Feeds:
Posts
Comments

Archive for the ‘Overpayments’ Category

Unum’s process for recapturing SSDI overpayments changed over the years from using a very straightforward “Payment Option Form”, to an unfair POF requiring voluntary liens on assets, to what is called, “Agreement Concerning Other Benefits.”

As most of you are probably aware, Unum offers claimants “an option” to receive reduced benefits or unreduced benefits while waiting for SSDI to make approval decisions. In reality, Unum “fronts” the amount of future SSDI awards as long as claimants agree to pay back the front money once SSA gets around to awarding benefits and paying the back money owed.

Although most claimants choose to receive unreduced benefits and pay back overpayments in a timely way, some claimants spend the money forcing Unum to reduce benefits to $0 until the full overpayment is recaptured.

As most of you know, I entirely support Unum’s efforts to recapture overpayments when claimants sign Payment Option Forms and agree to pay SSDI money back. Claimants who expect Unum to treat them fairly shouldn’t try to keep money that was promised to be paid back.

Unfortunately, Unum became weary of claimants who refused to turn over their SSDI overpayments and eventually came up with a Payment Option Form that forced claimants to agree to voluntary liens on assets – an action I totally disagreed with. Clearly, it was overkill, and placed claimants in situations of “no choice” either way.

Recently, I was provided with a copy of another version of a POF called “Agreement Concerning Other Benefits”. Actually, the form is very reasonable and states clearly the conditions under which Unum would agree to “front” SSDI money, and claimants’ agreements to pay back what is owed.

Basically, claimants agree to notify Unum within 48 hours of notification that benefits (or any other income paid ) have been approved, and pay back any overpayment due within 30 days. This places somewhat of a time crunch on Unum to calculate any alleged overpayment and communicate the financial outcome to claimants in time to allow overpayments to be paid back within the 30 days.

The new version of Unum’s POF is a much better form. I suspect the old POF may have been challenged legally forcing Unum to make a change to a better set of “conditions” for fronting SSDI money.

I don’t think claimants will have a problem signing the “Agreement Concerning Other Benefits” form for SSDI overpayments. The forcing of claimants to sign forms giving voluntary liens to assets was pretty nasty.

Read Full Post »

After receiving several more calls this week about Unum, Lucens, overpayments etc., I think it’s time to include a post on Lindanee’s Blog about insureds’ rights to keep Social Security information private. To my knowledge there is no Plan or policy on this planet that contains provisions requiring insureds/claimants to release SSDI files to disability insurers as proof of claim. Claimants are not required to disclose their SSDI files and may choose to keep any requested SSDI information private.

Some claimants really need to get their heads wrapped around this basic truth about disability accountability since SSDI and private disability are two separately distinct sources of income. SSDI is a federal entitlement, paid for by workers and their employers so that employees can have the expectation of receiving federal assistance for retirement  and/or disability.

Employer provided private group disability insurance is an employee benefit provided to “participants” to replace wages with reduced financial help. The intent of private insurance is that it should be considered temporary since group Plans are written adverse to claimants from the beginning.

Private insurers have no control over SSA or SSDI, and Social Security doesn’t keep up with what disability insurers do. To make matters worse, insurers such as Unum position disclosure requests as “we want to make sure we give your claim every possible consideration”, while The Hartford positions its requests as demands claimants are expected to provide.

However, if the Plan doesn’t specifically require the disclosure of SSDI files as proof of claim, you don’t have to sign SSDI Authorizations at all. This is NOT something you have to do in order to keep receiving your benefits. To put it another way, insurers CANNOT DENY BENEFITS ON THE BASIS THAT YOU REFUSED TO RELEASE YOUR SSDI FILE. THEY HAVE NO PLAN OR POLICY AUTHORITY TO DO THAT, AND THEY KNOW IT.

