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Bad dudes

For the last several years, Unum Group has been engaging in unfair claims practices with its over-restrictive new staff of claims representatives who feel they are qualified enough to make judgmental comments about work capacity.

One caller reported that a Unum claims rep actually said, “I don’t think there’s anything wrong with you, and you can work. Why aren’t you working?”

The truth is, claims handlers are not specialized medical/occupational reviewers and have no authority to determine whether someone is capable of working. In addition, no insurance representative has the right to make judgmental comments they know are upsetting to insureds. What is worse, is that there is every indication that Unum is targeting mental health claims with their disrespectful comments.

Another report to DCS, Inc. described claims handlers who continuously phone insureds they know have mental health claims. One gentleman told DCS, Inc. that he had a panic attack so severe he phoned his doctors afterward and had to go to the emergency room. Unum asked him to submit to a field visit. He is now so nervous that another panic attack is imminent.

Grossly inaccurate information is also being “suggested” to insureds by Unum reps. In order to persuade claimants to sign SSDI Authorizations, reps are “suggesting” that Unum has a “connection” with SSA and that they frequently communicate.

A very nervous Unum claimant wanted to know if Unum reports its denials to SSDI. Apparently, Unum’s agenda to convince claimants it has an “inside connection” to SSA is working in upsetting claimants who assume they will lose their SSDI benefits if Unum denies claims. (SSDI and private disability insurance are two different things. Unum can’t influence a federal entitlement you and your employer paid for.)

As if this isn’t enough, Unum’s reps are also telling claimants they must submit all patient notes and that the company is no longer requesting them. While it is true Unum’s ERISA Plans say that “proof of claim” must be submitted by claimants within 45 days of its being requested, Unum is still required to “fully investigate claims”. Frankly, it looks as though Unum isn’t doing anything to assist claimants of late since nearly all of its claims process has been outsourced to multiple third parties.

Finally, another caller told me Unum’s rep said he HAD to speak with Unum on the phone – another untruth. It is absolutely imperative that no Unum claimant or insured speak directly to any Unum claims handler on the phone. I was informed only this week that Unum management is placing a great deal of pressure on claim reps to make direct phone calls to insureds and claimants. This is why many Unum insureds report increased phone calls supposedly to obtain “updates.”

I defer to the many articles on this blog where I explain this is not such a good idea. Bottom line, no disabled person should place themselves in a position where they can be disrespected and bullied. Unum’s reps can’t be disrespectful to you in a letter sent in the  mail. Also, no one should be using Unum’s website portal since claims handlers use your visits as a reason to deny claims alleging its use shows functional capacity.

In my opinion Unum is out of control and should be examined by the Maine Insurance Department – again. The company has shown it is now engaging in deliberate “patterns of practice” designed to deprive insureds of legitimate benefits due to them.

Unum should be reported to the U.S. Department of Labor and state insurance authorities on every occasion. These situations are not indicative of a fair, reputable insurance company that investigates claims to pay rather than deny.

 

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Please read below the account of one insured’s experience with Student Loan forgiveness for total disability. It seems to me the “deal” isn’t what it’s cracked up to be.

Submitted by a blog reader and supporter. Thank you.

“I just have to vent about how disturbing the whole student loan disability process and how unorganized and  untimely it really is.

Forgiveness of student loans by reason of total permanent disability is handled by a company called Nelnet. They claim they are the exclusive provider of this service for the US Department of Education. When your loan is forgiven, you have to make less than the US poverty level for 3 years, otherwise your student loan is reinstated.

Three years ago when my loan was forgiven eveything went fine. But then, as you warn on your website, I claimed too much income (wife’s job) and my loan was reinstated. 

I do not believe Nelnet has any access to tax records. They just ask you to sign a statement that you didn’t work, or if you did, how much. I regret so much we answered that truthfully.

If you make too much, then you have to pay the loan again, and Nelnet gets the money. See the conflict of interest? Nelnet gets the money if your loan is reinstated, and they are also the one to decide if you are too disabled to work. They don’t do medical reviews, just doctor signature on the form or SSDI with a 5 or 7 year medical review (we are 3 year). So their only weapon is a delay.

