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Archive for the ‘Claims Process’ Category

On August 11th I wrote a post titled, “Unum’s Paranoia About Recording Calls”. (Please refer to the original post.)

However, as part of the continuing saga, apparently Unum was so upset about its own recording calls allegations that it contacted the claimant’s employer who proceeded to withdraw its support of the claim and claimant!

I spoke to the claimant yesterday who proceeded to tell me, “My employer says I’m in a lot of trouble”, he reported. “How do I prove I actually didn’t record anything? Now, my claim is in jeopardy, and my employer is mad as hell.”

If you recall, Unum insisted the claimant sign a statement that he will never record a call ever again, and provide Unum with a copy of the alleged recordings. I have to ask myself what Unum is so scared of that it has to threaten its insureds/claimants to NOT record calls. Is Unum recording calls? Its voice mail message says “calls may be recorded.” Which calls? Can the insured obtain copies of all calls recorded by Unum?

It almost seems incredible to me that we have a major insurance company acting like an unprofessional spoiled brat. This is one of the reasons why I always recommend “in writing” communications only.

Come on, Unum. Your claimant told you he didn’t record anything, why don’t you just move on and play nicely on the see-saw.

 

 

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As a Unum insured have you ever noticed that there seems to be no end to the letters, requests and phone calls you receive? As soon as you send in what Unum requested, within 30 days there’s yet another letter or phone call? The concept of keeping insureds and claimants “engaged” is required of all claims handlers in one way or another.

One of the worst situations claims management has to contend with internally is that of having a “backlog of untouched claims.” Viewed as lost profits and lost opportunities for denials, backlogs can literally cost insurers millions. In order to control/prevent outlandish backlogs of unreviewed claims, processes are put in place that requires claims handlers to “touch” claims at least every thirty days. Employee performance is then evaluated to determine whether or not claims handlers can in fact manage the 250 or so claims they have in their “block.”

Unum’s process includes a series of “flups” (follow-ups) created on the Navilink system that continuously shows next steps on the “primary plan” deemed appropriate by the claims handlers or roundtable reviewers. Each day, a list of flips shows up on the handler’s desktop, basically representing work for that day. Failure to take action on a “flup” and setting a new one is cause for termination.

So says, one Unum terminated employee who shared with me she was fired and accused. of not “taking care of a flup” while documenting that she had. Oops. This can easily happen in the course of a day and a few hundred flups, but Unum’s managers take this sort of thing seriously.

The ultimate result of continuously requesting information is to keep insureds/claimants constantly reminded of where they are getting their money from and who has control over it. Frequent requests for information, phone calls, and harassing patient records requests keeps insureds stressed out – and BUSY. Claims handlers are always “in touch”, or placing insureds on their fetch list every thirty days.

Even with taking care of daily flups it is possible for claims handlers to have backlogs. Managers keep a stern eye on the chasing of information from insureds with continuous reminders, checks and threats of termination when backlogs aren’t managed well.

Again, from the insureds perspective, receiving constant letters and phone calls from insurers is harassing to the point of creating anxiety and depression. This is yet another supportive argument for not speaking with Unum on the phone. At least the phone calls seem to come to an end when you put a stop to it.

The concept of insurance “Risk Management” involves the 1)assessment of the claim and setting a “primary plan direction”, 2) identifying the probable outcome (denial), 3) reviewing steps to bring about the planned outcome, and 4) controlling what requests need to happen to bring about the desired result.

Nothing inside a private disability insurance company happens by trial and error. Assessing, identifying, reviewing and controlling is at the heart of any claims review process, not only at Unum, but other insurance companies as well.

Nevertheless, if you’ve ever wondered why you keep getting multiple letters, phone calls etc. from your insurer, it’s probably because a “flup” came due on a 30-day cycle of “keeping you engaged”, and constantly reminded where your money comes from.

 

 

 

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Nearly all private disability insurers’ voice mails have disclaimers that “this call is (may be) recorded.” The intent is to scare insureds into thinking their calls are recorded and forevermore held against them. Although the message does a good job in creating anxiety, it is often not exactly the truth.

Although Unum’s voice menus also state, “this call may be recorded”, in a general sense it is not. Unum’s managers may slip in and out of phone calls for training purposes, but to my knowledge does NOT record each and every call.

Why not? Because Unum doesn’t want YOU recording them. And, how do I know? Unum’s claims handlers become very paranoid when they suspect phone calls are being recorded. In fact, claims handlers are instructed to shut you down and refuse to speak with you on the phone.

