Archive for the ‘Returning to Work’ Category

Step back in to woriDCS receives many questions and emails about returning to work after a period of disability. Although most disability insurers shoot themselves in the foot by forcing all claimants to apply for SSDI (a status of permanent disability), I find a small percentage of individuals eventually want to return to work in some capacity even when they have been receiving benefits for many years.

Given the current uncertainty of receiving private disability benefits long-term many claimants are now considering returning to work even if they are not fully recovered. And to be honest, returning to work after a disability should be a multi-step preparation for work not a “one day I’m totally disabled, and the next I’m working full-time.”

I’ve put together a checklist preparation for an eventual return to work after a period of disability. While I’ve written several previous articles on the subject of return to work, I’m hoping you will find this slightly different perspective helpful to you as you prepare to rejoin the workforce.

In order to return to work full or part-time, insureds should ask themselves the following questions:

Have I discussed my desire to return to work with my doctor? What does he/she think about it?

Unfortunately, insureds and claimants who have set their minds to go back to work often “talk their treating physicians” into releasing them even when the docs are skeptical about the prospect. Physicians want to support their patients and will give the go ahead for a return to work even when a successful outcome is questionable.

Although psychologically insureds and claimants are anxious to return to work, their desire is sometimes predicated on feelings of guilt, loss of income, and lack of support rather than accurate medical assessments and continued restrictions and limitations.

Frank and honest discussions between insureds and their treating physicians should always be the first step in preparing for return to work. Listen carefully to what your doctors tell you, and abide by their opinions and recommendations.

Do I have the physical and mental capacity to return to work?

Returning to work requires employees to have the physical stamina to remain on the job at least 8 hours per day 5 days a week. If you have been out of work for some time, it’s always a good idea to test your ability to perform basic physical tasks without becoming fatigued.

Are you physically fit? Those who expect to return to work should be able to sit, walk, stand for 1 hour or more intermittently without fatigue, or the necessity to take a break, or have the ability to do 5 METS on a treadmill or demonstrate the ability to perform at least 10-15 minutes of aerobic exercise. Even those who had sedentary positions were required to exhibit physical fitness  sufficient to endure 8 hours without fatigue.

To prepare physically for a return to work insureds should try a “work hardening program” whereby they can engage in volunteer activities a few hours a week and increase hours and frequency over a period of several months. If fatigue, general weakness, or exacerbation of chronic symptoms such as pain occur, returning to work should be postponed until your physical endurance and symptoms improve.

After all, employers have a right to expect that you will be able to perform jobs for the amount of time, and number of days needed. In order to meet employer expectations, you need to be physically fit – not necessarily gym-workout perfect, but able to work 40 hours without a significant amount of daily fatigue. Alternate standing, sitting, walking for up to 1-2 hours in an 8-hour workday is not unreasonable even for sedentary positions.

Are you mentally ready?

Working requires the mental ability to follow directions, solve problems, work with people in social work environments, multi-tasking, complex problem solving, and having the ability to remember and learn new information. Even those who expect to return to work part-time are required to think clearly and handle problems in a timely fashion.

Individuals who return to work should be free of daily or weekly headaches, confusion when fatigued, over-sensitivity, and possess the mental capacity to remember facts and figures short-term. Employers look for those who can interact with others and engage in teamwork to get the job done. Proper socialization (getting along) and the ability to absorb and remember new information are essential skills in the workplace.

Do I need additional training or licenses in my career field?

Believe it or not your qualifications to perform certain careers have probably changed several times since you’ve been out on disability particularly in medical, scientific and technological fields. Knowing how to use office equipment, new electronic devices and software, conferencing, and electronic data exchanges etc. are critical job skills in todays competitive workforce.

Employers are looking for employees who are technologically up-to-date and who do not need to be trained in basic computer skills. Medical professions have also changed significantly in the last 10 years. Licensure requirements may have also changed. In order to interest an employer in your skills you need to be up-to-date in your field of expertise, and additional courses and training may be necessary.

Will my age or physical appearance work against me?

There’s no point in trying to be “politically correct” here. Employers are reluctant to hire those who are over 50, overweight, or present themselves in physical appearance as odd or outside of protocols for any particular business. Despite the highest level of qualifications for particular jobs, employers often hire younger and more attractive individuals who are less qualified because they do not want to “buy any future problems.”

