Feeds:
Posts
Comments

Archive for the ‘Q&A’ Category

Friday Q & A

Q&A ButtonWhat are Unum’s Core Values?

Gee, I haven’t been asked this question in a while. Yes, at least publicly, Unum does have a Mission Statement and Core Values. See below from Unum’s Internet marketing pages:

Mission Statement

Our mission is to help protect people financially when they’re injured or ill and need it most. In today’s environment of economically fragile families, financial protection benefits are more important than ever.

Vision Statement

We will be the leading provider of employee benefits products and services that help employers manage their businesses and employees protect their families and livelihoods.

Values

  • Integrity
  • Commitment
  • Accountability

Oops. In reality, Unum doesn’t “help protect people financially when they’re injured or ill and need it most”, and I’m pretty sure no one would associate the word “integrity” to a company with such a terrible reputation for making unfair claims decisions. Unum very well may be the leading provider of Group STD/LTD, but the company does it’s job badly.

Does Unum have rehabilitation programs?

Yes, in fact most policies contain rehabilitation provisions, but it’s risky to ask Unum for rehab assistance. One of the first things Unum will do is contact your physicians for work releases so that you can participate in work activities. Once they have the work releases claims are denied citing, “since your physician released you to return to work you no longer meet the definition of disability.”

Unsuspecting Unum insureds must realize that any rehab program assumes an eventual full-time return to work followed by a termination of benefits. Unum isn’t offering rehab to help you, it’s offering rehab to eventually deny your claim. Very few rehab programs are successful, but my suggestion is that if you really want to trust Unum to help you return to work, get everything is writing. Don’t trust that Unum will work to help you, because it’s only working to help itself.

Rick Josephs again…?

I keep getting questions about one of Unum’s complaint specialists, Rick Josephs, and I have at least two posts about him. Suffice it to say that I knew him as a peer claims handler and he wasn’t a very good one. Unum made him a Complaints Specialist – go figure!

Filing an internal complaint with Unum is a waste of anyone’s time. In response to complaints the so-called specialists reiterate the history of the claim and defend the company with a ridiculous “we did nothing wrong” 5 page letter. Unum’s internal complaint department doesn’t solve problems, it defends the company line all the way. I wouldn’t waste your time.

DMS is very unfriendly, or is it just me?

No, DMS is the rudest, most out-to-get-you insurance company I am aware of. As a reinsurer it marches to a different drummer with frequent doctor shopping requests for IMEs, low-ball settlement offers, and claims handlers from hell.

Technically, reinsurers aren’t insurance companies at all, but are more like holding companies or financial investment entities who buy up the risk of certain product lines such as MONY, for the intended purpose of getting rid of the claims at a profit. State Departments of Insurance will tell you DMS is not under their jurisdiction although some will write a letter to find out what’s going on.

There are only three directions DMS takes: 1) settle the claim, 2) deny the claim and 3) engage in repeated IMEs until eventually a doctor comes up with an opinion to support denial. Clearly, DMS “doctor shops” for supporting opinions and is very disrespectful to insureds.

Read Full Post »

Friday Q & A

Q&A10How do I pass a neuropsychological test?

First, a neuropsyche test (handler slang) is NOT a pass or fail test. There is validity testing built into the test with a “fake bad scale” that determines whether you are trying to second guess the test or not.

DCS, Inc. recommends that anyone submitting to such a test be truthful with their responses and give it an honest go. To do otherwise almost always guarantees the test will not provide an interpretation favorable to you. I am asked this question quite a bit, but the only way to take the tests are to be honest and forthcoming.

Why would Unum audit your claim after 17 years?

Insurance companies can deny claims any time they want to. While it seems reasonable that the longer a claim is paid the more difficult it would be to terminate, it’s possible insurers could deny claims right up the maximum duration.

In the last two years Unum partnered with Lucens to obtain SSDI financial information so that overpayments could be recalculated and money found. The highest probability of overpayments is in the claims paid the longest; therefore, it appears Unum targeted claims paid a long time. Even though large overpayments were in fact found and forgiven, I now believe the whole purpose of the initiative was to correct overpayments mistakes moving forward.