As if that’s not enough paranoia to go around, Unum sends out letters to insureds making allegations about the recording and demands copies of all recordings be turned over to them “to identify customer service issues.”

In addition, Unum also requests a signed statement from the insured that they will never record Unum’s phone calls again. If insureds refuse to do what Unum demands, all customer service is shut down and Unum will only communicate with insureds by written communications. (If you ask me, written communications are the only way to go anyway!)

Insureds continue to report to DCS that Unum’s claims handlers and managers are rude, condescending, and quick to verbalize judgments about impairments. And, although it is within insureds’ rights in one-party states to record anyone without informed consent, Unum’s paranoia denies services to insureds who actually do record phone conversations. Unum’s message is very clear, “We don’t record you because we don’t want you recording us!”

Although Unum doesn’t really record phone calls to any great extent, other insurers do. MetLife’s claims handlers admitted to me all calls are recorded and I suspect The Hartford does as well.

Recorded calls are “discoverable” meaning attorneys can subpoena recordings and present them in court. Those insurers who record all calls could be memorializing phone calls they wish they hadn’t recorded! So much for common sense.

Unum always has been paranoid about what it does internally; it’s a company of secrets and avoidance of producing anything that is “discoverable.”

 

 

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It is not uncommon for those who are insured under ERISA Plans, or IDI policies to have unrealistic expectations of the products they, or their employers, pay for. From the beginning, insureds/claimants perceive the words “benefits”, “own occupation” and “employee benefit” as certainty that benefits will be paid when needed.

Nothing could be further from the truth. ERISA Plans are deliberately written with provisions that limit benefits to 60% of pre-disability earnings, as well as other writings that are adverse such as “offsets”, or reductions in benefits, and limitations for mental health illness. In addition, ERISA Plans often come ready-made with “discretionary authority” statements that gives insurers the right to decide who gets paid and what the Plan means. These things are just as true when employees first become eligible for STD/LTD coverage as they are when claims are filed in the future.

IDI policies have misled many professionals and highly paid executives into thinking they are given an “edge” on benefit payments and should receive 100% of total disability benefits when returning to work in alternative occupations. Policies containing “Residual Benefit” provisions are enlightening and surprising to those who think “own occupation” gives them 100% of total disability benefit. Also not true.

Here is a list of what private disability insurance is NOT. Hopefully, you will take a moment to think about this.

  • Disability insurance is NOT an entitlement. Insurance premium is a payment that covers the cost of assuming risk over a period of time. Unlike SSDI or SSR, your premium isn’t paid into a program that “entitles” you to benefits at a certain age or disability. Just because you’ve been paying premium over a long period of time, doesn’t “entitle” you to anything. The best thing you have is a promise to “good faith and fair dealing”, if in fact you get that at all.
  • Disability insurance is NOT dependable. Insurers “risk manage” claims for the intended purpose of reducing the actual number of claims paid. This is how disability insurers make their money. If they paid all claims that should be paid, and deny those that should be denied, they still wouldn’t be profitable. It is only by devising strategies to deny legitimately payable claims that produces profit – therein lies the profit margin.
  • Disability insurance benefits are NOT fixed. ERISA plans in particular “offset” or reduces benefits for other monthly earnings such as workers’ compensation, SSDI awards, both primary and family, retirement distributions etc. Plans only pay 60% of pre-disability earnings (a loss of 40% coming out the gate), and then further reduce for other sources of income. This is something families with dependents  and retirees should know from the beginning.
  • Disability benefits are NOT always tax-free. ERISA benefits are taxable to the extent the employer pays the premium. If your employer paid for your Plan, benefits are taxable. If you paid the premium for your IDI policy, benefits are tax-free. If you paid premium with pre-tax dollars, benefits are taxable. Consider – you have an ERISA Plan paid for by your employer AND you are awarded SSDI – both taxable. How much money are you really ahead?
  • Disability Insurance is NOT intended to last to maximum duration. Disability insurers actively take all necessary steps to invalidate and discredit claims so they do not have to pay them. Any insurer who winds up paying a claim to Lifetime or Age 65 considers it a loss situation. The probability of receiving benefits to Age 65 is less than 30%, based on my own knowledge of what gets paid and what doesn’t.

Although I could go on, I think you get the idea. So many people tell me, “I have to continue receiving these benefits or I’ll be out in the street”, or, “I don’t know what I would do if my claim is denied.”  The truth is, disability insurance isn’t reliable, secure, fixed, guaranteed, or assured.

Insureds/claimants often do not have realistic expectations about what private disability insurance really is. Therefore, at some point, it becomes clear that what was once thought to be a benefit, isn’t really, and reality sets in.