By “more attractive” I mean employment candidates who do not have any visible tattoos, nose or lip rings, and who present themselves as acceptable within the societal norms rather than outside of them.

Age and gender discrimination, although illegal, is also a common reality and is very difficult to prove. If you’ve been out on disability for some time, it’s always a good idea to at least consider future employability in these terms. Mock interviews seem to help some insureds with answering difficult interview questions.

What do I say to a future employer about my disability if they ask?

Hum….the dreaded question about missing time on the resume. The bottom line is that future employers need to know that you can be relied upon to be a good worker – to be at work on time, day after day, and have the ability to perform the applied-for job in accordance with employer expectations.

When asked about missing time on a resume, it’s always best to give a short but honest answer, “Yes, I had a period of medical disability, however I’d like to point out my current skills I can bring to the job as your employee.” Notice this response does not go into any detail about the cause of disability, but focused on your ability to bring knowledge and expertise to the  job.

Also I used the term “medical disability” as a generic term that includes both physical and mental impairment. There is no need to provide any future employer with details concerning a medical disability and in fact it would be inappropriate for the interviewer to ask you questions about it. Focus on selling yourself and your skills as they are now rather than describing in detail periods when you were unable to work at all.


One of the worst things disabled persons can do is to return to work prematurely, go back out on disability, return to work, and back out again. Although this consultant is of the opinion that working is physically and emotionally healthy and those who can work, should work, I am also of the opinion that those who have not been in the workforce for some time should prepare themselves both physically and mentally before accepting employment.

Private disability insureds have a great deal to lose by returning to a workforce in which they will eventually not be successful. Although SSA has “ticket to work” programs (see SSA’s “Redbook), the loss of SSDI (having been forced to apply and repay lump-sum money) could be a real pain with recurrent disability.

Of course, those who have adequately prepared to return to work enjoy their productivity and are able to move forward having a quality of life they didn’t have while disabled. These are the successes that most insureds look forward to.

I encourage all insureds to consider return to work if it is medically possible to do so. Unfortunately, not all medical impairment is repairable sufficient to be able to return to work in any capacity.

Returning to work after a period of disability requires preparation, re-training, and new perspectives on selling oneself in a competitive work environment.

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Friday Q & A

Q&A ButtonI have been on disability for the last five years. Unum forced me to apply for SSDI and I was approved. Since my health improved I’d like to return to work, but I hate to give up my SSDI and benefits. What should I do?

DCS receives many inquiries about returning to work after a period of disability. In fact, at least one of my prior posts deals with this subject in detail and is one of the most frequently viewed. It does seem to become a life choice when considering whether a return to work might be in the cards.

Claimants are put in a Catch-22 position by insurers to apply for SSDI when in fact they might not yet be ready to throw in the towel for physical total and permanent disability. So….in order to avoid the inevitable offset or reduction from benefits, claimants have no other choice BUT to apply for benefits and hope SSA approves them.

In way, one could say that the offset provision for SSDI “enables” claimants to develop the mind-set of disability even when a return to work in some capacity is possible.

On the other hand, it’s always been my experience in talking with perhaps thousands of insureds and claimants over the years that our “American work ethic” often pushes claimants toward unreasonable expectations of return to work when in fact it isn’t possible.

Returning to work after a period of disability (especially a long one) is more than just being able to perform a job. It’s having to be somewhere every day, living up to performance expectations of a boss, commuting back and forth to work, not to mention stress in the workplace and potential child care problems.

It’s also expensive to return to work – new clothes have to be purchased, perhaps even a new haircut, and more attention as to how one looks and is perceived in the workplace. All of the above should be considered before making any type of decision to return to work in any capacity.

The worst thing that can possibly happen is to return to work, give up SSDI and benefits, and then not be able to maintain, or stay at work very long. That situation is a potential disaster. Therefore, DCS recommends that claimants discuss “work hardening programs” prior to making any decision to return to work on a permanent basis.

“Work hardening” is a planned schedule of gradual temporary work or volunteer activity that requires claimants to be at a particular place, performing job tasks, in an effort to evaluate realistically what he/she can physically do.

I recommend claimants start cautiously such as volunteering 1-2 times per week and then gradually increasing hours over 1-2 months to see if a return to a paying job is realistic and possible.