It took them a few months, but many months ago, they claimed to be starting the reinstatement of the loan, with them as the collectors. I completed a new disability forgiveness paperwork and had the doctor sign it. Submitted it quickly. On the new applications, they have a 4 month timeline, but on these reinstated applications, they make clear on the phone they have no requirement for when they will review them. They will hold off requiring payment on the loan for 4 months, but after that, they want payment.

It’s been more than that. They STILL haven’t processed the disability application. They claim their Information Technology Department is still working on it. But the loan servicing part says a payment is due just a few weeks from now. I tried calling and asking for a forbearance for reason of disability. She granted a one month reprieve on the loan payment, with longer available after they review documentation. Nelnet insisted they needed the original SSDI approval, not a current statement (printable of the SSA website). The next day, they rejected it as too old. More significantly, the loan payment date changed, from in a few weeks to now PAST DUE of $50 with another payment due in a few weeks.

It makes me so mad that they can take forever to process this disability application claiming their Information Technology Department is working on it, but require payments from the loan which clearly the Information Technology department already worked on. And then make due dates earlier and claim something is past due days after saying it was due in a few weeks.”

(I think in cases like this I would give my Congressional Senator a call for assistance. Technically, these untimely decisions could result in Nelnet compensating you for interest on all of the payments you’ve made since requalifying for loan forgiveness. Give your Senator a good swift kick in the butt to do some work for a change and help you resolve this mess!)

 

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Despite the insurance industry’s push to deny more claims for 1st Qtr. profitability DCS, Inc. is having a record year of client successes particularly for IMEs, any occupation investigations, and initial claim approvals.

Greater than 98% of DCS, Inc.’s clients are keeping their private disability benefits with far less harassment and risk management. There is clear evidence that having an experienced claims expert assisting increases the probability of future benefits.

Although there are never any guarantees of success, taking the necessary measures to understand the process, and understanding how to defend one’s Plan or policy is essential to successful outcomes.

Lindanee’s Blog now has 1,832 posts in 143 categories. At the end of 2017 the Blog went over 1M Reads, currently at 1,050,142. I am looking forward to fantastic overall results for future clients into 2019!

 

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As most of you should know the proposed ERISA changes intended to go into effect on January 1st were extended to April 1, 2018. The extension was caused by the insurance industry’s opposition to changes that would “cost them more money”, or “cause the elimination of disability insurance offerings.”

Of course we can all assume that the real reason for the opposition is that the proposed ERISA changes provide an even playing field for claimants and make it more difficult for insurers such as Unum, (a company opposing changes) to deny appeals.

Lately, DCS Inc. has been receiving calls from claimants telling me that attorneys, who formerly refused to accept their cases, are calling them marketing their services under the proposed new regulations. I also heard from several sources that some attorneys are putting forth the changes when they aren’t even effective yet.

Wait a minute Esq.’s! The ERISA changes won’t be effective until April 1, 2018, if in fact they are approved. Try as I might to find ways to be kind to attorneys on the blog, I think over booking the ERISA changes prematurely, or marketing future services based on the proposed changes sounds a bit like a squeaky wheel to  me.

In any event, please see the proposed changes listed below. If these changes do go through the Department of Labor claimants may finally get an even playing field in the ERISA claims review process.

Disclosure Requirements.Benefit denial notices must contain a more complete discussion of why the plan denied a claim and the standards it used in making the decision. For example, notices must include a discussion of the basis for disagreeing with a disability determination made by the Social Security Administration (“SSA”) if presented by the claimant in support of his or her claim. (Actually, Unum already does this and has a scheme in place to “not consider” SSDI decisions.)

