Archive for the ‘Bad Faith’ Category

Hungry VultureDCS, Inc. received several calls in the last two weeks from distraught claimants who received notifications of terminated Unum claims. We are indeed heading toward 1st Qtr. profitability targets and Unum, in keeping with its prior strategies for terminating claims, is once again living up to its reputation as a “Hungry Vulture”.

First Quarter profitability is always a popular time for Unum to establish the momentum for the rest of the year. Quite a few people receive terminations prior to March 31st, which coincidentally is just after Unum employees receive their annual bonuses for living up to Unum’s denial agenda.

This year appears to be particularly egregious, and for me, bad news about Unum never seems to end. Terminated employees still contact me, and former Unum physicians continue to call DCS, Inc. looking for other work opportunities once away from Unum’s cultish practices and control.

Just last week a retired Unum physician whose name I have seen in the record many times, contacted me. He was able to verify Unum’s continued bad faith practices – in his own words, “particularly in appeals.” I’m never surprised when Unum denies legitimately payable claims.

I really feel awful for all insureds who have been on claim for sometime only to be contacted suddenly about a claim termination. But, the reality is that this is how Unum Group conducts its business. Patterns of practice and strategies generally do not stray far from the management tree, and many claimants and insureds suffer losses as a result of the targeting, “snatching”, and misrepresentations of medical information.

Please be aware that Unum claims denied from now through March 31st are likely the result of target planning for 1st Quarter profitability results.




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Silly MeIn 2015 CIGNA was slapped with a Multi-State Settlement Agreement very similar to that of Unum Life Insurance. The CIGNA investigation resulted in discovery indicating the company engages in unfair claims tactics, and it was fined.

Here we are three years later, and the company is still engaging in unfair tactics to deny payable claims. Case in point is CIGNA’s denial of a Life Waiver of Premium based on its own IME wherein the examining physician said the insured was unable to work. From the IME report CIGNA alleges it was able to abstract restrictions and limitations that lead to the finding of alternative occupations, and the Life Waiver was denied.

Next step is to deny the disability claim at the change in definition. Without allowing the insured’s physician to write a rebuttal, CIGNA denied the claim most assuredly to recapture a $2M financial reserve prior to year-end. It’s mind-boggling!

I also begin to wonder about the CIGNA people, who by the way, are so paranoid they don’t include their last names to identify themselves on letters. Claims handlers know exactly what’s going on, but usually choose to hurt people in order to protect their jobs.

Because of the very large monthly benefit, this case may very well wind up in court. In my book CIGNA remains one of the “bottom feeders” in the disability world of unfair insurance companies. Disbelieving its own IME is a new low even for CIGNA.

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This post is an addendum to my October 15 post, “Unum Is Really Out Of Control.” Although this blog holds ALL private disability insurers publicly accountable for their actions, of late there seems to be no end to Unum’s unfair tactics and abuse. (Please forgive the cartoonist-like image, I couldn’t resist!)

DCS, Inc. continues to receive phone calls and inquiries from mental health claimants and insureds regarding Unum tactics that appear to be questionable. Today I received a call from a mental health insured who shared that in the beginning Unum’s rep attempted to make himself her next best friend. While he continued to express his concern about her financial well-being, he also persisted in recommending that she apply for SSDI so that “she won’t be left with nothing after 24 months when Unum terminates her claim.”

Despite hoping that she would be able to return to work in the future, Unum’s rep continued to harass her about applying for SSDI. The claimant did apply and was awarded SSDI almost immediately resulting in a considerable five-figure overpayment.

Of course, shortly thereafter Unum denied the claimant’s claim, which she subsequently won on appeal. However, Unum is now expecting to be repaid a lump sum overpayment. Had the claimant waited another 12 months before applying for SSDI, she would not have owed Unum anything after benefits stopped due to the 24 month limitation.

I’ve been told lately that Unum’s reps are divided between those who are abusive and those who, like the tooth fairy, promise benefits in return. Reps appear “nice and helpful”  on the phone only to stab claimants in the back when given the word to deny claims. Apparently Unum’s “I’m your best friend tactic” is winning since claimants feel much more comfortable to share information, particularly about their families.

It is also true that Unum is now alleging that since this claimant was able to successfully manage her appeal on her own, that she probably has work capacity. “How impaired ARE you?”, Unum is now screaming. The claims handler’s nicety has turned into contempt. Imagine that!

Several callers report being told misinformation by Unum reps in order to encourage claimants to “do what they want.” It’s an endless cycle of misrepresentation and harangue from an insurance company hell-bent on meeting its profitability targets.

