It has always been very interesting to me that DCS, Inc. receives many more calls about Unum claim denials at the end of a financial reporting period than any other insurer. As we near the end of August denied Unum claimants are looking for consulting assistance with an overwhelming number of claim denials.
To date, DCS, Inc. has NOT received any phone calls from those reporting denied claims from any other insurers. It’s a sure bet Unum is up to its old tricks of targeting claims at the end of a month, quarter, or year-end in order to bolster profitability.
I can say this with some degree of certainty since I once worked for Unum, and in combination with Unum’s other patterns of practice and multiple claimant phone calls to DCS reporting unfair or egregious claim denials at the end of the month, it quickly becomes clear what Unum’s playbook really is.
Let me say first and foremost that targeting specific claims for denial at the end of a financial reporting period to bolster profitability at the expense of insureds and claimants is an unfair claims practice. It was unfair when Unum management forced me to do it, and it’s unfair today.
Common indicators of targeting claims include multiple and often harassing attempts to obtain medical paperwork beyond the 15th of the month of profit reporting whether it be the end of a month, quarter or year-end. IME and field visit requests seem to come out of the woodwork as Unum claim specialists are pushed to do whatever is necessary to obtain back-up to deny more claims.
Arbitrary and unreasonable deadlines for submission of additional information are communicated as Unum staff prepares to carry out its “primary plan directions” or ERDs (Expected Recovery Dates) by certain dates corresponding with profitability reporting.
Management often schedules Saturday “focus” days to locate vulnerable claims that can be denied easily while claims handlers are forced to “present” claims at roundtables in order to obtain “activity” ideas intended to gather file documentation in a hurry. There’s the “Rule of Threes” meaning that claims handlers are sent on hunts to obtain buy-in from three sources that claimants can return to work.
Although Unum no longer hangs thermometers on the wall, or plays the lottery to encourage handlers to deny more claims, it is our understanding from former Unum employees that internal protocols to bolster profits hasn’t changed all that much. These same former employees told us that Unum still has target “sheets” handled to them by managers looking for the “biggest bang for the buck.”
When asked, Unum claims handlers are trained to say, “But we don’t do that anymore.” However, if any state regulator were to engage Unum in a conduct market examination and request random selections of claims denied comparing actual dates of denials, it would be my opinion that the results would indicate a significant increase in claim denials nearing specific periods of financial reporting.
Again, I don’t hear really awful and unfair denial case histories from claimants with The Hartford, Aetna, CIGNA, Reliance Standard, Northwestern Mutual, Principal, Mass Mutual, Dearborn, Ohio National, or any other insurer coinciding with end of the month profitability reporting. DCS,Inc., however, has at least a 50% increase in calls from Unum claimants as we near the end of the month. Since Unum calls increase consistently toward the end of any Unum’s profitability reporting period, it doesn’t appear to be coincidence.
Inherent in all this is the realization that Unum Group hasn’t changed its patterns of practices subsequent to the multi-state settlement, and in fact appears to be worse in its conduct of business. Also clear, is that Unum earns its poor public reputation honestly in that it continues to engage in practices that are hurtful to the majority of its insureds and claimants.
DCS, Inc. does not expect any disability insurer to automatically “approve” all claims submitted to it. However, all insureds and claimants have a right to expect insurers to afford them fair, objective and equitable claim reviews. ERISA folks have the right to expect insurers review their claims as a fiduciary, deciding indeterminable issues in their favor.
Targeting for profitability remains an unfair claims practice resulting in increased denials to bolster financial reporting at the expense of insureds and claimants. While Unum stockholders may realize an additional 5 cents in dividend per share, Unum insureds and claimants are thrown under the bus for the sake of a mere nickel.