Although most claimants are overly optimistic about returning to work, it is often not possible when one considers the toll of stress, fatigue, and the need for consistent reliability. After all, employers expect employees to be present at work 5 days a week and be able to perform the job as it is expected to be performed.

In many ways, private disability “conditions” claimants to think of themselves as totally disabled, and it would be difficult to “give up” benefits and SSDI to return to a competitive workplace. Returning to work without attempting “work hardening” is a recipe for disaster!

Although SSDI does allow part-time work, it is often not worth it to claimants to report earnings and have benefit reductions for both SSDI and part-time earning. It’s almost not worth the effort financially.

However, returning to work, like many other things in life requires planning and certainty that once you actually go back to work, you are healthy enough to stay there.

Returning to work in any capacity should be positioned very carefully by treating physicians since most insurers accept part-time capacity, but not permanently. Eventually, insurers get into “if you can work 24 hours why can’t you work 40?” Oops,  not exactly what you intended, right?

DCS takes the position that it is healthy to work if you can. At the same time, we encourage planning, and testing work capacity before any permanent decisions are made, such as through a work hardening program of some kind.

Claimants are often surprised to find after a week of working how fatigued they are, and how much worse their health seems to be. Returning to work should be planned in conjunction with the support of a treating physician, a work hardening program of some kind, and an “on paper” look-see as to financial impact.

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RehabDCS has been getting quite a few questions from insureds concerning disability rehabilitation and return to work assistance programs. Although nearly all group disability policies contain provisions for rehab, they are rarely used in lieu of denying claims outright.

Under certain circumstances, rehab assistance and compensation for child care while on rehab can be extremely helpful to those who have some work capacity. Not reading disability policies and Plans is the primary reason why claimants miss out on opportunities that may be beneficial to them.

Here is the provisional language from one of Unum’s LTD policies:


Unum has a vocational Rehabilitation and Return to Work Assistance program available to assist you in returning to work. WE will determine whether you are eligible for this program, at our sole discretion. In order to be eligible for rehabilitation services and benefits, you must be medically able to engage in a return to work program.

Your claim file will be reviewed by one of Unum’s rehabilitation professionals to determine if a rehabilitation program might help you return to gainful employment. As your file is reviewed, medical and vocational information will be analyzed to determine an appropriate return to work program.

We will make the final determination of your eligibility for participation in the program.

We will prove you with a written Rehabilitation and Return to Work Assistance plan developed specifically for you.

The rehabilitation program may include at our sole discretion, but is not limited to, the following services and benefits:

  • coordination with your Employer to assist you to return to work;
  • adaptive equipment or job accommodations to allow you to work;
  • vocational evaluation to determine how your disability may impact your employment options;
  • job placement services
  • resume preparation;
  • job seeking skills training; or
  • education and retraining expenses for a new occupation.

This particular rehab wording pays “an additional disability benefit of 10% of your gross disability payment to a maximum benefit of $1,000 per month” and will continue to pay a monthly benefit for 3 months after your disability ends.

Claimants should notice immediately that participation in Unum’s rehab programs is at “Unum’s sole discretion.” In other words claimants cannot force Unum to offer rehab simply because they ask for it.

Although rehab programs can benefit those who have work capacity some caution must be taken to ensure any rehab program offered is explicitly detailed in writing. Some Unum policies also allow the company to deny claims when claimants are given part-time work capacity by their physicians, but do not return to work.

In the past, I’ve seen Unum deny claims after entering into rehab programs when claimants are released by their physicians, but then cannot physically endure the rigors of returning to work in any way.

Without specific written rehab expectations written by treating physicians that the medical release given is for the purposes of rehab and work hardening only, insurers will exercise their right to deny claims if a work release exists, but no return to work actually takes place.

Make no mistake – the intended purpose of rehab provisions is to eventually terminate claims because claimants are able to return to work successfully. No insurer is out there working with claimants out of the goodness of their hearts because it’s the “right thing to do.”

Another pitfall that some claimants fall into is thinking too optimistically about their actual physical capacity for work and actually “talking their physicians into” medical releases that are unrealistic to various medical conditions.

