As you may already be aware Unum Group is required by the Multistate Settlement Agreement to consider SSDI decisions when making their own liability determinations. In order to make it look as though Unum is in compliance, the company has been requesting signed SSA authorizations in order to obtain copies of SSDI files. Now I know why.
If the SSDI documents are in the claimant’s file at Unum, then it appears as though Unum gave it some credence or weight in the process. This does not mean Unum actually reviews or even changes its determinations based on SSDI decisions. In fact, I’ve read Unum letters informing claimants it “considered the SSDI decision” but that the company disagrees with it.
The exercise in obtaining a copy of the SSDI file is only to cover Unum’s behind with regulators.
BUT…..Unum apparently has a new protocol. Based on the newest denial letter from Unum, the company states (and this is a direct quote): “the fact that we obtained IMEs to assess your restrictions and limitations (and any resulting disability) which were performed after your SSDI benefits were awarded provides compelling evidence that is more current and relevant in making a disability determination based on your present level of restrictions and limitations.”
In other words, although Unum obtains the SSDI file to create the illusion of compliance with regulators, Unum also demands IMEs AFTER SSDI WAS AWARDED, and then states the IME report is more current and relevant. This gives the company license to completely ignore SSDI decisions justifying the IME reports as more current and relevant than any SSDI decision.
Unum Group is indeed the master of deception. By obtaining SSDI files and placing them in the record it appears to regulators Unum is in compliance with the Regulatory Settlement Agreement. This is a grave inaccuracy since Unum will then demand IMEs after the SSDI decision was made and claim the report is more current and credible than the decision made by SSA.
Ok, let’s get this straight. Unum forces everyone to apply for SSDI. SSA’s definition of disability is that claimants must be totally and permanently disabled from doing any job in the national economy for the next 12 months or have an impairment that will result in death.
Claimants are forced to use GENEX under threat of reducing monthly benefits. When claimants are awarded, Unum demands to be repaid the overpayment in a lump sum. Once the money is given back Unum requests a copy of the SSDI file and then demands a set of mandatory IMEs. Unum’s next step is to deny claims and allege its decision is more current and relevant than that made by SSDI. Are you kidding me?
Why request the file at all? Because it gives the illusion to regulators Unum is in compliance with the RSA and considered SSDI decisions when the company really did not. These practices are deceptive and need to be stopped. I’m sure someone at Unum figured out the cost of an IME is a small price to pay if more claims can be denied ignoring decisions made for SSDI.
Unum’s internal claims practices are so egregious, deceptive and unfair its unthinkable. The fact that Unum is allowed to continue denying claims without accountability is unconscionable and is a damning testament to Unum’s ability to review claims with “good faith and fair dealing” at all.
It’s horrible, and something needs to be done about it.
Please note there is no contractual provision requiring any insured or claimant to “give up” a copy of their SSDI file. The multistate requires Unum to “consider the SSDI decision”, but doesn’t require you, the insured to give up a copy of the file. Claimants might want to consider carefully whether they should give Unum a copy of the file just so the company can create the illusion of credibility with regulators.
Despite Unum’s claims it considers SSDI decisions, it’s doubtful the company has any intention of doing so, and actually has internal protocols getting around it.