stupidity of such conduct. “In a conference room?” Really? Maybe this post should be made into a major movie sage since it has all the elements of intrigue, suspense and sex to make millions.

Unum Enterprise and the drones who worked there went about the business of excess provided on the backs of insureds and claimants who lost benefits to meet unattainable profitability goals. When asked what he had to say upon retiring, Jim Orr III was reported as saying, “I hope I didn’t let them down.” He was referring of course to Unum’s employees not its insureds and claimants who gave up benefits to support VPs in the manner to which they had become accustomed. And  yes, he let us down.

Stealing from insureds should be illegal

While Unum’s executives lived the luxury of wealth, claims handlers felt the stress of managers who demanded more and more claim terminations. If you can, picture a work area with a large red thermometer on the wall keeping track of denials, and a service bell alongside a large fishbowl into which lottery tickets were placed by those lucky enough to deny multiple claims, you would realize there was no “free lunch” at Unum. Each “ding” of the bell signified another denial complete with applause and upping the red target thermometer on the wall.

On the half hour Unum’s managers drew a ticket from the fishbowl and awarded picnic gear, movie tickets, lawn chairs and other prizes to claims handlers who denied claims. There was no specific regard for claimants or insureds only Cathy Liston’s retorts to her managers, “You tell them to go down there and deny more claims.” Terminating disability claims was a “lottery” in itself and many claims handlers walked away with grills, beach balls, Unum umbrellas, and expensive free dinner cards.

As a newbie claims specialist I was told that I had to deny $270,000 in claim reserves plus another $27,000 in settlements. In fact, my manager communicated to me often enough that if I couldn’t “roll in” my personal reserve goals of claim denials that I should look for another job. The game was on, and it wasn’t pretty. I wasn’t sure I wanted this job after all.

Unum’s claim procedures in the Central Benefit Administration were deliberately unfair in order to deny more and more claims. Highest reserve claims were targeted by using an archaic electronic system called EIS to sort claims by accumulated financial reserve. Managers went for the “biggest bang for the buck” and although Portland didn’t have a “hungry vultures award” it certainly gave money to claims handlers who denied the most claims calling it “shareholder value awards.”

What I objected to at the time was Unum’s patterns of practice to unfairly “trump up” or “stack the deck” against insureds to deny claims. Claims handlers were also told to call claimants from the south with 8th grade educations and offer them settlements, and or offer larger numbers of settlements around the holidays when claimants were in need of money.

“Blue memos” emerged informing claims handlers to deny claims for non-contractual reasons. Most of us shook our heads trying to figure out how to deny claims without a contractual reason for doing so. How do you explain something like this to insureds who ask why their claims were terminated?

Managers demanded that claims be 90 coded just prior to the end of a month, quarter or year-end profitability cycle so that financial gains could be over inflated just prior to profitability reporting. 90 codes allowed Unum to shut down financial reserves 90 days prior to actually terminating claims.

In essence, Unum and its managers and representatives were doing everything they could to NOT pay legitimate claims, or terminating claims with extremely low settlement offers including advance pay and close – yet another gimmick to trick insureds into taking money to resolve claims without appeal rights.

All Unum employees receive annual incentive bonuses to support Unum’s agenda to deny more claims and contribute “shareholder value” to the company. These bonuses are held over employees heads as incentive to work longer hours and pull off unattainable profit goals. It’s my understanding Unum employees today receive annual incentive bonuses if they support Unum’s agenda that contributes significantly to shareholder value.

In reality, Unum Life Insurance was engaging in business practices that were unfair and in some cases illegal. As an employee observer there was nothing fair or equitable about the manner in which Unum Life reviewed and made liability decisions. Unsuspecting insureds and claimants were “played” by skillfully trained Unum claims reps who could choose claims at random and successfully deny them for any reason. I know because I was there and I did as I was told.

In 1998 it became increasingly clear that Unum’s extravagant operations weren’t sufficient to show adequate profitability since the company was losing millions; and suddenly the good ol’ boys from Chattanooga came in and “stole the company’s cheese.” Although Harold Chandler and his henchmen provided no improvement, at least he ended the age of overabundance and extravagant golden parachutes for Unum’s executives who left voluntarily with hundreds of thousands in hand.

Elaine Rosen’s  retort of, ” we will pay the claims we have to, but not a penny more” also didn’t help and Jim Orr III retreated with $50 million in severance plus stock and other benefits. With the exception of Elaine Rosen and John Roberts, Unum’s other 24 chief executives took their severance and jumped ship, leaving Unum Life Insurance in the hands of questionable Provident henchmen supported by the Maclellan Foundation and their millions.

Many readers of today’s blog may wonder what all of the above past history has to do with Unum Group today. With the exception of extravagance, there is no indication that Unum Group made any significant changes in its claims practices even after it was found lacking via a 48-state commission of examiners, including the state of California’s settlement initiated by John Garamendi who referred to the company as an “illegal organization.”

Today, Unum’s internal claims practices hide abuse in plain sight with multi-level medical reviews and outsourced private investigation which can be misrepresented and used to deny claims. Essentially, there has been no progress; Unum may not be calling its internal processes by the same names as in 1998, but as a horse of a different color, the company continues to “stack the deck” against insureds and claimants for the sake of profitability while lead regulators, such as the Maine Department of Insurance, turn a blind eye to Unum’s patterns of practice which clearly defraud claimants out of benefits to which they are entitled.

Unum’s claim representatives often operate beyond any reasonable ethical or professional standard of “good faith and fair dealing”, and like robots perform all tasks even when it’s clear management’s demands are unreasonable and unfair. To my knowledge Unum’s Consultants are not licensed to practice in any state and are protected by Unum’s staff of attorneys who themselves are complicit in Unum’s bad faith.

Unum’s legal department is now arguing that insureds and claimants should not be able to retain qualified assistance to help them manage their claims. Without outside assistance Unum will be able to deny more claims than ever and has gained the support of the Maine Attorney General who is in bed with Unum’s agenda. One has to wonder if the Maine Attorney General isn’t also in Unum’s pocket.

Unlike Eliot Spitzer who filed criminal charges against Unum when he was Attorney General, Janet Mills and her assistants support Unum’s agenda to act as an egregious marketer of policies the company sells with no intention of paying for in the future. One has to look no further than Maine to find governmental support for a company whose executives should have been jailed a decade ago. The Maine Attorney General has been in bed with Unum for quite some time.

Learning from the past is a good clue to Unum’s future and it’s response of “we don’t do that anymore” doesn’t walk the talk. It’s definitely time to take a second and third look at a company who sells insurance products and then doesn’t fairly deliver.

When Unum’s manager makes the statement, “Like slinkys, claimants aren’t worth much, but you like to see one fall down the stairs every now and then”, one gets the picture of what Unum is all about in a hurry. Looking to the past isn’t such a bad idea after all.

Stay tuned for Part II –

http://www.newyorkpersonalinjuryattorneyblog.com/2013/07/judge-rips-doc-for-huge-lie-perjury-prosecution-possible-victims-may-number-in-thousands.html

Knowledge is PowerFrom my perspective it is often true that insureds and claimants, and in fact their physicians, are completely unaware of the importance of medical restrictions and limitations in the evaluation of disability claims.

Although most insurers continually request patient notes, physicians rarely (if ever) include R&Ls in the notes. Lacking the specific information they need, insurers then keep asking for the same information over and over again, only to deny claims by citing, “there are no restrictions and limitations to preclude you from working.”

My reviews of most claims show that despite voluminous patient notes and recommendations there generally is not one R&L among them. Without specific R&Ls to support disability the door is left open for insurers to deny claims legitimately even when it’s clear from the combination of patient records there is no work capacity.

Let’s start at the beginning.  Definitions of disability written into private policies are really double-edged swords requiring both medical impairment AND inability to perform one’s occupation, job, or any other jobs for which insureds have training, education and experience. Therefore, the burden of proof required to receive disability benefits is both medical AND occupational.

The occupational “proof” of private disability consists of “medical restrictions and limitations precluding work”. From the insurers perspective without R&Ls there is no payable disability claim.

“Restrictions” are defined as work or life activities insureds should NEVER do. “Limitations” are defined as “work or life activities insureds can do, but only to a limited extent. And, all good intentions aside, many physicians themselves are not aware of these definitions and rarely write them in patient records or on disability forms.

Without knowing the importance of medical R&Ls insureds (and their physicians) continually send in patient notes and then wonder why the insurance company “doesn’t get it.” There is no such thing as a disability claim without medically supported R&Ls addressing medical diagnoses AND why the impairment precludes patients from working.

Eventually, insurers get tired of requesting the same information and getting the same answers when the dots aren’t connected between medical disability and the inability to do one’s job.

Most insureds who have access to their medical records will say, “Well, it’s clear from my medical records that I can’t work.” Well…..no it isn’t.

In fact, insurers will “snatch” and misrepresent patient notes to their own favor when specific R&Ls are missing from the file. The work “subjective” is used by insurers over and over again to create the illusion that there really is no medical evidence per se other than what insureds tell their doctors. (It’s all in their heads!)

Insureds and their treating physicians should never present insurers with the opportunity to decide for themselves what medical records mean because of the conflict of interest on the part of insurers to deny claims and increase profitability.

Therefore, insureds should always discuss the importance of including medical R&Ls with their doctors. Again, all good intentions aside, a notation on an APS statement, “Patient is totally disabled” is NOT a medical restriction because it does not address why the “total disability” precludes the patient from working.

Insureds and claimants should always present their physicians with copies of job descriptions so that together discussions can take place about which occupational tasks and duties patients can no longer do, or have difficulty doing.

It is always a good idea for both patients and physicians to agree on:

  1. Primary and secondary diagnoses.
  2. Treatment plans
  3. Medical and occupational R&Ls
  4. Statements of whether or not the patient is at Maximum Medical Improvement (MMI).
  5. Allowable activity levels included as part of the physician’s treatment plan.
  6. Medication side effects
  7. Prognosis

Without all of the above clearly indicated in the record, private disability claims will be problematic. DCS clients are provided with assistance to ensure that R&Ls are present in the disability file and that treating physicians understand the importance of notating reasons why insureds are unable to work.

The important thing to remember is that it is not enough to just provide medical records as proof of claim for any disability claim. Medical information should always “connect the dots” between medical disability and the inability to perform one’s job. Without R&Ls insurers presume there is no medical support for disability and often deny claims.

This is probably one of the most important posts you will ever read concerning disability claims.

FearJust yesterday I spoke to an insured who, like many others in the last 13 years, described fear about his disability claim to me in detail. “I get that nervous anxious feeling in my stomach, and I haven’t been sleeping; I can’t think or do anything about the time I’m expecting my check. It’s awful.”

Many others express their fear about cause and effect, “What will Unum do to me if I……?” or, “If I turn down the settlement will The Hartford take it out on me? “Can Unum take my car if I don’t pay them back, or my property?” “I don’t want the claims handler to get angry at me…..” “What will Unum do to me if hire people to help me? ” Can Unum deny my claim if I don’t want to speak with them on the phone?” “Will Unum have me arrested and take me away?”

And on, and on and on………..

First of all, it’s important for everyone with a private disability claim to clearly understand that the relationship between themselves and insurers only exists within the policy contract. Beyond the policy contract no relationship exists and claimants have nothing to fear.

Insureds often ask me if Unum conducts surveillance even after they’ve signed settlement agreements! The answer? Of course not. These insureds obviously haven’t gotten over their “Unum paranoia” yet.

In other words, insurers can only DO what policies allow them to do. There is no such thing as “the Unum police” and in fact, no American corporation has the legal right to make you fearful, or dread the enforcement of a legal contract to the point of making you sick.

Having said this, it is presumed that insureds and claimants also do what policy contracts require including being honest and forthright with information when requested to do so.

Of course insurance companies can charge insureds with fraud for deception; that goes without saying. If you sign Unum’s new POF and then refuse to give back the overpayment Unum can take all of your assets because you gave it a voluntary lien to do so.

In order to deny any private disability claim insurers must cite directly in the denial letter what policy provision insureds no longer meet. There must be a reason why the claim has been denied and that reason must be disclosed.

For example, there is no policy provision I am aware of that requires insureds and claimants to speak with insurance reps on the phone.

In fact, please consider WHY insureds should NOT do so:

  • Any insured who is taking narcotic, opiate, or new medication with side effects should not speak on the phone with any insurance representative. Speaking on the phone requires clearness of thought, decisive and accurate answers, and the ability to communicate vocally with confidence and clarity.
  • Insureds who have not obtained copies of their policies, have not read them, or understand the provisions should never discuss claims on the phone. How can you defend what you don’t know?
  • Insureds are generally not experts in understanding or interpreting insurance rights and policy language and shouldn’t be expected to provide answers that are accurate and appropriate to defend claims.
  • “Telephone interviews” are designed to coerce insureds to provide information outside of that needed to investigate disability claims.
  • While insureds are “over speaking” their claims to convince reps their claims are credible, the same specialists are coaxing more and more information that can be used adversely to deny claims.
  • Once insureds are agreeable to phone contact, insurance reps may call everyday or several times a day. This is harassing to most disabled persons, but insurers do it anyway.

Insurers may NOT deny any disability claim because insureds request all communications in writing. What would they give as a reason in the denial letter anyway?

The important thing for insureds to remember is that policies do require the submission of updated medical and other information; as long as the insurance company is receiving what it requests whether you speak with them on the phone or not is not relevant.

Not speaking with insurance reps is just one reason why insureds are afraid, but there are many other reasons why insureds often become afraid of nearly everything in their lives because they are receiving disability benefit and have no other means of income.

Money and the ability to pay bills is very important…I get it. But fear can cause human beings to live “on the edge” for long periods of time causing them to think and act in strange ways.

Those who eventually wind up with denied claims are those who are so stressed and fearful that they will do and say almost anything with the belief that they will keep their claims if they just tell all, provide all, and protest not. Unfortunately, the claims process doesn’t work that way.

Insureds are encouraged to stand their ground, and maintain control of their disability claims. Those who manage claims themselves should keep journals and records of insurance requests contacts, doctor’s visits, mail and fax confirmations etc.Insist on all contact in writing so that you have an opportunity to think about your responses.

Don’t accept everything insurers tell you as accurate information. Give the impression that you are not helpless and are able to understand how the process works. Don’t allow your physicians to be harassed with multiple phone calls. Speak up when you think the insurance company is making a mistake, and ask for everything in writing.

Most of all, put your claim into logical perspective. Of course there is no such thing as “the Unum police”, and “no, there’s not surveillance behind every bush.” No one is going to be dragged to the who scow and we didn’t wake up in China today. (At least not yet!)

Insurance companies are just that – American corporations looking to increase their profitability at your expense. And, you can handle that.

Finally, every insured will always have apprehension and worry about not having enough money to pay bills. That part of having a disability claim will probably never go away.

But, placing insurance companies into an unreasonable scary category with unlimited powers doesn’t do anyone any good. Unreasonable fear is harmful, both emotionally and physically.

Recognize Unum, Prudential, CIGNA, Aetna, Reliance Standard, The Standard, DMS, RMS, Northwestern Mutual, Principal, Lincoln Financial, Liberty Mutual, Trustmark, Ohio National, and Guardian for what they are and rest easy.

There is no such thing as the insurance boogie man.

Field Interview photoAs most of you are already aware insurance field rep visits have become more and more like interrogations complete with personal profiling in the background. While there is no doubt that field visits may at first glance appear to be innocent interviews to obtain more information, evidence suggests that outsourcing field visits to private investigators places the activity high among the risk management resources available to insurers to deny more claims.

Requests for field visits should never be considered “routine” or “normal and customary” as insurers suggest. Although field investigators have absolutely no authority or control to make claims decisions, information obtained and fed back to claims handlers can be used to justify claim denials.

In today’s environment where “everything you say to insurers” is used against you, it’s important to understand and be prepared to remain in control of the field interview and not allow insurers to “fool you” into showing work capacity where none exists.

For example, recently I heard from two separate insureds that Unum now has a 15 page template of questions field PIs are asked to use when conducting interviews. Insureds and claimants are told the interviews will take 4 hours! The “4-hour rule”, so-called, wasn’t chosen by chance since the capacity to sit, or alternate sitting and standing for 4 hours is identifiable as part-time work capacity.

Insureds need to think for just a moment. Is there realistically any occupational, financial or medical information that should take 4 hours to relate? Interviews that go on and on for 4 hours are those asking personal, and/or family related questions for the purpose of keeping the individual engaged long enough to prove part-time work capacity.

Questions about family and other personal matters are beyond the scope of a disability contract. Although insurers may have a vested interest in finding out what your activities are definitions of disability cite “the inability to perform material and substantial duties” not walk dogs, or occasionally garden and pull weeds.

In addition, the longer the interview, the more likely it is for insureds and claimants to provide information that may or may not be accurate. It is impossible to give the same answer over and over again avoiding “inconsistency of report.”

It is important to make the distinction between what insurers need to know to pay claims versus what they need to know to deny them. Most insureds who have been interviewed may have noticed most of the questions have to do with activity or secondary activities of daily living.

“Do you mow lawns? Laundry? Cook?” “Does your family help you clean house?” These are questions the insurance company wants to know in order to “equate” your daily activities with work capacity to deny claims.

Most field interviewers ask to take photos of not only your driver’s licenses, but you. Driver’s licenses ensure that the right person is being interviewed while the photo is used to identify you for future surveillance.

Unum is also asking insureds to bring their medication bottles to the interview. This is to make sure that you have not listed a medication you really aren’t taking. In my opinion, this is pretty silly since most patient medical records always list medications and I’m certain physicians aren’t misrepresenting prescribed medications in patient medical records.

Therefore, one has to ask the question what the field interview is all about if most information is already in the record. That’s the million dollar question here literally.

Unum always has gone after the “credibility niche.” Whenever Unum can catch insureds in a lie or dishonesty it can deny claims. It’s the old, “We’re going to twist your arm until we get you to say something we can use against you” ruse that makes the company’s stockholders millions.

Bottom line, there is nothing occupational, financial or medical that is deserving of 15 pages of questioning under pressure. Forty-five minutes is reasonable and insureds have the right to leave anytime they aren’t feeling well or become fatigued and confused.

Questions should always be limited to occupational, financial or medical issues and be relevant to disability policies and the current claimed disability. That generally takes two pages, not fifteen.

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