Although “disability guilt” is a very common phenomenon, entering into a rehabilitation program prematurely, or having unrealistic expectations about return to work, can often cause the loss of benefits before claimants are actually able to remain at work long-term. “Thinking and wanting” to return to work and “being able to work long-term” are often two different things.

DCS supports return to work programs and will help claimants work through the process, but in a way that is advantageous to them.  We want to make sure the proposed rehab program is reasonable and the written agreement includes details particularly about what happens if claimants are unable to continue working and need to go back on total disability.

Working is healthy, both emotionally and physically, and those who can work should work.

Claimants are also allowed to work while receiving SSDI according to the limitations below. Many claimants are unaware that they can keep their SSDI while earning less than $1,090 per month in 2015. In combination with Unum’s WIB program for the first 12 months, claimants can actually benefit and get a fresh start.

Claimants should always consider return to work expectations carefully including a realistic view of fatigue and energy levels, and physical ability to remain at work long-term once a return to work plan is started. In addition, it is extremely important to obtain any rehab program in writing from insurers before obtaining any medical release.

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Part time helpOne of the most interesting aspects of managing disability claims is the ever-present possibility of insureds and claimants returning to work. Although I am not asked to write about returning to work that often, I am of the opinion the subject should probably be addressed more often than it is.

Returning to work after a period of disability is more involved than most people think. “Working” for someone else requires a great deal more than just performing job tasks for a paycheck. Among other things, working requires employees to “be somewhere” every day and to have the physical and mental endurance to perform job tasks on a regular basis. Most people could probably work a week with poor health, but it is the permanent and regular nature of employment that can become a problem when re-entering the workforce.

To begin, insureds and claimants should have a frank and honest discussion with their physicians prior to considering a return to work. Although most physicians would be inclined to release patients for work upon their request, the question still remains whether or not a person who has not worked in years has the physical capacity to “be somewhere every day” and remain able to perform a job permanently.

It does not do insureds any good to prematurely attempt work and begin an “in and out” of disability claim process eventually leading to total disability again. Therefore, first and foremost, a decision to return to work should be made by insureds in conjunction with their treating physicians considering the possible effects of fatigue and recurrence of symptoms. DCS, Inc. recommends to insureds that they consider a “work hardening” program for a period of time before sending out resumes in search of full-time work.

A “work hardening” program can be as simple as “showing up” for volunteer work on a regular basis to determine any physical endurance limitations. Or, “work hardening” can be a more organized effort such as finding a menial part-time job working 1 or 2 hours per week and gradually increasing the number of hours worked to reach full-time in a month or so. Depending on the amount of time insureds have been on disability, former employers may agree to a formalized work hardening schedule allowing insureds to come back to work at full capacity over time.

Most claimants find that work hardening programs pinpoint physical exertion levels that rarely support full-time work. The worst thing that can happen is that insureds push themselves into full-time work prematurely and later discover they just can’t do it.

In addition, insureds and claimants may want to take pencil to paper and, in combination with the terms of their policies describing RTW and SSDI awards, actually figure out what their disability benefit would be if they returned to work part-time. Most ERISA group plans contain a Work Incentive Benefit (WIB) program whereby claimants could possibly work part-time for 12 months and keep both work earnings and full benefits for a period of 12 months. Of course, keep in mind that SSDI awards are still offsets from benefits.

Some claimants may actually attempt a part-time return to work when in fact, financially, they would be worse off. Group insurers shoot themselves in the foot by strong arming claimants into filing for SSDI. Once awarded, claimants may find it isn’t feasible financially to return to work part-time if at all.

Nevertheless, anyone hoping to re-enter a competitive workforce after more than a year on disability is already behind their peers in keeping up with technological advances and new information related to their education and skill set. Prospective employers will want to know if the individual they hire is up to date and has the physical and mental capacity to do the job well. Missing employment periods and lack of current training may prove to be a problem when constructing a new resume and employers will question whether candidates for employment can actually return to the workforce after not working for long periods of time.

Returning to work also requires money, reliable transportation, and gas. First, depending on what kind of work insureds apply for, they will need to buy appropriate attire. Insureds need to dress appropriate for the job, and have reliable transportation that doesn’t break down all the time. Some disabled persons actually rely on others to get around and a return to work may involve buying a car or looking into alternative transit systems. Also, there should be sufficient money available to buy gas until the first paycheck is received.

