According to information received by DCS, Inc. regarding several insureds, Unum is scheduling quite a few Independent Medical Evaluations in an effort to discredit legitimate claims. Insureds asked to submit to the IME contractual obligation have been diagnosed with impairments Unum frequently targets such as FMS, CFS, psoriasis arthritis, Lupus, MS, HIV and cognitive disorders.
IMEs victimize insureds because although policies require them to submit to the evaluations, the same policies do not require insurers to give a reason as to why they request the examination. In fact, if you ask Unum to provide a reason why it requested the IME, you will be told Unum is exercising its right to have you examined. That’s not a reason, but it’s the only one insureds are going to get.
Internally, insureds are forced to submit to IMEs because one or more of Unum’s “board certified” internal physicians reviewed claim medical information and produced documents disagreeing with information treating physicians provided. No one should be surprised here; nearly all American insurers refer claims to insurance-paid physicians who are well acquainted with the drill of producing documents used to support insurance denials.
Once Unum physicians have completed their negative internal reviews, Unum’s claims reps send out communications informing insureds the company “does not understand your medical restrictions and limitations. In order to better understand……..request an Independent Medical Evaluation”, yeah, yeah, yeah….. At least the company could have told you the truth up front, but alas, Unum doesn’t do that.
To begin, IMEs are NOT “independent” in the sense of unbiased, or fair and equitable. The word “independent” connotes an examination by physicians insureds have not consulted before. The purpose of insurance IMEs is to have insureds examined by physicians who are in the pocket of the insurance industry for the purpose of agreeing with all internally provided medical reviews supporting non-payment of claims. Insureds and claimants would do well to remember this one thing when attending IMEs with physicians paid by Unum.
Insurance IMEs are mandatory since nearly all disability policies require the submission to examinations when requested. If this isn’t “stacking the deck” against insureds and claimants I don’t know what is. Unum employs an entire hierarchy of medical staff who review claim files, none of which disagree with reviews lower on the review ladder. The claim file is stacked with adverse reviews followed by the grande finale IME report which creates the illusion that Unum made or will make the only correct decision to deny benefits.
If Unum pays good money to collect adverse documentation what consideration is actually given to patient notes and medical restrictions and limitations from treating physicians precluding work? None, I’m afraid. Unum continues to embrace Tim Arnold’s (UnumProvident) methodology of basing liability decisions only on medical reports and documents from Unum’s own medical staff. This is why insureds frequently ask, “My doctor has always supported my disability. How can Unum deny my claim?” The simple answer is, Unum completely ignores any and all information provided by treating physicians – an unfair claims practice the company was cited and fined for in the 2004 multi-state settlement agreement.
Unum’s stacking of the deck against insureds and claimants consists of 5 actions taken to deliberately work against insureds: 1) internally generated negative medical reviews rejecting treating physicians and their assessment of impairment and disease; 2) employment of a medical hierarchy beginning with RNs, OSPs (on the floor docs), and Medical Directors who render adverse medical reports to pad claim files; 3) surveillance to confirm and support internal medical reviews, interpreted to be consistent with conclusions insureds can work; 4) field representative visits to obtain information indicative of “inconsistency of report” which discredits information in the file provided by insureds at various points in the claim history and 5) doc-to-doc calls to persuade and intimidate treating physicians to agree with Unum’s point of view that insureds can work.
Anyone who still thinks the disability claim review process is fair…well, I have some swamp land in Scarborough, ME I’d like to sell you. If information from your treating physicians is ignored, how fair can the process be?
Last week I had a call from an individual who wanted to become a DCS, Inc. client because she was forced to submit to a Unum orthopedic IME with a physician who was rude, condescending, and kept her in his office for ten minutes. As she was beginning to leave the office the IME physician said, “The insurance company is trying to take away your benefits you know.” You think?
Although Unum isn’t the only American insurer to require IMEs, it is much more sophisticated in terms of targeting, strategy, and creating illusions of propriety and fairness. Unum pays a great deal of money to its internal physician reviewers because the company buys their “board certified” credentials and demands value for the bucks spent. Unum’s internal medical staff “can’t do” regular patient care on their own, but instead choose to capitalize on the multimillion dollar corporate industry of supporting the insurance agenda to deny legitimate claims. Medical ethics parked at Unum’s door in the morning won’t put food on middle class tables.
DCS, Inc. clients continue to receive benefits approximately 85% of the time after IMEs. Still, the process of submitting to an IME when the potential outcome is predicted to be adverse to insureds isn’t easy to manage.
There are still insureds and claimants out there who mistakenly believe Unum’s motive in requesting IMEs is to “better understand restrictions and limitations”, or “clarify medical information” because that’s how Unum’s letters position the request to attend. IMEs aren’t a good thing, and like all Unum requests IMEs need to be managed by knowledgeable people, not naive claimants.
The IME process does not need to result in claim denials, but Unum’s intent to deny claims is very clear as evidenced by their internal strategies of review.