Having said this, since Unum’s Group STD/LTD Plans DO authorize the company to offset for SSDI Primary and Family awards, claimants ARE required to provide any insurer with the original SSDI approval letter so that offset amounts can be verified and overpayments calculated. Please note, I said “SSDI Approval Letter”, not a letter of “Favorable Decision” from an Administrative Law Judge.

One would normally assume Unum could calculate overpayments correctly and not be overly concerned with “mistakes” as they are now. It would also be appropriate for Unum, or any other insurer, to ask you if you received additional letters from SSA increasing benefits for “additional earnings.” SSDI COLA does NOT increase SSDI offsets – you actually are allowed to keep these increases. You are NOT required to provide any insurer with COLA increase letters from SSA.

Now, enter Lucens. Lucens is Unum’s third-party SSDI paper chaser. I’ve received many calls from claimants who are literally “flipping out” about Authorization requests from Lucens – “Who are these guys?” “Why am I getting this request when Unum already has all of my SSDI information?” “Can Unum deny my claim if I don’t sign it?”…..and more.

To make matters worse, Lucens’ Authorization is designed to “look like” a form from SSA, when it is not! The purpose of Lucens Authorization requests is to get you to give up financial data (and more) from your SSDI file so that Unum can chase over payment mistakes the company will ask you to pay back. I’ve written several articles about how Unum is “nickel and dimming” its claimants with minimal offsets after alleging much larger overpayments due.

Bottom line, you don’t have to sign any Authorization giving Unum or Lucens permission to obtain information from your SSDI file, and “No” they can’t deny your claim if you respectfully decline to sign it. Unum has its own SSDI Authorization that’s valid for two years. Why two years? Unum’s SSDI Authorization actually lists SSA Form 831 disclosing the name of the DDS (Disability Determination Specialist), and SSA listing codes for the basis of awarding benefits. Claimants should never sign an SSDI Authorization valid for two years!

Obviously, Unum is attempting to determine if SSA awarded benefits under any mental or nervous listing code so that they can “agree” with it and terminate benefits after 24 months. Unum may also attempt to contact your DDS by making you stay on the phone with the claims representative through the SSA menu. This should never be allowed to take place.

To the extent that these potentially illegal and out-of-contract requests are allowed by claimants is reasonably explained by the fact that so many people are scared and intimidated by Unum and believe they have to do everything Unum requests even if it is inappropriate and deceptive.

One claimant who called me had already contacted SSA, and several attorneys asking what she should do with the Lucens Authorization. She didn’t get any answers because SSA reps are often not aware of private disability Plans, and of course attorneys, are not experts on ERISA Plans and don’t realize there’s no requirement to agree to Unum’s demands. Generally, instead of defending the Plan policy, some attorneys recommend signing the Authorizations to avoid any future conflicts, often not in the best interests of anyone.

When the claimant contacted the Department of Insurance they just told her, “Well, don’t sign it.” Alas, an accurate answer, although she did contact me to confirm it.

From what I’m experiencing in my own consulting practice alone, there is considerable angst, anxiety, stress and worry over these Lucens requests for SSDI information. Unum’s requests for signed SSDI Authorizations are deceptive.

I’ve read many Unum denials stating [paraphrased] that because Unum has more recent information than what was available to SSA at time of the award, they disagree and deny the claim anyway. Unum isn’t trying to give your claim “every possible benefit” and its obvious when you see the results of the end-game. That’s deceptive.