I have also found some evidences that at one time Unum targeted claims that were part of the multi-state settlement reassessment in an effort to recoup losses in some 275,000 claim denials the company was forced to overturn and pay.

Any insurance company can audit, or target claims up to the point of maximum duration.

I notice Unum’s stock is selling a little above $35 per share. It was selling for $50 per share. What happened?

In the last 5-6 years Unum tried every possible strategy to increase its profitability. As part of the economic growth of Wall Street since the 2016 election, Unum’s stock increased to over $50 per share, but has now declined once again to a little over $35 per share. In theory, increases in market shares are supposed to reflect steady growth of the company, profitability, and buyer confidence.

In an effort to “manipulate” its market price as stock continued to decline, Unum bought back millions of shares of Treasury Stock (its own stock) to artificially inflate the market price. Unum’s increase in market shares were initially created by economic and political changes, not from growth or profitability.

Most people don’t realize that the cost of market shares can be manipulated – buying back Treasury Stock increases the market cost per share, while selling more stocks dilutes the market and (lowers) the cost. This is called “making the market”.

In my opinion, I think it’s pretty obvious that Unum’s ups and downs represented in its stock price are NOT the result of company long-term growth or profitability potential.

What types of income are reportable to my insurance company?

In general, income derived from rents, royalities, copyrights, and capital gains are not reportable to insurers. Everything else is reportable. Income reported on Schedules E and D are not income and need not be reported.

Read Full Post »

Q&ACan Unum make me go to therapy?

“No” insurers cannot compel insureds to seek out therapy THEY recommend. Actually, insurance companies could kill people since they do not have complete patient histories, or a history of consultation with those who have claims. While it is very important for insureds to remain in “appropriate and regular care”, it is up to their physicians to decide and document what that is.

Can Unum be charged for records retrieval?

Although I’ve written about this before, basically the answer is, “it depends.” If Unum, or any other insurance company requests patient records on their own directly from the docs, then treating physicians should include an invoice to cover not only photocopying of records, but use of facilities, use of time and staff etc., and any other fixed costs involved in providing records.

Invoices for $200 are not uncommon. Those physicians who find themselves frequently harassed by one insurer should increase the fee $100 per request until the insurer gets the idea. It surprises me that doctors do not bill insurance companies the way they should since charging for records retrieval discourages harassment for records over and over again. The quickest way for physicians to halt records request harassment is to begin invoicing for the records.

If, however, claimants and insureds need to have their own updated paperwork completed, then they must pay their own physicians’ fees. Physicians can only bill insurance companies for records requests made by insurers directly to their offices.

What happens when a doctor resigns on behalf of an employee?

No doctor can resign a work position on behalf of his patient – only employees can sign a work resignation. As most of you know I do not recommend “resigning” for disability absences for any reason. There is a big difference between “resigning” and “leaving work because of a disability.” Please see the more specific articles I’ve written on “Resignation” from this blog. You can use the “Search” box from the Homepage.

Can neuropsychological raw data be sent to a non-neuropsychologist?

As far as I know, “No.” Raw data can only be provided to a person who is qualified to interpret it. Some credentialed psychologists have specialties in neuropsychology, but in general, only other neuropsychologists are permitted to have access to neuropsychology raw data. In the past this was a recommendation of the American Psychological Association and is made to protect the integrity of the tests.

A couple of years ago a caller ranted on and on about how she was able to get a copy of her own raw data and that the rules have changed……I’m not aware of that and didn’t take the information as truthful since I never verified it. If anyone can send me legitimate proof of any changes in raw data distribution I’d appreciate it.

Read Full Post »

Friday Q & A

Q&AWho has oversight of the Maine Attorney Generals office?