Claim File and Internal Protocols. Benefit denial notices must include a statement that the claimant is entitled to receive, upon request, the entire claim file and other relevant documents. Currently, this statement is required only in notices denying benefits on appeal. Benefit denial notices also must include the internal rules, guidelines, protocols, standards, or other similar criteria of the plan that were used in denying a claim, or a statement that none were used. (Internal claims manuals etc. would need to be provided.) Currently, denial notices are not required to include these internal rules, guidelines, protocols, or standards; instead denial notices may include a statement that such rules, guidelines, protocols, or standards were used in denying the claim and that a copy will be provided to the claimant upon request. (Insurers may decide to republish their benefit claims manuals to remove process disclosure. Some companies such as Lincoln Financial and Liberty Mutual will have a problem with giving up this information.)

Review and Respond to New Information. Plans may not deny benefits on appeal based on new or additional evidence or rationales that were not included when the benefit was denied at the claims stage, unless the claimant is given notice and a fair opportunity to respond. (This suggests that appeal denial decisions must be based on whether or not the original denial was the right decision to make. Many insurers engage in ad hoc investigations to obtain new evidence to deny claims.)

Conflicts of InterestPlans must ensure that disability benefit claims and appeals are adjudicated in a manner designed to ensure the independence and impartiality of the persons involved in making the decision. For example, a claims adjudicator or medical or vocational expert could not be hired, promoted, terminated, or compensated based on the likelihood of the person denying benefit claims.

Deemed Exhaustion. If a plan does not adhere to all claims processing rules, the claimant is deemed to have exhausted the administrative remedies available under the plan, unless the violation was the result of a minor error and other conditions are met. If the claimant is deemed to have exhausted the administrative remedies available under the plan, the claim or appeal is deemed denied on review without the exercise of discretion by a fiduciary and the claimant may immediately pursue his or her claim in court. A plan also must treat a claim as re-filed on appeal upon the plan’s receipt of a court’s decision rejecting the claimant’s request for review.

Coverage Rescissions. Rescissions of coverage, including retroactive terminations due to alleged misrepresentation of fact (e.g., errors in the application for coverage) must be treated as adverse benefit determinations, thereby triggering the plan’s appeals procedures. Rescissions for non-payment of premiums are not covered by this provision.

Communication Requirements in Non-English LanguagesBenefit denial notices have to be provided in a non-English language in certain situations, using essentially the standard applicable to group health benefit notices under the Affordable Care Act (“ACA”). Specifically, if a disability claimant’s address is in a county where 10 percent or more of the population is literate only in the same non-English language, benefit denial notices must include a prominent statement in the relevant non-English language about the availability of language services. In such cases, plans also would be required to provide oral language services in the relevant non-English language and provide written notices in the non-English language upon request.

Claimants should be aware that these proposed changes, if approved, won’t be effective until April 1, 2018. In my opinion it is unethical for attorneys to be marketing their services based on changes that are not yet approved or in force. If you receive any cold calls from attorneys on this matter, tell them to take a hike, at least until April 1st.

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Thanks to an insured who sent me this very important link. If it acts like a duck, quacks like a duck, it’s probably fraud.

https://theintercept.com/2018/01/11/aflac-fraud-lawsuit-sales-associates/

 

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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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Several times this month I’ve received phone calls asking me to recommend insurers for both Group STD/LTD and Individual Disability. While the disability insurance industry is corrupt as a whole there are insurers who engage less in bad faith than others.

Here is my top 20 ranking for 2017 beginning with the worst insurers.

 

 

  1. Unum Group
  2. Prudential
  3. CIGNA
  4. Met Life
  5. Aetna
  6. The Hartford
  7. Mass Mutual
  8. Sedgwick/The Reed Group
  9. Guardian/Berkshire
  10. Disability Management Services, Inc.
  11. RMS
  12. Ohio National
  13. Mutual of Omaha
  14. Lincoln Financial
  15. Liberty Mutual
  16. The Standard
  17. Standard Reliance
  18. Aflac
  19. Principal
  20. Northwestern Mutual

While there are no real “better” group STD/LTD insurers, the Individual Disability market shows both Principal and Northwestern Mutual to be fair reviewers of individual disability claims. Congratulations to NWM and Principal for continuing to perform objective claim reviews in 2017!

In my opinion, the “Top 10” listed are not fair disability claim reviewers and should not be considered to be fair in any aspect of claim investigation.

 

 

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