Archive for the ‘In the News’ Category

Daily BuzzMost insureds and claimants probably didn’t keep up with Maine’s elections, but in this particular case, it is important for insureds to know what could happen with Janet Mills as Maine’s newly elected Governor.

To begin, this post isn’t about a political party, it’s about “the person” and what could happen to devastate disability insureds. In Maine, the Governor appoints the Superintendent of Insurance. Some of you may recall that in the past Maine had been a lead regulator in the Conduct Market Examinations of both Unum and CIGNA. As a result of the Multi-State Settlement Agreements, (at least for a while) these companies were held accountable and fined for their misconduct and unfair claim review.

In my dealings with Janet Mills as Attorney General it quickly became clear that she and Unum were very close bedfellows. As Governor, she now has the authority to appoint a new Superintendent of Insurance, I suspect might be connected to Unum, Prudential or hail from the insurance industry with strong ties to Unum.

This in itself will be devastating to those who are covered by ERISA Plans as well as IDI policies since an insurance biased Superintendent of Insurance will not be looking to investigate Unum and other insurers to the point of holding them accountable. An ex-Unum attorney as Superintendent of Insurance will be equivalent to no regulatory oversight at all.

Remember, the UNUM and Cigna Multi-State Settlement Agreements affected all UNUM and Cigna insureds nationwide, so this isn’t just a Maine issue, nor is it a political issue. In my opinion I think Maine citizens made a wrong choice for Governor in light of the possible consequences that could be damaging to insureds nationwide. Clearly, I’m focusing on possible future adverse actions affecting insureds, but this could turn out to have horrendous effects for insureds.

We clearly would not want a Unum attorney from Pierce Atwood to be Superintendent of  Insurance in Maine. The lack of regulatory control could signal increased unfair tactics and insurance bad faith nationwide.



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Recently I was interviewed by a reporter for “Lawyers & Settlements”. Here is the article. I didn’t see the article before publication and I can’t say that it’s all accurate, but it mostly is.

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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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Great JobI want to take this opportunity to thank all of my blog readers for your continued support in 2016. Here are the stats for DCS’ current success rates.

Lindanee’s Blog receives between 400 and 800 reads per day.  There are 210 blog and 207 comment followers who often contact me with many additional questions and claim issues.

This blog contains 1,514 posts within 112 separate categories. Insureds look to Lindanee’s blog for information of importance to them.

The most common read article is “Resignations – A Disability Claim No-No” and “Returning to Work After Disability.” These two posts are read at least once everyday. From January to September 30, 2016 DCS received over 200 phone calls and 139 emails from insureds and claimants.

Disability Claims Solutions, Inc. currently has 92 clients insured by all major insurance companies in the US and Canada. All of my current clients have successful claims and continue to receive policy and claim advice as well as access to electronic forms, books and claim materials. We referred 5 clients in 2016 to attorneys for successful lump sum settlements and 4 clients were referred for appeals based on phone calls we received.

I continue to work for several attorneys on a regular basis providing reports, recommendations, and file reviews when requested to do so.

The most problematic issue for DCS is receiving calls from insureds and claimants who have already retained attorneys, or from insureds who are looking for additional information to keep their own attorneys informed. Although I wish I could help everyone who contacts me, my responsibility remains with those clients who have actually retained my services.

Lindanee’s Blog continues to be read by insureds and claimants, attorneys, IME physicians, insurance agents and brokers, vocational experts, and of course, insurance companies and large numbers of their employees. All are welcome!

I hold all insurance companies accountable for their claims practices as issues and matters are reported to me, or that I personally observe from letters, file copies and other insurance data. After all, since insurers are publicly held corporations the public has a right to know the same information insurers use to evaluate claims.

Again, thank you for your continued support and I look forward to very successful 2016-2017 year. Those who read Lindanee’s Blog are the best people in the world and I couldn’t do what I do without all of you.


Disability Claims Solutions, Inc. is a fee based, national consulting organization that provides expert claims management services to those with private insurance. I offer free initial consultation. If you are interested in becoming a DCS client, please feel free to visit my website at: http://www.disabilityclaimssolutions.com

Telephone: (207) 793-4593
Fax: (207) 274-2331
Detailed information can also be viewed on this website by clicking the Tabs at the top of Lindanee’s blog Home Page.