Although these suggestions may seem common sense, some disabled persons literally have to start over in order to return to work.

Finally, if there are dependents at home arrangements have to be made for child care and the expense of child care should be considered into the return to work financial plan. Sometimes the financial advantage of returning to work is literally “eaten up” by expensive child care costs.

DCS supports the idea that “working is healthy” and if claimants can work, they should work. Still, the system of private disability insurance is such that it forces claimants to apply for total disability SSDI benefits that are hard to give up once approved. Financially, returning to work may actually mean a loss of income and there is no incentive for claimants to perform work even when they can.

In my experience as a consultant, claimants return to work when private benefits are denied, or there is fear they will be denied.

In any event, returning to work is healthy, both physically and mentally, but after a period of disability, it should be planned and realistic. The risk of having to go out on disability again should always be considered as well as putting a work hardening program into place for a period of time to test endurance and fatigue levels.

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SeveProblemral problems have come up recently involving claimants who return to work part-time while receiving STD and expect to continue to receive residual LTD benefits in the future. Employers are not well-informed as to the “Minimum Hours Worked” provisions in group Plans requiring claimants to be working a minimum number of hours in order to be eligible to receive LTD.

Most policies specifically require 20-30 hours of minimum work time in order to be eligible for LTD. Most insurers attempt to interpret LTD group provisions to mean that in the case of a return to work part-time during STD, claimants must return to the required number of hours in order to be eligible for LTD.

I would maintain, however, that dates of disability do not change when claims transition from STD to LTD. Claimants must be working the minimum number of hours just prior to their “date of disability“. Therefore, if a claimant was working 30 hours just prior to his date of disability but returned to part-time work of 20 hours, he still met the minimum hours requirement prior to his date of disability.

These are the types of issues employers can’t explain to you because they don’t know anything about the provisions in their own group Plans.  And…I’m sure benefits have been denied as a result of unknowledgeable claims handlers and managers.

Once again, calls to DCS have indicated that claimants haven’t bothered to obtain copies of their SPD (Summary Plan Descriptions) or Certificate Booklets (Plan or policies) prior to filing for STD or returning to work. I can’t write enough about the importance of obtaining, reading and understanding one’s group Plan before going out on disability.

The “Minimum Hours Worked” provision can be significant consideration prior to filing any ERISA claim.

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Honesty Works!

Truth2Hypothetically, suppose a former heating and plumming technician had to go out on Unum disability for his back. After a year or so, fearful that he wouldn’t have a career to return to, he created a plumming business and began to hire people to do the work here and there until such time as he could return and run the business full-time. To promote his new business this claimant created a Facebook page and website.

Since this winter’s harsh weather produced quite a few broken pipes, Unum’s claimant began to perform jobs for which he earned and was paid by check several thousand dollars. In his mind the money was untraceable if he pocketed the money and didn’t run it through his business. When it came time to fill out Unum’s forms asking, “Have you performed work of any kind?”,  he responded “No.”

To make matters worse, Unum’s claimant had not obtained a copy of his policy and of course did not have an opportunity to learn about part-time work, Work Incentive Benefit, or residual earnings. Fearful that Unum would deny his benefits if he reported the income, this claimant chose to keep silent and not report the few thousand dollars he pocketed. Instead he chose to engage in insurance fraud by falsely reporting to Unum “No” when asked about working and reported earnings.

Eventually, Unum discovered his business and when confronted with a Unum field rep at his door the claimant gave it up. Fearful of Unum’s reaction which was, “you might as well be honest about it”, withdrew his claim for $1,750/month in order to avoid prosecution for fraud. Not realizing Unum could refer him to the state attorney general regardless of whether he withdrew his claim or not,  the claimant became a nervous wreck and waited by his door for the police to arrive.

This claimant would have been so much better off to have obtained a copy of his group LTD plan early on, and have a clear understanding that he still would have been eligible for benefits if he returned to work part-time. He could have informed Unum, “I created a business in anticipation of returning to work and I performed several jobs in the month of January earning $2,000. I wasn’t sure what my capacity for work was, so I tried several jobs to see if I could do it. I created a business so that I would have a means to return to work in the future.”

That’s the truth, and that’s what the claimant should have said to Unum from the beginning. He could have kept his benefits and received payment for residual earnings under the WIB program, but instead chose to hide income and misrepresent his ability to work on forms. 

