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Archive for the ‘Breaking News’ Category

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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You're Fired2

Unum Firings – No Job Security

Unum insiders continue to report the company is still terminating employees, mostly women over 50. Unum is well-known for its terminations of mature women spanning a decade or more. The company’s mantra is to target females over 50 by padding personnel files with issues alleging “poor performance.”

Unum isn’t the company for females looking for job security. Current employees continue to report lack of upward mobility for most claims personnel. In addition, Unum does not approve employee FMLA and STD claims even for its own. Instead, employees who go out on medical leave are quickly disposed of through the auspices of “poor performance.”

Unum is NOT a good place to work since claims handlers are repeatedly forced to watch their backs in addition to performing jobs that are extremely stressful. My impression when I actually worked for the company was that those who picked the toenails of managers were promoted and pushed ahead even though most were one taco short of a combination plate! Hence, Unum’s frequent lack of knowledgable leadership.

Unum’s continued fast forward to outsource most work leaves little expectation of job security for those who remain employed, at least for the time being.

PA1959Pennies From Piggy Banks

Unum insiders are also reporting the company’s “hunt and peck” for SSDI monies owed may be including COLA specifically excluded as an offset in all ERISA Plans. It’s unclear how complicit Lucens is in the scheme to find “a dollar here, a dollar there” overpayments.

Claimants should always request Unum “to prove it” [overpayments] before agreeing to pay back any money. Requesting SSDI 1099s does not separate gross benefit from COLA; therefore, it’s a mystery why Unum even requests the 1099s.

Still, there is usually no logic to Unum’s schemes other than to bolster profitability. Unum should always be asked to “put up, or shut up” when it comes to allegations of owing money. The Financial Department’s efforts to hunt down pennies out of SSDI award piggy banks is an indication of how badly the company may need the money.

“It’s All In Your Head”

All in your headThere are also recent reports that Unum Group fully intends to use the “self-reported” language in its Plans and policies to deny claims particularly for fibromyalgia, chronic fatigue and possibly memory and cognitive issues, Lyme disease, depression, and any other impairment it can throw under the bus.

Anytime a disability insurance company reviews claims with an objective of denial rather and approval, it can be reasonably said the company is engaging in unfair claims practices. To seek out legal support in various states that will support such tactics is a deliberate effort to target certain impairments and classify them as “self-supported.”

Fibromyalgia and chronic  fatigue have always been challenged (particularly in the UK) as “fake” or “somaticized” impairments. The new DSM 5 suggests that anyone who is worried or preoccupied with anything that’s wrong with them is also crazy. Clearly, one has to question the classification of somatic illness when it’s defined as worry, preoccupation and overindulgence with symptoms imagined or real.

Seems to me the current DSM 5 definition of somatic syndrome leaves the door open to classifying nearly everyone as mentally ill. Needless to say, it looks as though Unum is back to its nasty tricks of alleging physical disease is “all in one’s head” in order to avoid payment.

corporate theft SSDI Hold Ups For Repayment

Unum’s Financial Services Department does not get a gold star when in comes to chasing down SSDI overpayments from claimants. Representatives are pushy and demand repayments via threatening letters and demands for repayment.

This particular issue was brought to my attention when demands for repayment of SSDI money not received crossed the line of fair review. First was a situation wherein Unum’s reps attempted to use, “Well, SSA usually makes a decision in 4-6 weeks and your application is over 3 months old….we’re going to offset your benefit with an estimate” as a threat.

Second, Unum demands repayment under threat of offset even when the claimant hasn’t yet received any money from SSA. Claimants cannot pay what they do not yet have, simple as that. Yet, claimants are often penalized with offsets prior to receiving any actual money to pay back.

Is Unum really that hard up for money? The company’s new tactics and objectives are about as far away from good faith and fair dealing as they can get.

 

 

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DCS has been getting many inquiries concerning the letters Lucens is sending out asking claimants to sign Authorizations to obtain SSDI financial information. These requests are making some claimants very anxious. Therefore, I want to be very clear about what claimants’ rights are under the provisions of their Plans and policies.