No one. Technically, the Maine AG is appointed by a highly political legislature but isn’t accountable to the same Ethics Committee congressional members are responsible to. As Attorney General, Janet Mills operated under her own authoritarian rulership and I have long maintained the AG in Maine should be an elected office. Mills’ governorship is also likely to reflect her tendency toward overstepping her authority, but at least she’s responsible to the people now as an elected official and can be impeached. She may now find it a bit more difficult to inflict her authority on Maine’s people particularly if she follows through with placing tracking devices on citizen cars so we can be taxed for our travel. And, Maine’s a tourism state?

What’s the deal with insurance Claims’ Manuals? Can insurance companies really get caught with something if you get a copy?

In the past, a lot of fuss has been made over Claims Manuals, but the truth is that insurers rarely put “procedural” information in their claims manuals. For example, it would be impossible to take Unum’s Benefit Claims Manual and follow a claim from the time it is submitted through the process.

The Manuals give general guidelines as to  what the companies’ official positions are about certain things, however, managers can over ride the manual and investigate claims any way they want to. In terms of litigation, Claims Manuals aren’t that useful anymore and most insurers won’t even disclose them. At one time prior to the Multi-State Settlement there was hell to pay because Unum didn’t have an official “Manual” per se, although the company quickly put one together and alleged they had it all along.

Unum’s “Intranet” and inter-company emails probably have more information in them than any Claims Manual.

Does Unum have a good reputation?

Uh……no. Despite the fact I heard through the ranks that Unum spent quite a bit of money to “clean up the Internet” after the reassessment of claims in 2008, the company never really “walked the talk” of fair review. The Internet contains extremely negative claim information, and given Unum’s current negligence in administration it’s unlikely to get any better.

Unum has such a bad reputation in the UK that people actually took to the streets in protest to remove the computerized diagnostic system called ATOS that Unum supported and helped to set-up. Unum’s Individual Disability in the UK was discontinued but Unum UK is still selling employer Plans and causing mayhem wherever it goes.

I actually obtained a copy of one of Unum’s employer Plans from the UK and I was really dismayed. The Plans require an immediate IME on all claims and the claims themselves are managed primarily by employers. This may be consistent with the UK being a “socialist” country where most activities are controlled by the government, or government agencies. One good thing is that disputes are brought before a governmental arbitrator whose decisions are final.

At one time, Unum tried to establish disability policy markets in Africa and Japan, but that didn’t work. The Japanese work ethic didn’t understand the ethics of paying for insurance when you are sick when in their culture, many people work anyway. I also understood something shady also went on there, but it wasn’t clearly disclosed.

 As far as I know Unum was asked to stop selling their products in Japan and leave the country. Unum’s bad faith seems to have continued somewhat with Canada’s RBC although Unum Canada was sold and is entirely separate from Unum Group in the U.S..

My point is, that while Unum seems to have a foothold here in the United States, it’s reputation as a fair company is non-existent – internationally. Unum seems to cause the same havoc regardless of where it is.

So “no”, Unum does not have a good reputation and it’s almost inconceivable that US employers still spend their benefit dollars for coverage they know won’t pay. One might say the same for ALL Group insurance these days although Unum seems to cross the line more so than most. Companies can’t seem to “walk the talk” of fair and equitable claim review.

What do you know about the Unum Aspire program?

I’ve already written a post on Lindanee’s Blog dealing with Unum’s Aspire program, but the topic keeps coming up on the questions. Basically, Unum managers choose employees who have been “smoozing” them for a while and send them to Disneyland for a week for more brain washing.

I could never understand why adults craved a trip to Disneyland so much, but after working in a Peter Pan environment, it does make sense that Mickey Mouse might have become the company’s idol.

When Jim Orr III was CEO Unum awards were much more prestigious and respectful of accomplishment. “Rewarding” employees with a trip to Disneyland does not, in my opinion, honor anyone’s accomplishments particularly when middle age adults are “aspiring” to watch “Pirates of the Caribbean” when they’ve already seen the movie twice. Employee’s who actually win the trip to Disneyland should just say, “no thank you.”

 

Read Full Post »

CommentsDCS has been receiving so many questions that it’s difficult to keep up with lately. Here are a few questions I’ve received in the last week.