Honesty works. The truth is always preferable to dishonesty particularly in today’s environment when insurers are reporting fraud more than ever. In some cases, however, insureds and claimants may feel that meeting dishonest insurers on the same dishonest battlefield will ensure continuation of benefits. With today’s technology, Unum, or any other insurance company, will be able to locate business information very quickly.

This kind of thinking lands individuals in jail. It is never OK to be dishonest when reporting information to an insurance company. Claimants should always utilize the part-time work provisions of the policy if it is possible to return to work in a reduced capacity.

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RehabNearly all Unum policies contain provisions offering rehabilitation assistance. And, nearly all insureds, optimistic about possible returns to work, hope for a time when they can take advantage of Unum’s assistance to go back to work doing something other than their own occupations. Insureds and claimants may find, however, that instead of getting assistance to return to work in some capacity, their claims are suddenly denied.

Of late, claimants are reporting to DCS Unum’s offers of rehab assistance resulted in recent claim denials to bolster end of the year profitability. This is something we’ve always known about Unum’s rehab services, but it is extremely unfair to offer assistance and then suddenly throw claimants under the train. Unum’s usual strategy is to initially encourage rehab services but once work releases are obtained from treating physicians, claims are suddenly denied instead. The strategy is an age-old “bait and switch” scheme for the purpose of denying claims.

In order for Unum to even consider rehabilitation services it must be “clarified” with treating physicians that claimants have the physical and/or emotional capability of returning to work in some capacity, after all Unum’s motives are to help claimants “get off claim.” Treating physicians are contacted to obtain their “buy-in” of Unum’s rehab services but once given, it’s bye-bye claim.

Unfortunately, physicians aren’t savvy enough to realize they need to limit their permissions and re-write medical restrictions and limitations for rehab only. For example, a physician could document, “Patient is released to 3-4 hours of non-exacerbating clerical training per week as able for insurance rehabilitation services only. Should patient not be able to consistently sustain the above schedule, she is immediately returned to restrictions precluding work and is again considered medically totally disabled. This release is valid only through the first two-week of re-training at which time they will be re-evaluated.”

Statements such as the above limit any work release under specific conditions and time periods making it more difficult for Unum to allege physicians “returned the claimant to work full-time.” Remember, Unum doesn’t offer anything without a specific agenda in mind to deny claims. DCS always recommends obtaining signed rehab agreements prior to agreeing to participate in any Unum rehab program. Dialog with treating physicians is also very important so that appropriate releases to participate can be written limiting scope and time.

The idea of Unum rehab is viewed favorably by insureds because of the emotional roller coaster of not being able to work, guilt, family and financial pressure and many other emotions that unfortunately blind side insureds into accepting the reality of their physical capabilities. Human nature, cultural mores, and societal norms often create a optimisim for returning to work, when work in real-time is impossible.

As a result, Unum often takes advantage of the vulnerability insureds have regarding work by artificially creating schemes of rehab assistance designed to deny claims after a certain period of time. Without realizing it, claimants jump in with both feet and quickly find out too late they made a mistake.

DCS recommends that all insureds and claimants considering rehab assistance from Unum do the following:

  1. Have frank conversations with all treating physicians as to your realistic ability to sustain any work activity prior to agreeing to any Unum rehab plan. Discuss limitations in ability and setting time limits for work hardening programs. Review any “release” given by your doctor for rehab before it is sent or provided to Unum. If the release doesn’t limit the scope and time period of the work trial, ask your doctor to write it again. Rehab releases should mention a return to total disability if the patient is unable to sustain the activity.
  2. Get it in writing. Unum isn’t known for “good faith and fair dealing.” Make sure the rehab agreement represents YOUR interests and not just Unum’s. Don’t sign any agreement you aren’t happy with just because it offers to pay for minimal training.
  3. Insist on rehab that will provide enough services to accomplish what you want to do.
  4. Don’t settle for rehab that won’t result in sufficient income after Unum terminates the claim. Opt for employment services as well.

Although Unum’s policies “look good” because they contain rehab provisions, there is always a “catch” to the deal. Once physicians give an unrestricted work release, Unum can deny claims. Consider “Unum’s rehab deal” carefully, particularly this time of year.

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