Please….consider that the Unum tooth fairy isn’t going to pay your benefit by leaving it under your pillow. Communicating nicely and making you feel comfortable enough to share information is a “tactic” that should remain in children’s story books.

Insureds and claimants who buy into Unum’s “let’s be friends” conversations will end up toothless with nothing to show for it under the pillow. In my opinion, Unum is indeed out of control.

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In the past, I supported Mass Mutual as a fair reviewer. In fact, it was commonly known that “Mutual” insurers tend to offer fair claims reviews since insureds are actually owners of the company and are treated fairly when they file claims.

However, over the last several years Mass Mutual descended into the abyss of egregious claim reviewers when the company showed signs of untimely review, interpretations of policy provisions unfavorable to insureds, poor customer service, and use of third-party biased medical reviewers to support terminations.

One such case in point is an elderly executive with a history of mental illness including several incidents of attempted suicide requiring brief in-patient care. Although his history is fairly complicated, he eventually was forced to sell his companies and file for disability because of his chronic pain and inability to manage his depression and anxiety.  The policy with Mass Mutual is for Lifetime and has no limitation for mental and nervous disease. The claim is also worth approximately 2.5M in financial reserve.

Mr. X. was able to manage his life, but just. With he help of his wife, he appeared to be managing his symptoms of chronic pain without the opiates that got him in trouble. After a physician prescribed medicinal marijuana, Mr. X. was able to continue counseling and was living his life with disability benefits until he got word Mass Mutual was demanding an IME.

On the day of the IME, a neuropsychological evaluation, Mr. X. was asked to complete questionnaires in a reception waiting room. The IME physician and his staff could only be described as “smart alecks” who took pot shots at the insured and moved him around from room to room for the test taking. To make a long story short, Mr. X. had to return for another session, and the IME was documented that he could return to work.

Those who have been diagnosed with mental health issues serious enough to stop them from working are generally managing life on the edge. The complex process of living with a disability claim in combination with the inability to manage basic life situations often deprives insureds of basic life skills needed in order to be successful.

Clearly, trying to manage through an unfair claims process that includes meeting deadlines, preparing multi-page updates, and submitting to external reviews, can seriously impair one’s ability to think and act in a way that produces successful claims.

I’ve had several recent dealings with Mass Mutual involving contract interpretation that is largely an Aesop’s Fable concocted to support not paying benefits in accordance with policy provisions. I’ve also been in contact with claims handlers that seem a bit spaced and not well-trained in the area of disability claims.

While Mass Mutual used to be considered a good company, there are evidences that it has now fallen into the devil’s den of unfair claims review. In addition, Mass Mutual is not the only company to slip into the abyss. In fact, it now joins Guardian/Berkshire as notable has beens in the fair review category.

Those with Mass Mutual claims need to be particularly wary of policy citations that are not contractual, and the use of third-party reviewers, including IMEs that are really arms of an insurance industry lending denial support.

Mr. X.’s claim in particular showed at least a $2.5M hit to profitability when it was denied. The decision to deny Mr. X.’s claim at his expense was a really bad one, probably one of many resulting from the new Mass Mutual mantra of denying claims unfairly.

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One of the companies I’ve been watching for several years is The Standard – a misnamed organization that has no standards when it comes to administering Disability Claims. By my observation alone, and in conjunction with working for attorneys filing appeals, it is obvious The Standard’s “standards” are rife with unfair claims practices, untimely reviews, and non-existent ERISA appeals.

In my opinion, The Standard is eternally in violation of ERISA law. Not only does the company NOT disclose all information relied upon in making claims decisions, it alleges, “the claimant received a fair review, therefore, we don’t have to disclose anything.”

WOW. Just because The Standard alleges to have given claimants fair reviews it means they aren’t subject to ERISA laws? Now, that’s a first.

The Standard does not disclose copies of claims manuals, actual internal or outsourced medical/vocational reviews, actual communications. When requests for disclosure are received, the company  “tells” you what the medical reviews said, but won’t disclose the actual medical write-up. As an appeals expert working for attorneys I don’t accept what The Standard said was reported, I want to see the original medical review.

Forget it. The Standard continues to allege throughout the appeal in response to counsel that because the company gave the claimant a fair review, it doesn’t have to disclose internal medical, diary or vocational reports. In reality, such failures to disclose internal claim information deprives counsel and his/her insured of information needed to defend continuous payable benefits.