To my knowledge no where in any of Unum’s ERISA Plans does it require claimant’s to release SSDI information. This includes any part of the SSDI file whether it is medical or financial. Claimant’s may choose to keep their SSDI file private and choose not to release any part of it.

Recently, Unum has joined forces with a company called Lucens to obtain financial SSDI information presumably for the purpose of recalculating offsets to identify large overpayments that are owed back to the company. Periodically, Unum begins these “financial recalculations” as a company wide initiative to reduce benefits to $0 to recover alleged overpayments that do not exist.

I am assuming that while Lucens is requesting SSDI files from the ERISA folks, IDI handlers are requesting extensive previously tax returns from those insureds who worked residually. Insureds who have been residually employed are at risk most, since a nefarious re-calculation of PMI (Prior Monthly Income) by Unum (or Lucens) could allege 6-figure overpayments.

But, to be clear, neither claimants nor insureds are required to sign Authorizations releasing any information to Lucens or Unum. Individuals can respond to the Lucens letters by faxing a response informing them you do not wish to sign the Authorization or release any information.

Having said this, Unum IS entitled to have a copy of the original SSDI approval letter that is quite informational and contains all of the information Unum needs to calculate overpayments, attorney’s fees, and initial benefit amounts. Unum’s ERISA Plans do not offset COLA amounts.

End of the year 1099’s from SSA do not break out COLA amounts paid from total payments, therefore I’m wondering  for what purpose Lucens wants to see SSA 1099’s. They would be better off referring to initial approval letters that have the needed information.

I suspect Unum is also concerned about SSDI increases due to additional earnings, or worker’s compensation adjustments. Calculations of benefits paid (using new methods) can produce any result. Years later, Unum calculates again and still finds additional overpayment. It’s a never-ending process to avoid paying benefits due.

Generally accepted accounting principles include a “Continuity” requirement that ensures consistency in calculation and methodology in the financial records. For Unum to recalculate benefits and offsets every few years for the same claimants and insureds is a violation of “Continuity and Consistency” in financial reporting.

Asking yourself why Unum is engaging in this focus initiative? To find money….to bolster its profitability, reduce monthly benefit payments to $0 and improve its cash flow. The money trail is always a good indication of why Unum engages in any new focus project.

 

 

 

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Readers may recall in a previous post that Unum deliberately deducted an estimate from a client’s benefits for estimated SSDI. After two months of taking the estimate, Unum at first refused to stop the deduction and pay back what it took out-of-contract.

After several letters from my client requesting reimbursement and interest, Unum agreed to repay her for the estimates taken in error and actually paid interest on the amount over 30 days.

Make no mistake, Unum didn’t send the reimbursement without a fight, but in the end Unum agreed the estimate was taken in error. My client was properly advised by DCS as to her rights and provisions under her employer’s Plan, and she brought the proper arguments to Unum’s attention along with a copy of a complaint made to the State DOI.

After written notification, my client sent me the following email: “Unum deposited over $5,000 today in to my checking account! As usual, your advice concerning my policy paid off. Thank you, Linda, for properly advising me!”

While my opinion of Unum’s tactics isn’t changed, in the interest of fairness it’s only fitting that I recognize the claims specialist from Unum’s financial department who made good on the error.

At least for now, it seems as though even the bad guys can make things right!

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Unum’s New Business

Unum must have a new strategy: “If your disability business is failing just start something new.” This didn’t work out well for Unum’s Long-Term Care insurance did it?

http://unum.newshq.businesswire.com/press-release/productsservices-news/unum-launches-stop-loss-coverage-self-insured-companies

 

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Unfair Medical Reviews Continue

Recent narrative letters from Unum’s physicians to treating docs seem to indicate Unum is still using Dr Alex Ursprung to review medical records and write reports favoring denial. I had previously thought the egregious “Dr. U” had retired, but apparently he hasn’t.