Therefore in summary:

  • You do not have to sign any Authorization giving insurers the right to obtain your SSDI files. Your Plan or policy does not contain such a requirement.
  • Insurers cannot deny benefits for your choice to keep SSDI information private.
  • Private insurers have no influence or contact authority with SSA unless you give it to them by signing SSDI Authorizations.
  • Lucens is Unum’s third-party gopher of SSA information. When contacted, notify your claims handler that you “consider your SSDI file to be “PHI” (private health information) and that you consider it confidential and choose not to disclose it.”
  • Unum’s own SSA Authorizations asks for disclosures of SSDI information potentially favorable to denial, or subject to misrepresentations of issues in “conflict of interest” with the rights and privileges of group LTD Plans or any semblance to fiduciary duty.
  • Conference calls to SSA with Unum claims reps on the line should not be permitted for any reason.
  • The only duties claimants have is what is specifically required in their group STD/LTD Plans. There is no requirement to allow disclosure of SSDI files, and therefore, claimants may choose to hold all SSDI information (with the exception of initial award letters) private and confidential. It doesn’t matter who’s asking for it, Unum, Lucens or GENEX.

If you have any further questions about SSDI Authorizations, Lucens, or Unum’s alleged overpayments, please feel free to contact me. I hope this post clears up the questions concerning SSDI file disclosures.

 

 

Read Full Post »

Credible sources continue to report that Unum/Lucens continues to hunt down every nickel and dime associated with SSDI and other monthly earnings offsets including Retirement Income. The process is somewhat convoluted since Unum never proves what is owed, and asks for the same amount of overpayment from every claimant.

The process begins with a request from Lucens, Unum’s third-party paper chaser of SSDI Authorizations, and ends with a overpayment of $696, the same for everyone regardless of the disclosed actual amount alleged to be owed. Although DCS does not recommend signing any SSDI file Authorizations, Unum still requests SSDI 1099s which are recommended to provide to Unum.

Nevertheless, it appears Unum is targeting claims paid for a long-time in hopes of coming up with overpayments it can collect. What is Unum looking for? Increases in SSDI benefits due to additional income, miscalculations of SSDI offsets, retirement income that was never offset, workers’ compensation omissions etc. And, they are harassing claimants, even those with maximum duration and closed claims to repay amounts alleged to be due.

My beef with Unum is that it does not have the authority to arbitrarily calculate a overpayment and offset or reduce benefits to $0 without first showing calculations and proving to the claimants’ satisfaction that amounts alleged are actually due. Unum doesn’t do that. It simply calculates the overpayment and then offsets from benefits.

What is also suspicious is that regardless of Unum’s allegations of large overpayments due, the company always seems to come up with $696 due because Unum “is so gracious and forgiving of the remainder of the debt.” (Paraphrased) What? Why go through all the bother of targeting and recalculating for offsets and then only ask for $696 back?

This is actually an ingenious psychological plan on Unum’s part. Individuals I’ve spoken to in this situation say, “Oh, thank goodness, I only owe $696. I don’t mind paying that back”, or “You only pick the battles you can win, right?”  Oh boy! It seems that claimants are often all too ready to jump right in and pay the $696 alleged overpayment rather than the few thousand dollars alleged. Clever isn’t it?

Most of you know I’m a contract specialist, and I’d be willing to say that in a large number of cases, claimant recalculations of pre-disability monthly earnings, residual disability under WIB or PPL, COLA, indexing etc. might actually prove Unum owes claimants money back and not the other way around.

Of those client claims I’ve actually investigated and calculated myself I found overwhelmingly large numbers of claims where Unum’s figures for pre-disability earnings and indexing were grossly inaccurate. I doubt if you could actually find a Unum claims handler today who knows how to perform the calculations for indexing, COLA and WIB or PPL part-time earnings. Supposedly, claims reps send files to the financial department for calculations, but they cannot explain anything to claimants who call for an explanation.

Bottom line, when faced with a $696 overpayment letter, it might be helpful to claimants to do a few recalculations themselves to determine whether they’ve been paid correctly elsewhere in the policy. It might be possible that Unum owes YOU and not the other way around, even subtracting the $696 alleged due by Unum.

The process of “forgiving” alleged overpayments except for $696 for everyone is deceptive particularly when Unum never has to show calculations or prove what’s owed, and people are enticed to pay the lesser amount in lieu of what’s actually owed.

In my opinion, it’s a “nickel and dime” scheme that’s deceptive.