It’s also unclear to me whether or not The Standard affords insureds a fair appeal review at all. In my experience as a consultant, I have never witnessed The Standard over turn an unfair denial when appeals are filed. I’m sure they must overturn some, but I haven’t seen it.

The Standard is an arrogant company refusing to abide by ERISA disclosure requirements and does not, in my opinion, give claimants fair appeals reviews. Due to the fact that The Standard is one of the bottom feeder private disability insurers, violations go unnoticed and the company continues to violate the law.

If you have The Standard as your insurance company, I would make sure that the company abides by the policy contract and provides you with fair reviews. From what I’m seeing, The Standard has no standards.


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I wonder sometimes whether those who read my articles actually put my recommendations into practice. However, today I was made aware of a Unum denial letter that says, “because you were able to access, review and respond using Unum’s website, you do not have a cognitive condition.”

WOW. Unum recommends to insureds and clients that they use its website portal to communicate and then turns around and uses it against them? I have known about the tracking software for a long time, but this is a new low even for Unum.

Just so everyone understands…………Unum encourages use of its website portal and then uses it adversely to justify denying claims. DCS, Inc. clients are recommended NOT to use Unum’s portal. I am also told that once an account is created, it cannot be deleted.

The lesson here? DON’T USE UNUM’S WEBSITE PORTAL TO COMMUNICATE WITH THE COMPANY. This might be one time when those who read my blog actually listen to best advice. Unum actually cited use of the website portal as cause for denial.

In addition, I should also mention that social media such as Facebook, Twitter, LinkedIn and chat rooms should also be off-limits if you are receiving benefits. All of your social media is hacked, including the pages of your friends, and their friends, and their friends etc.

Is Facebook really worth risking your benefits?  Please do yourself a favor and do not use Unum’s website portal! If you have been using it, delete your computer cookies and history immediately. Then, insist on all communications in writing by mail.

Unum’s recommending use of the website portal, and then using it to justify claim denials is an unfair claims practice.

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Christmas GrinchThis time of year is extremely stressful for those who work in the disability claim areas of major insurance companies. Claims managers visit cubicles of employees armed with named targeted hit lists of those whose claims won’t be paid in the new year.

Already, CIGNA has emerged as the major harbinger of doom as the company continues to deny claims indiscriminately without investigation, cause or reason.

Obviously,  CIGNA’s 2013 Multi-State Settlement did nothing to improve the inefficient and negligent claims process that is earmarked by untrained, lazy and inefficient claims handlers. But, that doesn’t help claimants who are depending on benefit income for the Christmas season.

Unfortunately, MetLife, The Hartford and Mass Mutual are also pushing the boundaries of “claim target management” by requesting more IMEs, surveillance, field visits, questionnaires, and repetitive requests for patient files. If you’ve received multiple requests for the above since October, you are most likely a victim of year-end targeting schemes designed to deny claims when profits are most needed.

Reducing financial reserves and accumulating multiple profitability hits is a major objective of every disability insurer in the United States. For example, claims with over 1M in financial reserve will immediately contribute 1M to Balance Sheet profitability when they are denied.

You may have noticed I haven’t mentioned Unum Group thus far in this article and, well, in my opinion, Unum is still the Village looking for its idiot. Apparently, the company is lurching forward with Lucens requests for SSDI financial information in order to find a dollar here, and a dollar there, in overpayments it can recover.

Unfortunately, I’m still getting the impression that Unum is a company searching for its Leader who has gone off with an Atlantean alien to discover the ultimate Gnome on another planet. Outsourcing its operations to “black matter” in the universe doesn’t seem to be working all that well for Unum – at least so far.

Lately, playing “bad cop, good cop”, Unum tends to bend with the wind in its denials and doesn’t seem to have a distinct direction on anything. I’m sure Jim Orr III’s perception of his  former Unum accomplishments as CEO also agrees with mine in that Unum has gone from the “Lighthouse” to the “Outhouse” in a little more than a decade.

Still, Unum’s end of the year profitability targets continues to appear in the form of repeated questionnaires and doc-to-doc calls. Insureds and claimants should be wary of insurance doctors communicating denial agenda to treating physicians, who sometimes agree when pressured.

All in all, December is the primary “target” month for private disability  insurance leading insureds and claimants in “watchful mode” to prevent claims review abuse.

All insurance companies earn profit by NOT paying claims. And, I’s sure no one wants a claim denial delivered by their particular insurance Grinch during the coming holidays. If you need help, please give me a call.


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