I hope my readers hear the message of this post loud and clear and begin planning alternative sources of income for the future. Putting all of your chips in the private disability basket may not be a great way to high stake your finances in the future.

Please give this some thought.

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One of the topics I have not addressed in a long time is the issue of Unum’s use of barcodes on its forms. Unum insureds and claimants should be aware of the fact that the company’s update forms contains barcodes on the upper right corner of each form with a long number underneath. Go ahead….if you have a few blank Unum update forms around, check it out!

While it is widely accepted that insurance companies are “paper crunchers”, recent speculations of what financial, personal and health information is going where raises the questions of how insureds are identified on the update forms.

For example, who or what codes the barcodes, what information does the barcode contain, what happens to the actual “paper” form after its barcode is scanned, etc. Wouldn’t you be interested to know what information is floating around via this barcode? Or, where the information is electronically sent?

When I worked for Unum there were no barcodes. Paper update forms came into the company and were forwarded or assigned to a claims handler. Later, each piece of paper was scanned and sent electronically to a claims handler’s desktop. Apparently, at some point Unum made the decision to barcode its update forms.

Consider. Unum recently removed its IT division to India. Employees complain Unum still uses out dated technology and is extremely disorganized. How is the company managing barcoded information, and what confidence would you have in a system run by a publicly recognized negligent and chaotic company?

Although we just don’t know what information the barcode contains, and putting aside any scary implications of conspiracy of giving information to government agencies, it is a bit disconcerting that insureds/claimants/patients are not told the significance of the barcode, what purpose it serves, and what information it contains.

A question I’ve had for a long time is, (and this may pertain to other insurers as well), what happens to the actual “paper” documentation if everything is electronically scanned and sent electronically to reviewing resources? Also, since insurers are now opting for third-party reviewer facilities, what happens to documentation sent to them, and what do they do with the barcoded information? How long is it kept on file? How is it discarded or destroyed?

We know that basically HIPAA is a failed piece of legislation since HIPAA approved Authorizations themselves tell you once information is released it loses any protection it had, if any. Another question might be whether barcoded health information is HIPAA protected, or like many other aspects of private disability claims management, it is excluded from privacy at all.

In my opinion, there are far too many questions surrounding Unum’s use of barcodes.  DCS, Inc. does not submit forms for clients with barcodes. Clients have a right to know what information is coded on the update forms, but I’m guessing claims handlers wouldn’t be able to tell you, since they too are kept in the dark.

Any information, whether it’s asked outright, or hiding in plain sight should be disclosed to insureds and claimants. Barcodes are obviously “hiding in plain sight”; rarely do insureds pay any attention, having already been conditioned to having UPC Codes on everything we buy.

Remember though…barcodes contain information. Wouldn’t you like to know exactly WHAT information is coded on the forms? I know I would.

 

 

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This morning I spoke with someone who told me that he calls Unum on the phone and speaks to the representative quite often; he does NOT have a copy of his employer’s Plan and has never read it; uses Unum’s website portal for communications which he checks at least once a day; uses Facebook to speak with his family; and doesn’t think he has anything to worry about because he doesn’t do anything wrong.

Wow. My first reaction is that the gentleman caller has a great deal of trust in an insurance company doing its best to not pay him. I realize that not everyone has access to Lindanee’s Blog, but seriously?

Although I have said this on many occasions, I probably should say it again. Insureds and claimants cannot defend what they haven’t read, or have possession of.  Insureds couldn’t even verify that policy or Plan citations in letters are accurate, or if Unum calculated the Elimination Period correctly etc. Taking any private disability insurer “on faith” is a very naive mistake.

Consider. I received several phone calls this week from those who told me, “I spoke with my Unum representative and he told me………”, which when I heard it, knew it to be wrong. Unum reps aren’t trained to adjudicate disability Plans and policies and therefore they aren’t knowledgeable enough to answer contract questions.

Yet, even after I informed the caller of the correct information, he still wanted to believe Unum. I guess  as a Consultant, there are some things I just can’t change. This particular caller was receiving $4,000/month in benefit and was risking around $500,000 in future benefit. Naïveté can be costly.

Copies of ERISA Plans should be provided at the time of annual enrollment, an ERISA requirement most employers don’t know about, or don’t want to know about. Bottom line, given the total financial reserve of private disability today it’s costly to NOT know what’s at stake and how the process works.

In addition, let me say that my client list includes claims for attorneys, plastic surgeons, scientists, engineers and others who are well-educated and credentialed. Private disability can be an equal credential spoiler.