 

 

 

Read Full Post »

If you ever wanted to know the tragic effects of Unum’s hunt to recalculate claims long-term for non-existent overpayments please read the email sent to me below.

“I am attaching a message I wrote to a friend just for the sake of telling you what is going on. I am another victim of UNUM. I’m about to have my 66th birthday and after years of battling these people they have struck again. If you would be so kind as to review this short version and let me know if I have recourse or who I can contact to help me I would really appreciate it.

I had the worst thing possible happen this past week. Years ago when I was forced into medical retirement,  the plant gave me my retirement and submitted me for disability insurance. I had paid for it for years out of my own pocket but never saw a policy or knew much else other than what they had said to promote it. They told me when I signed up it was for 60% pay replacement.  

When I met with the Human resources rep for the company I was told I would receive my retirement as well as the UNUM insurance benefits which would equal about what I was currently making. I was so happy that I had paid for the UNUM disability insurance all those years. Other than then I had to start paying about 8 times more for health insurance, I was receiving close to what I did while I worked.

I never questioned it at all or had a second thought. After about 2 years, Unum contacted me and said that they had learned I was getting income from my retirement and that it hadn’t been discounted from my benefits.  So they had said they had over paid me some $20,000 dollars. Even though the amount was reduced by counting my retirement as income,  they took back what they were supposed to pay me and kept it. Now mind you, I had paid taxes on all this. And my income from Wolf Creek was nothing, because once I was retired my health insurance took all but a couple hundred dollars a month from my retirement.

So virtually I was receiving very little income other than social security.

UNUM told me when I turned 65 that I would still owe them about $4000 even though I never got money at all for several years. Last year for some reason they deposited $7 or so into my account per month without a letter of explanation or anything. I had heard that  last year there was a big lawsuit against UNUM and they were ordered to repay millions of dollars to people whom they had scammed out of disability benefits. I heard nothing more from them and my usual forms for the doctor to show I still qualified for disability didn’t come.

Finally, nearly a year later I had relaxed and decided that they had tried to scam me as well and I finally decided I didn’t need to worry about them. Well this weekend I got a letter from them saying that I owe them $4700 and they’d be contacting me for payment. First I have no idea why the amount is higher. Secondly I didn’t expect it, and thirdly I don’t just have that kind of money laying around.

I’ve been rat holing some money so I could afford to go to the dentist since my teeth are trashed and I can’t wear my partial any more. And I need new glasses but hated to spend the money to get them.

Well obviously that wasn’t enough to cover those expenses anyway, and now I have to come up with a lot more money to get these people off my back. So I guess I am supposed to give up being able to see and to eat so I can pay them back.

I also have never seen or read the policy for this insurance. All I had to go on was what I was told by Wolf Creek. Back when this first letter from UNUM came several years ago I talked to a benefits representative for the company I worked for Wolf Creek Nuclear, and she said I had no recourse and that I had to pay it. I had called and talked to an UNUM representative on the phone and asked why other people who had been put on medical retirement were getting their retirement as well as the full 60% pay replacement from UNUM She said that it was none of my business and she wasn’t obligated to explain anything.

When this first came up I called virtually every attorney I could find to see if someone would represent me and not a single one I talked to would look into it.

 I tried to contact the insurance Commissioner’s office as well and was basically told that it was impossible to meet with him. I found that no matter what I was helpless and had no way to fight this.

 Once again I am all stressed and wondering how on earth I’ll pay them off. I absolutely refuse to make payments and therefore short myself even more every month. So I guess my only option is to start selling whatever I can to make money.

 My friend sent me a link to your page. If there is anything at all you can do to guide me to help me I would really appreciate it.”