Dr. Ursprung is a well-known Unum “claims killer” psychologist who has a longstanding history of providing documentation that can be used to deny claims. I’ve seen his name on many internal review reports I’ve read over the years including when I was actually employed by the company. Typically his reports are overwhelmingly unfavorable to insureds.

Some time ago it was Dr. Ursprung who recommended that an opiate addicted anesthesiologist return to the surgical arena where exposure to drugs is readily available. Although Dr. U’s report placed not only the anesthesiologist’s patients at risk, but also the insured, Unum denied the claim alleging an addicted physician could return to work based on Ursprung’s report.

Unum’s medical reviews are not intended to be accurate assessments of functional capacity or measurements of disability, but rather deliberate misrepresentations that are prejudicial toward Unum’s business and profitability agenda.

There is now an overwhelming amount of public information available on the Internet and from other resources indicating that Unum’s internal medical reviews are biased, and literally bought and paid for by the insurance industry.

Let’s not forget that Unum’s physicians are paid yearly bonuses for supporting the company’s agenda to increase “shareholder value”, or profit.

I can’t say that I’m pleased to see Dr. Ursprung’s name on narratives to treating physicians. In my opinion, Dr. U. is nothing more than an old Unum hack from way back still assisting Unum to deny claims unfairly. Not good news for insureds.

Unum Suspends Benefits After Receiving A Request To Reschedule An IME

Unum’s recent trend toward “suspending” benefits continues simply because several of the company’s claims handlers feel mean enough to do it.

Remember the slinky comment one Unum manager wrote about on his Facebook Page?

“Insureds are like slinkies – they aren’t worth very much, but you like to see one fall down the stairs every now and then!”

Unum’s policies do not require insureds to “show up” for an IME whenever it says they have to show up. After all it is insureds who are ill, and in the past they were given considerable lead way to determine when they can make arrangements to attend the IME evaluation.

Recently, a Unum claims handler arbitrarily decided to “suspend” benefits because an insured requested a rescheduling of an IME. Although the IME was rescheduled, the Unum claims handler “suspended” benefits pending attendance on the new date – out of pure meanness.

I suspect the real motive behind the suspension action was that the claims handler was really ticked off since she had targeted a denial for month-end in April and now will miss her target. Therefore, she coded a suspension of benefits giving Unum some profitability hit anyway.

Unum’s “suspension” of benefits is an out-of-contract action that is in violation of ERISA after 30 days. Nevertheless, suspending benefits because an insured requested a rescheduling of an IME is an act of hostility toward insureds, and the claims handler in question should be fired.

If anyone is interested in knowing the name of this particular Unum rep, send me an email and I will give you her name.

Unum Estimates and Reduces Benefit for SSDI In Violation Of Plan Policies

Unum’s ERISA group Plans allows Unum to reduce benefits with an Estimate when (and only when) claimants refuse to apply or continue the process through the allowed appeals.

Recently, a case was brought to my attention that a Financial Department Rep coded an offset for March and April to reduce benefits even when the company was aware, and had been provided proof of application for SSI and SSDI.

Of course it makes perfect sense that Unum would code an offset on BAS to make sure the company realized a financial reserve gain just in time for 1st Qtr. profitability. However, Unum’s action, at the expense of the claimant cost her more than $5,000 and was in violation of her employer’s Plan.

The problem here is that Unum, as I’ve recently reported in prior posts, doesn’t give back estimated SSDI deductions even when in error,  or the claimants aren’t awarded at all. Of course, if the claimant is awarded SSDI, Unum will reduce the amount owed back by the estimated amount, but that’s not the point.

Unum violated the terms of this claimant’s Plan by taking an estimated offset for SSDI when the claimant was in complete adherence with the Plan by applying and following through with the process.

Unum is also now insisting that claimants sign the Payment Option Form to prevent estimated benefits. This action can also be in violation of some Unum Plans.

If anyone is interested in the name of the financial rep who deliberately reduced this claimant’s benefits maliciously, please send me an email and I will give you his name.

Unum Conducts Surveillance –  Wrong Person and Dog – Wrong Person Working

Other phone calls to DCS indicates Unum conducted surveillance on insured’s daughter while she was walking the family dog. Although the claim was denied on that basis, Unum remains unconvinced daughter is not insured even though the real dog-walker is only 15 years old.

Clearly seen on the surveillance DVD, the insured’s daughter is obviously much younger, in fact a good 20 years younger. Unum doesn’t seem to give any credibility to the fact that their vendor conducted surveillance on a 15-year-old teenager. Even more ridiculous, Unum denied claim based on the mistaken identity surveillance.

Second case – Unum snooped on the Internet and found recent work history for an individual with the same name as one of its insureds. The company sent the insured a very threatening letter demanding information concerning “her recent earnings and work history.”

That’s one thing about snooping on the Internet…..a lot of it is “fake news.” Still, one would think Unum would immediately reverse its decision and pay benefits. Unfortunately, it hasn’t done so yet.


There is no question but that Unum, in my opinion, is an unfair insurer. Unum’s medical reviews are prejudicial, information is literally “snatched” from patient notes and misrepresented, medical information favorable to insureds is ignored, benefits are suspended for no logical reason in violation of ERISA, claims handlers have become rude and contentious, the company is frequently in violation of contract or Plan.

Remember, it’s not just Linda Nee saying so either. Unum has a longstanding history of unfair claim review – the Internet is full of information, litigation records, and public records indicating the same.

In my opinion, group employers need to move away from Unum and seek to spend their benefit dollars elsewhere. Claimants should inform their former employers of the need to provide benefits with a more successful company.

Obviously, Unum is not the “Lighthouse logo” it used to be, but an “Outhouse” that needs to be emptied.

 

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Breaking News!

Breaking news

Unum And Suspension of Benefits Update

Unum Group continues to violate ERISA by “suspending” benefits while conducting alleged investigations that go beyond 45 days. The issue isn’t Unum’s right to investigate claims, but rather the suspension, or withholding of benefits for long periods of time causing financial hardship to those who should be paid.

Insurance companies have two contractual obligations – to pay claims, or deny them. “Suspension” of benefits for any alleged reason cooked up by claims handlers, managers or financial reviewers, is out-of-contract. ERISA violations are also evident since no written appeal rights are given and investigations are well beyond ERISA disclosure timelines of 45 days.

Even Unum’s frequent use of Reservation of Rights status to accrue premature claim profitability is out-of-contract.

Readers might be wondering, “What’s in it for Unum?” My guess is cash flow. Not paying benefits for many months decreases cash flow although it’s a bit crazy to delay payment to a time in the future when cash flow may have to be decreased because the claim is paid.

“Suspending” benefits for long periods of time is deception. To those who seem to say that Unum has “cleaned up its act”, they need look no further than what is going on currently with the company’s new “let’s not pay benefits while we’re investigating” to conclude the opposite.

Unum is NOT cleaning up its act and continues to financially harm ERISA folks who depend on benefits to pay bills. This situation is unconscionable!

Unum Aggressively Manages Claim With $300/month benefit.

Recent DCS callers describe situations wherein Unum continues to risk manage claims paid long-term with low monthly benefits, and/or claims paid long-term as part of Unum’s reassessment under the multi-state settlement agreement.

The question asked is whether Unum’s decision to throw money into surveillance, IMEs and other risk management activities is cost effective when monthly benefits are low.

Unum continues to pay for risk management activities because the financial claim reserve is greater than the cost of conducting surveillance etc. Even in those situations where claimants are receiving minimum payment amounts under the Plan, it is likely claim reserves are over $20,000 and are worth the “investment” of additional investigation to terminate claims.

Although I have known situations where Unum paid for risk management well beyond the financial reserve, it was usually due to unit managers whose bread dough didn’t rise to the top.

In all other situations, it really isn’t cost effective to pay for risk management activity when the claim financial reserve is low. Unum has a lot of crazy managers though who might order investigations even when the claim is “in the Red.”

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