Prior to the merger with The Provident Companies in 1999 Unum Life Insurance was accused of “paying too many claims.” I know this because I was briefed by a Chattanooga “consultant” who presented a negative presentation on the evils of “paying too many claims.” Shortly after the merger in 1999 a company wide memo was distributed from Tim Arnold, head of claims, informing all claims decision going forward would be based solely on the medical reviews conducted by internal physician consultants and staff. No longer would claims decisions be made based on medical restrictions and limitations provided by insured’s physicians.
The infamous memo from Tim Arnold also stated all claims previously reviewed and paid would be re-examined and subjected to the new “complete disregard” philosophy. Thousands of claim were re-reviewed and denied prompting a second message informing the claims department NOT to inform claimants of their ERISA appeal rights on the phone because the appeals department was over run with requests for appeal. Thousands of claims were denied unfairly only on the say-so of Unum internal physician consultants who were paid a monetary incentive to document claims for denial.
As it turned out, Tim Arnold’s decision to deliberately disregard medical patient records backfired when the Multistate Settlement RSA required the company to “reassess” approximately 250,000 disability claim decisions from 1999 and several years forward. Many claims denied from 1999-2002 were overturned and paid based on the scrutiny of federal and state regulators who forced Unum to review claims fairly.
For a period of time (2004-2008) Unum was required to maintain the appearance of fair and equitable review. Then, in 2008 the RSA ended, and with excitement and deliberate efforts to resume its prior claims procedures, Unum re-organized, changed its logo and began selling itself as a people oriented organization. Unfortunately, Unum is once again disregarding all medical information provided by the insured’s primary care physicians, a claims practice that is extremely profitable, but once again risks the scrutiny of regulators.
Recently, Unum denied a DI claim of a migraine sufferer over the objections of a qualified physician who emphatically stated the insured was not able to return to work. Although Unum’s internal physician attempted a doc-to-doc call, the insured’s physician held firmly the insured was precluded from performing any work. This is the same insured who was “fired” by his neurologist because Unum so harassed her office staff for medical records, the physician finally decided she didn’t want anything more to do with Unum. So what happened here?
Unum harassed a primary care physician (a neurologist) until she fired the patient forcing him to seek out another specialist. In the meantime, Unum also attempted a doc-to-doc call, but was unsuccessful in getting the doctor to change her mind about disability. Eliminating physicians from supporting insureds is an unfair claims practice.
Having made the insured vulnerable without a treating physician specialist, Unum’s internal physician (Dr. Cohen), documented the insured was able to work and the claim was denied. There was absolutely no weight placed on the opinions rendered by the primary care physician.
This claim situation is all too reminiscent of Unum’s prior claims abuse and the company should once again be held accountable for engaging in claims practices which are based solely on its own medical opinions. It’s pretty easy to deny claims when the only opinions considered are its own.