(This is a very tragic story in that this claimant can’t even interest attorneys to assist her. In the end Unum’s persistent financial reviews to hunt down every lost nickel and dime characterize the company as an unfair, egregious insurer. Unum’s endgame, of course, in requesting SSDI Authorizations to obtain financial information, is to allege overpayments it cannot prove, but fully intends to collect.
No employer at this point should be purchsing any group product from Unum Group. It’s just not worth it to employees anymore.)

 

Read Full Post »

It occurs to me that Unum Group is always the Village looking for its idiot.  Yesterday a claimant received a letter from Unum’s Offset Management Coordinator holding her accountable for an imaginary deadline to receive SSDI approval/denial decisions.

Unum’s rep Mr. DD said in his letter, “The national average decision time for the Social Security Administration to make a decision on an initial application is three to six months. We received notice of your proof of the Social Security Disability Application in January.”

Mr. DD goes on to threaten the claimant, “If we do not receive the information by September 5, 2017, we will begin reducing your benefit by the estimated amount indicated, resulting in a reduced Long Term Disability benefit.”

Since when does Unum arbitrarily decide when SSA should make its approval/decisions? And, how is it that the claimant will be penalized if SSA makes an error, or takes longer than the “national average” to report decisions? What if SSA requires the claimant to have an IME and takes longer than usual to make a decision? What if the claimant has to appear before an Administrative Law Judge and it takes a year to get a hearing date?

Needless to say, Unum Group is way out of line here. To begin, there is nothing in Unum’s ERISA Group Plans that gives the company the authority to hold claimants accountable for untimely SSDI decisions. Remember, Unum does NOT reimburse claimants for estimated payments taken if SSA doesn’t approve their claim for benefits. In fact, Unum recently refused to reimburse a claimant after it denied her claim and SSDI had not yet been awarded.

Therefore, any estimates taken by Unum Group are never reimbursed if SSDI doesn’t happen. If Unum’s rep, Mr. DD, is now saying that the company will be holding claimants responsible to receive SSDI awards on Unum’s timeline upon threat of removing estimates from benefits, well….in my opinion, that’s outright extortion.

Dealing with a government bureaucracy is not walking into Wal-Mart and making a purchase – it often takes time. Whatever the alleged “national averages are”, there is always the exception when the government process breaks down and future SSDI recipients are left holding the bag.

It has been recommended to this claimant that she file complaints, not only with her state, but also her federal Congressional senators.

If Unum needs money and profitability it should find other ways rather than penalizing their own claimants for a slow and often agonizing  government process.

Finally, Mr. DD should be made aware that Unum’s Plans do not have provisions that require SSDI decisions be made within certain time frames. His letter is entirely inappropriate. If he does follow through and reduce benefits with an estimate for untimely SSA decision-making, Unum can be sued, and it should be.

If you receive a letter from Unum telling you that SSA has been too slow in making a decision and it will reduce your benefit with an estimate by a certain date, file complaints and inform Unum it has no authority via the Plan to do it.

Claimants should also notify their employers of the scam Unum is attempting. Request that employers purchase their Plans elsewhere with companies that do not hold employees/claimants accountable for SSA’s untimely decisions.

Unum is acting out of line, out of Plan, and like the village idiot who is looking for a way to make the almighty buck!

Read Full Post »

Unum insureds and claimants who have been harassed by Lucens and Unum for financial information resulting in alleged overpayments should contact the law firm below with your story.

It is my understanding this firm is preparing a class action lawsuit against Unum for alleging overpayments and several other issues.

Marcus A. Castillo, Esquire
Haas & Castillo, P.A.
Attorneys At Law
19321-C U.S. Hwy 19 N, Ste. 401
Clearwater, Florida 33764
(727) 535-4544 telephone
(727) 535-1855 facsimile

If you’ve received notification from Unum that you owe an overpayment after many years, please contact Attorney Castillo to lend your support.

Class action lawsuits can be a bit tricky, but please give your support to this law firm and his team who is willing to do something to stop Unum’s atrocities.

Thanks!