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Breaking newshttp://www.prnewswire.com/news-releases/cathy-liston-appointed-to-lead-sun-life-financials-us-group-and-voluntary-claims-practice-300306723.html

In my opinion, wherever Cathy Liston is isn’t good news for claimants.

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In The News


Due to the AFLAC quack-quack commercials on TV most insureds have a tendency to view AFLAC disability insurance as a type of “indemnity” – you notify them you are disabled, and they pay the claim. Not so.

My current dealings with AFLAC tend to indicate the company is grossly disorganized and “risk manages” disability claims by contacting physicians, obtaining medical records, and keeping track of potential return to work dates even when there are none. The coverage as described by AFLAC reminds me of “indemnity” STD with risk management. Those who buy the insurance thinking they will receive payment right away may be disappointed.

It takes roughly 10 days for AFLAC’s powers that be to approve third-party authorizations. The company processes claims in the order received and aggressively investigates claims. I’m not sure why the company requests patient notes because it would take them a long time to review, I’m not sure by whom. AFLAC’s policies do not cover what other insurers cover, therefore, it’s a good idea to check this product out before buying it.

Prudential’s Fibs

The next time a Prudential rep tells you, “This is the last IME we’ll request from you”, or, “Make sure you try your best on the neuropsyche test”, recognize the fib and motivation. Prudential, like all other private disability insurers, has the contractual right to request IMEs “anytime we consider reasonable.” Also, Prudential’s claims handler do not have the autonomy to make these types of decisions, therefore, I wouldn’t hang my hat on what the reps tell you.

Disability insurers often do not tell you the truth and it would be very unwise to believe what is said. Unum reps are particularly skillful in saying things that aren’t true.

Prudential’s Investigators Knock on Doors

A Prudential field investigator got an earful when he began knocking on the doors of neighbors to find out information about an insured.

One neighbor told the investigator, “Doesn’t he have Alzheimer’s? He always looks like he doesn’t know where he is. And…he looks bad.” Yet another neighbor said, “He’s really disabled all right. I never see him.” Still another shared, “Yea, I never got to know the guy, but I heard from my other neighbors that he’s sick.”

This just goes to show you how reliable neighbor reports are. The insured was actually injured in an accident and had chronic back pain. Sometimes the information insurance companies obtain is about as unreliable as it gets.

Insurance Authorizations – Mental Health

Nearly all insurance companies have Authorizations they require insureds to sign. Most insureds do not actually read the whole thing, or if they do, miss out on a very important point. For example, in the middle of Unum’s general Authorization, it says very clearly, “This does NOT include actual psychotherapy notes.”

Unum often sends this Authorization to therapists with a request for psychotherapy notes. Unfortunately, therapists do not read the Authorizations either and send the notes, essentially without permission. Unum and other insurers have separate Authorizations to obtain psychotherapy notes, but the claims reps are ignorant of the issue and send therapists the wrong Authorization authority.

This is a case when everyone involved is not paying attention. Please look at your most recent Authorization you signed and locate the section that says in parentheses (Does not include actual psychotherapy notes.) This should be brought to the attention of all of your mental health providers who should not be sending patient notes with this type of Authorization.

Every one needs to pay attention here. Unum throws a bit of hissy fit when insureds and claimants point out the attempt to obtain psychotherapy notes under false pretenses. I once complained to Unum’s Rick Joseph’s about claims handlers using the wrong Authorization, who later reported it to a Consultant (Diebold), who then brought it up to the Maine Attorney General saying, “How dare she make such a complaint!” It’s all so much chortle! This is what I mean about Unum’s hissy fits though. When Unum claims handlers are wrong, they’re wrong regardless of who makes the complaint.

Other insurers simply ask you to sign the appropriate authorization and apologize for the mistake. Unum doesn’t like to be wrong.

What! No policy?

Claimants need to understand the importance of obtaining a copy of their Plan policy. Every other call to DCS this past month has been from those who do not have copies of their policies. How can you protect your benefits when you don’t know what they are?  Or, prevent unfair denials when you have no idea what to defend?

Please, please obtain copies of your policies today.


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