Is FMLA and ADA the same thing?

Insureds are often confused about FMLA and ADA. FMLA is an acronym for the Family Medical Leave Act and ADA is the American’s with Disabilities Act. FMLA and ADA are two separate federal laws.

FMLA runs consecutively with STD and is unpaid leave and job/benefits protection for a period of 12 weeks. Employees are entitled to FMLA after working 12 months and accumulating 1,250 work hours. FMLA entitlement is limited to 480 hours (12 weeks x 40 hours per week) but employees can continue to be paid by using up vacation and sick time.

Employers often go crazy when employers work fractional hours. It’s often a nightmare to keep track of, particularly when employees are out and back and out and back to work.

FMLA can involve an entirely different set of paperwork including physician certification. Basically, FMLA is a “permission” for unpaid leave, job protection, and continuation of payment of health and other benefits for a period of 12 weeks. After 12 weeks employers may terminate employment with the full buy in of the federal government. When they DO terminate employees they must offer COBRA, an expensive health insurance that charges insureds a 42% surcharge.

ADA, or Americans with Disabilities Act deals with employer accommodations for those who want to stay at work but require special “considerations” from employers. Amendments to ADA have given employers significant decision-making authority to either agree to workplace accommodation or turn it down.

There are now so many loopholes to ADA it’s difficult to support the law as having real benefit to employees. Those who are receiving STD, and who can return to work with accommodations, might be disappointed when employers refuse an ADA accommodation as unreasonable or an unreasonable burden. Bottom line, employers want healthy employees who are able to perform jobs the way they should be performed without accommodations.

What does the doctor mean when he says I can return to work with “limitations?”

A “limitation” is a work duty you may do, but only to a limited extent. For example, statements such as “Patient is limited to walking/standing not greater than 10-15 minutes” is a work limitation. Physicians often miss the boat in describing specific limitations particularly in complex situations.

Limitations are “assignments” of work activity you may only do to a limited extent. This is different from “restrictions” which are work duties you may never perform. For example, “This patient is permanent restricted from prolonged keyboarding” vs. “This patient is limited to intermittent keyboarding to 10-15 minutes.”

If your physician recommends you can return to work with limitations I strongly suggest that you contact your current employer for a return to work, or start looking for another job with a new employer.

Questions about Jim Orr III and Harold Chandler.

I’ve been getting a lot of questions about these two Unum CEOs lately. I worked for Jim Orr III as a Compensation Specialist in Unum Enterprise at the beginning of my career with Unum and found him to be an executive who had real concern for the employees. I attended a breakfast for claims handlers with CEO Orr who said, “Unum wouldn’t exist if it were not for you [pointing at all of us].” Jim Orr was personable, appreciative and ran Unum putting employees first.

Jim Orr III did everything he could to save the company, from starting the 1998 People Goals programs to granting employee Stock Options, to documenting company wide diversity programs. I considered Jim Orr III a CEO “of the people” so to speak. Unum’s lighthouse logo of “We see farther” was epitomized in the person of Jim Orr III.

In contrast, Harold Chandler literally stole our cheese. He and his Provident/Revere thuggery stormed the Portland, ME campus with a vengeance. I remember watching him arrive at the HOIII building on outer Congress Street surrounded by his “wise guy” bodyguards. The team of Chandler/Mohney/Arnold literally removed every employee benefit there was, from cafeteria subsidies to bonuses, to increasing the workweek from 38 to 40 hours, –it was a real mess.

Despite the deliberate awarding of employee stock options to encourage employees to stay during the merger, many employees said, “the hell with this” and left anyway. Internally, pronouncements were made directing claims handlers NOT to consider the opinions of treating physicians, and financial reserve figures were connected to BAS coding requiring managers to “validate” every claims decision. Autonomy to make independent claims decisions was removed and the company launched into a huge understaffed backlog that took Unum many years to crawl out from under.

When Jim Orr III was paid a $50M bonus, Harold Chandler quickly threatened suit if he was not paid the same. There are those today who allege Chandler and his wise guys ruined the company. I agree with that notion, but he did get his $50M.