The best educated insureds who are naive about the claims process are more likely to lose benefits because he/she believes their education makes them qualified to manage their own claims. In today’s world it is more likely than not that insureds seek additional information and assistance to ensure payment of legitimate benefits – regardless of educational backgrounds.

Finally, insureds need to understand from the beginning that private disability insurers lie to you about most things. In order to deny more and more claims, insurers continue to devise claims review strategies that misrepresent information and “position” arguments in highly covert and unfair ways.

Hiring attorneys who know less about the claims process than you do isn’t the answer either. These same lawyers may have experience in ERISA litigation but who wants to have no benefit and a claim in court? Most people just want to be paid the benefits they are entitled to without giving up 40% of future benefits. You shouldn’t have to pay expensive attorney fees to have the blind leading the blind.

Insureds/claimants should make a real effort to understand the private disability insurance claims process. It’s not going to help you to allow your insurer to manage your claim when they are “staking the deck” against you with every activity.

You have to be smarter these days and one step ahead of the monsters.

 

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Everyone can probably recall at least one friend over the years who is a bit scary. You know, the friend who is quirky, moody, unpredictable, and just plain crazy. Even businesses theses days have their own idiosyncracies in process and attitude. And, although insurance companies have always maintained very high standards on the “crazy” ladders of inefficiency, one has to wonder how Unum as a company manages to exist.

I can well imagine Unum Life’s old CEO, Jim Orr III sadly shaking his head in disbelief as   Unum Life Insurance, previously  known as, “Lighthouse to the World” became “An Outhouse” of insurance bad faith in little more than a decade.

Reports continue to filter in regarding Unum’s negligent and inefficient claims process that is grossly untimely, managed by representatives who are rude, disrespectful and unkind. Repeated reports of Unum’s inability to handle STD claims in a timely fashion continue to be reported to me. Not only is Unum the company of “No”, it’s also joined the ranks of CIGNA, Aetna, and The Standard as bottom rung insurers who have difficulty working through their own claims processes.

What does this mean for Unum insureds and claimants?

  • Continued letters from Lucens asking for SSDI Authorizations even when you’ve previously notified you will not sign.
  • Rude phone exchanges in the form of “talking over you” and not giving you a chance to answer questions asked. (Most of you know I do not recommend speaking with Unum reps on the phone anyway.)
  • Allegations of not receiving paperwork with requests for the same information over and over again.
  • Claims reps not reading your file and trying to manage claims with limited or inaccurate information.
  • Using outdated technology internally to attempt to process approximately 500,000 new claims every year.
  • Internal strife — claims reps terminated due to age, sex and accusations of poor performance. Result? Constant new claims handlers, poorly trained and inexperienced.
  • Frequent harassing of physicians for more and more information.
  • Poorly trained claims handlers who are not trained in adjudicating ERISA vs. IDI claims.
  • Letters sloppily written, misspellings etc. Menu template paragraphs not deleted from letters to which the templates do not apply.
  • Gross untimeliness and violation of ERISA timelines.

There is enough evidence out there to suggest that Unum’s operating under a large backlog managed by claims reps who have no idea what they’re doing.

Despite the company’s poor public reputation and negligence, I spoke on the phone to an individual yesterday who told me, “I know my Unum claims handler. I don’t think she would do anything to hurt me! She’s been really nice!” Are you kidding me?

Let me be extremely blunt here. Unum’s claims handlers are trained to NOT tell you the truth, to question you in a way that provides information it can use against you, and is told time and again by management those who file claims are malingerers.

The entire time Unum reps are slapping your backs with gracious platitudes, they are internally  setting up “Primary Plan Directions” describing how they will work toward denying your claims. No one inside Unum is actually working for your general good to pay claims.

To think otherwise is actually, “the blind leading the blind” and is an extremely naive and pitiful position for insureds to take. Insurance companies do NOT work for your general good, nor do they plan to pay your claim long-term. The problem is that Unum now adds “crazy negligence” to the claims process contributing to an already complex and nerve wrecking claims process.

Does any of what I’m talking about sound familiar to you? Do you recognize Unum from your own personal experiences? If so, then you understand entirely the dilemma of Unum’s inability to manage claims in an organized timely fashion.

If it walks like a duck, swims like a duck, and quacks like a duck, it’s obviously a duck. In this case it’s a crazy Unum duck that can’t seem to get it’s ducks (pun intended) together to review claims fairly in a civilized way.

And, buying into the crazy won’t get you a paid claim.

 

 

 

 

 

 

 

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