Read Full Post »

As an addendum to yesterday’s post (below), recent information also indicates Unum [Lucens] is now requesting claimants to submit 1099s they received from SSDI going back many years. This should give every Unum claimant a head’s up that Unum is pursuing “re-calculations” of offsets going back, if possible, a decade or more.

Claimants who refuse to sign the Lucens Authorization to obtain financial information directly from SSA are subsequently asked to submit 1099s, which by the way, do not break out gross benefit from COLA and adjustments for additional earnings.

Therefore, Lucens could potentially calculate overpayments based on COLA additions that Unum does not have the contractual authority to offset. Why Lucens/Unum is requesting the 1099s is beyond me.

It’s reasonable to understand that SSDI recipients may not want their file information distributed to yet another outside party. Although Lucens’ letters communicate they protect confidentiality, there is no recourse for release of information if they don’t. Besides, Unum’s Plans do not require claimants to release SSDI information as proof of claim.

What is so ridiculous about Unum’s initiatives to “re-calculate” everything is that they have already been provided with SSDI award letters giving Unum all the information it needs to offset benefits. Of course, Unum is interested in SSDI increase adjustments for additional earnings, information they may not have access to as well as correcting all of their previous claim errors.

Here are a few facts Unum claimants and some insureds should think about.

  • If by re-calculation Unum/Lucens were to find that they owed YOU money, would they inform you accordingly and pay with interest? There is no guarantee of that.
  • How many of you have verified (in accordance with the definition of MONTHLY EARNINGS in your Plans), your pre-disability earnings on which the 60% of benefit is figured? Are you sure Unum figured it correctly?
  • How do you know Unum calculated “indexed pre-disability” earnings correctly if you are working part-time, or an any occupation investigation was recently completed? Have you verified that calculation? $1 can sometimes make the difference between gainful benefits or no benefits after 24 months.
  • Does Unum owe YOU money? Have you checked and verified?
  • Does Unum owe you COLA or Income Revenue Protection contributions (TIAA-CREF funds) the company conveniently forgot? Are the calculations accurate? Have you checked?

Unum’s “you owe us money” scheme is a two-way street and DCS, Inc. has already begun our own initiatives to assist our clients in validating payments. If Unum owes my clients money we’ll be requesting repayment with interest. DCS, Inc.’s client recalculations include calculation of Elimination Periods, WIB and PPL benefits, and any other Plan calculations that are appropriate.

Also, if you are one of the unlucky claimants Unum informs that money is owed, immediately request verification by asking for a complete spreadsheet of Unum’s calculations – month by month.

If any other company informed you you owed thousands of dollars wouldn’t you want to see verification that it was really owed? Ask Unum to prove their alleged overpayments by providing you with a copy of its complete month-by-month re-calculation before benefits are reduced to $0 to recover. Do you really want to take Unum’s word for it that you owe money and need to pay it back?

Isn’t it pretty convenient that Unum/Lucens performs the re-calculations, but never discloses actual calculations, or proves the money is really owed before it stops benefits to recover? Wouldn’t you want proof from Unum that the money is really owed first?

Personally, I’d want disclosure of all monthly calculations relied upon in claiming I owe Unum money. Do you really want to repay only on Unum’s say-so? Given Unum’s track record for dishonesty, I would think claimants would want more verification than just a letter telling you what you owe.

You can also ask for an ERISA appeal of Unum’s calculations and alleged overpayments including full disclosure of communications between Unum/Lucens and all financial data relied upon in claiming monies are owed.

Unum really should be providing claimants copies of its re-calculations prior to reducing benefits to $0. ERISA appeal opportunities should also be disclosed allowing claimants the opportunity to challenge Unum’s so-called overpayments and obtain disclosures.

Don’t allow Unum/Lucens to cheat you out of benefits you legitimately should be paid. Truth be known, it’s entirely possible Unum could owe claimants more than the company alleges claimants owe them. Check it out.

 

 

Read Full Post »