What does 50% of pre-disability earnings mean?

Pre-disability earnings means the salary or wages you received just prior to your date of disability. Every disability policy contains provisions as to how “pre-disability earnings” is defined. Sometimes it’s defined as,” W-2 income” of year prior to disability or an average of 12. months earnings including (nor not) commissions and bonuses. It’s important to read in your policy how “pre-disability earnings” is actually defined. Benefits are always a percentage of calculated pre-disability earnings [50%, 60%, or 66.667%, rarely 70%] This type of benefit calculation is most common in ERISA Group Plans as compared to IDI policies where insureds actually buy a fixed stated amount of benefit.

Are neuropsychological tests wrong?

Not necessarily, but they are “opinionated” and in my opinion should not be classified as “objective evidence.” Neuropsychologists administering the exam choose a “battery of tests” that are supposed to represent diagnostic tools to evaluate the individual. However, in reality, insurance neuropsyche (claims handler slang) tests are set ups from the very beginning because insurance evaluators choose batteries of tests that evaluate, not the disability, but malingering and somatoform situations.

In any event, the insured is administered an unrelated “battery of tests” and the results are compared to statistically generated averaging within certain groups to determine the results. Once those results are obtained, evaluators then “interpret” the results. And this is considered “objective evidence?” I don’t agree.

Treating neuropsychologists should have input into the selection of the battery of tests and then have the opportunity of reviewing, and interpreting the raw data. Insurance neuropsyche tests are one of the most misused “stack the deck” evaluations used by insurers as back-up to deny claims.

 

 

 

Read Full Post »

Friday Q & A

Q&AWho actually makes claims decisions? I thought my doctor was the one who put me out on disability.

Quite a few insureds have the mistaken impression that once treating physicians adequately document a medical disability, the insurance company must pay benefits. This notion is really an “old claims tale” that is often communicated inaccurately on the Internet and elsewhere.

While it is true that only a physician can take you out of work, the opinions of treating physicians can be accepted, ignored, investigated and/or rejected outright. Disability insurers are NOT compelled to accept what your treating physicians certify to as “disability” and can override opinions simply by having medical information reviewed by those who are paid to support insurers and their agenda to deny claims.

In truth, internally, claims go through an investigative procedure of obtaining opinions from the insurance companies’ own resources – medical, vocational, team meeting, and managerial reviews. At the end of the line is a claims manager who looks at all of the recently obtained opinions and gives direction to the claims handlers to either pay or deny claims.

Claims managers have access to financial reserve information and can manipulate the timing, balancing approvals with denials, in order to meet unit financial profitability targets. Therefore, claims decisions are ultimately made by the insurers and their managers who “validate” claims decisions in order to maximize the meeting of profit goals and objectives. What your physicians report usually isn’t taken into consideration.

Can you explain what goes on with a “surveillance?”

This is actually a very good question because with today’s technology surveillance takes on a completely different form. Insurers encourage their customers to use online website portals and “Apps” while at the same time holding it against insureds if they have the medical wherewithal to deal with the technology.

Social media such as Facebook, LinkedIn, Twitter and My Space are always popular targets to obtain private information, particularly about activity. Online spying is successful and profitable because the general population is absolutely, without a doubt, HOOKED on the idea that everything in our lives MUST be shared with others either by “texting”, or posting it for everyone to see. We now know that FB sells private information to other sources and that nothing you post there is security protected. In my opinion,  social media addiction is an increasing problem in our culture exposing us to controls we may not really want.

Enter the insurance companies and their underhanded deceptive ways of obtaining information. Although they still do connect with G4S, HUB Enterprises etc. to send burly looking men in trucks and vans with blacked out windshields to spy on you, it is misleading to think “that’s all they’re doing.” Insureds seem to be more comforted witnessing a man hanging out of his truck window with a video recorder, than with covert social media spying no one sees or suspects.

