In 2010 Unum embraced the idea that insureds receiving disability benefit checks should not be engaged in any observable activity outside of the home. In other words Unum presumes “disability” means insureds should be entirely housebound, socially withdrawn and unobservable for maximum duration of claim. Should the insured dare to venture outside the home for groceries, medical attention, or just a few hours with friends, he/she risks being caught in the activity resulting in a misinterpretation and a potential claim denial.
DCS is able to report these findings after reviewing no less than 150 Unum files in 2010 so far containing surveillance reports some of which were used to deny claims because the insured was observed outside the home engaged in errands, visited a second home in another location, was sitting in a car with a woman and was presumed dating, went to a family reunion, had lunch with a friend at the Mall, and attended Church on a regular basis.
The notion that disabled persons must exhibit no activity at all in order to be eligible for disability payments is beyond reasonable belief. Such claim denial attacks on insureds because of varying degrees of activity are also NOT medically sound. In addition, the fact that a major disability insurer such as Unum allows documentation of such nonsense placed in a claim file is also incredible. Sounds to me the company may be desperate.
I think it’s worth mentioning that although other disability insurers use surveillance to “catch” their insureds engaged in conflicting activity, only The Hartford and Unum abuse the activity by interpreting surveillance to their own advantage.
Most of the remaining insurers do not indiscriminately use surveillance activity on ALL or a majority of claims obviously because surveillance is an expensive referral. Apparently, only The Hartford and Unum can afford to use surveillance in the majority of claims and certainly wouldn’t continue to do it if it weren’t profitable.
Only in extreme medical emergency or terminal claims do physicans restrict physical or social activity. In fact, just the opposite. Treatment plans communicated to patients always include recommendations from physicians to continue normal physical activity as able and to remain actively involved in family gatherings and with friends.
This is particularly true in mental health claims, but Unum’s surveillance reports on insureds diagnosed with depression and related mental illness appear to indicate it expects people to not engage in any physical or social activity at all without the risk of a claim denial.
Here’s how ridiculous Unum can get. For example, an ERISA claim was denied because the insured, diagnosed with migraine headaches, failed to put on his sunglasses after he left the field interview. In another case of migraine headache, Unum reported to a primary care physican the insured had been “surveilled four times outside of his home.” In this case Unum claimed surely the insured should have had a migraine at least one day out of the 4 days surveilled.
Interestingly, there is a wealth of medical journal information recognizing the value and health benefits of regular exercise and social interaction during periods of medical disability. Another example is a Unum surveillance of a diabetic patient alleging “the claimant walked extensively.” For diabetic patients, “walking” is not just a medical recommendation, it is a prescription.
There is an appropriate use for surveillance. Surveillance should be interpreted and judged credible by the insurance company when observed physical activity exceeds medical restrictions and limitations given by the insured’s physicians or clearly indicates “inconsistency of report”.
Bottom line, physical and social activity is medically recommended for disability insureds. However, it’s companies like Unum and The Hartford who abuse the process of claim investigation by interpreting any activity at all as evidence of “full-time work capacity.”
Clearly in 2010 Unum’s management pushed the “surveillance button” to support claim denials and continues to get more and more egregious and inaccurate in its interpretation. DCS strongly suggests following our insured surveillance guidelines.