Social media is now the number one source of adverse information insurers can find to discredit claims. And, disability insurers are not the only ones using it. Travelers has been looking at FB pages for clear evidences of “hazards and perils” in order to charge increased premium for auto and life insurance. It has always been true that anything posted on the Internet goes Global for the world to see. You post it anywhere, insurers will see it.

 

 

 

 

Read Full Post »

Friday Q & A

Q&A26We received some very interesting questions this week, so here goes!

Is gainful employment the same as work?

This is actually a very good question since “gainful” employment is NOT the same as work. The word “gainful” has a very specific meaning for disability insurance. ERISA Plans usually include a provision describing what “gainful” employment is, for example, “…60% of indexed pre-disability earnings.”

“Gainful employment” for private disability is used in the context of performing an “any occupation” investigation at the change in definition of disability. It sets gainful wage parameters preventing insurers from finding alternative occupations with wages lower than pre-disability earnings.

In this context one might say that all gainful employment is work, but NOT all work is gainful employment.

Can you talk a little more about Unum’s workplace harassment?

Actually, I’ve written several articles about Unum’s internal employee harassment and I suggest you Search from the Home Page if you’re looking for what Unum does. I’ll just give you a brief list here of Unum’s employee harassments:

  • Padding of personnel files with negative performance related comments to discredit employees, but support future termination. It has been reported that Unum’s managers often add adverse information to personal files even after employees have left the company.
  • Frequent probations for minor infractions.
  •  Managers discussing employee performance problems with peers and others in the unit to embarrass and humiliate.
  • Assignment of projects managers know employees will not be able to do. Managers deliberately set up employees for failure when they want to terminate them.
  • Denials of STD and FMLA applications for employees.
  • Relocation of work stations to outside of the unit areas to ostracize employees from peers.
  • Discrimination against women over 50 – age and gender discrimination, other human rights violations. Discrimination of men with health problems and HIV.
  • Uses company benefits against employees –using PTO time, allegations of misuse of company phones. Using PTO time for snow days…..
  • Negative performance noted for unsocial participation, for example, employee fails to volunteer for local food kitchens, does not attend unit lunches, beer fests etc.
  • Reporting of employee to HR for minor job performance issues.
  • Daily harassment to deny more and more claims. Denial of claims linked to performance reviews.

Although there are many other things Unum managers do to harass employees, I think you get the picture. Unum employees should always keep detailed journals of what’s happening during 1/1s, unit meetings, and internal procedures that are clearly unfair or biased.

Arthur Hackett at Unum – who is he?

I am chuckling to myself that someone asked this question. It always seemed a bit Charles Dickensish to me to have someone in Unum Complaints by the name of “Hackett” for indeed that’s what he did. I honestly don’t know if Arthur Hackett is still working in Unum Complaints, but if he is, it’s still laughable.

As with all of the Unum Complaint mouthpieces, Hackett defended the company line with a “we did nothing wrong” letter that served no purpose whatsoever. I think everyone knows by now that filing an internal Unum complaint is a waste of your time.

People are asking about Unum’s Robert Crispin again.

Please Search for “Robert Crispin” from the Home Page. This is a very interesting post.

What does it mean when my doctor says I can work with limitations?

A “limitation” is defined as work duties you may perform but only to a limited extent. This is in comparison to a “restriction” meaning you can’t perform the work duty at all. If your doctor documents that you may work, but with limitations, it is imperative that your physician be very specific as to what those limitations are.

For example, your doctor might say, “…this patient is limited to a maximum of 10 hours per week with employer accommodations for alternative sitting, standing, no prolonged keyboarding, or lifting overhead.” Depending on the occupation, insureds may or may not be able to return to their same occupations. Returning to work with limitations usually infers insureds can perform their job duties, but only to a limited extent.

The worst thing a treating physician can do is make a notation on a form, “…Patient is released to part-time work”, or “…Can perform part-time work.” This type of release gives no specific explanation as to why only part-time work is allowed and, clearly does not  identify what limitations exist. All “limitations” need to be specifically described.

Read Full Post »

Older Posts »

%d bloggers like this: