Archive for the ‘Scams’ Category

This is just a reminder that September is the end of third-quarter profitability results for insurance companies.  After the 15th of August, most insurers, particularly Unum Group will begin to find new claim targets to manipulate and plan for terminations.

If you begin to receive increased requests for information, notice surveillance, are notified by your physicians that insurers are harassing for patient records, receive field visit requests etc., your claim is on the target list for third-quarter profitability results.

Unum’s “hungry vulture” will be looking for vulnerable claims and will be engaging in unfair practices such as alleging physical impairments are mental and nervous limited to 24 months. Other insurers such as The Hartford, Reliance Standard, Lincoln National, Liberty Mutual, CIGNA, Aetna etc. generally engage in the same practices.

Insurers will be asking for increased Independent Medical Evaluations while they still have time to get the results back by the end of September.

Please feel free to give me a call to discuss your claim if you notice increased requests that should be managed to avoid the “hungry vulture” for third quarter!

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First there is a request for your SSDI Award Letter. Then a letter arrives from Lucens asking you to sign an Authorization releasing financial SSA information. Next, a letter arrives requesting all SSA 1099’s relating to SSDI payments. Finally, a letter arrives informing you that you owe Unum an excessive amount in overpayment since Unum overpaid you. Whenever is it going to end?

Do you get the impression Unum is fishing for something? In my opinion, the company’s targeting of SSDI (including all of the ERISA folks), and past and present IDI “Residual” insureds to recalculate SSDI offsets and earnings is for the purpose of, well let’s say, “creative accounting” to arrive at large overpayments due. Every time Unum’s management fixates on a new financial target, they keep coming up with different answers that costs claimants and insureds money.

The ultimate goal of such internal projects is to reduce claimant benefits to $0 (increasing cash flow) until the alleged overpayments are paid back. Although Unum is well-known for its fictitious overpayments resulting from recalculations, Unum’s new initiative involving a new outsourced company, Lucens, appears to be targeting every one to “verify” SSDI, other offsets, and residual earnings.

With respect to SSDI offset calculations, SSA’s initial approval letter contains all of the information needed for Unum to calculate an accurate offset and overpayment amount. Requesting SSA 1099’s will not be helpful to Unum in this regard since only the total amount of benefit received is recorded on the 1099 and the amount of COLA increase is not broken out.

Of course, Unum’s ERISA Plans do not offset for COLA so the 1099’s won’t be helpful. Why  provide documentation to Unum (or Lucens) that Unum will misrepresent as total benefits (offsets) when it includes COLA amounts? The only figure Unum is permitted to offset is the amount of the original award. This figure is always on the initial award letter SSA sends out to those with approved benefits.

There are so many SSDI complicated situations I couldn’t begin to explain them here, but I am reminded of cases where a disabled father’s children are awarded dependent coverage that goes to the mother, the (custodial spouse). The claimant is already getting hit twice and doesn’t need Unum to allege he owes back more money when he doesn’t.

I don’t think anyone would challenge Unum’s overpayment recalculation due to error within a reasonable amount of time – this makes sense, correct the error and move on. But, when hundreds of people, having been on claim for many years begin receiving letters from Unum alleging large overpayments, this is an indication of a “pattern of practice”, or initiative to demand repayment of overpayments that are merely the result of recalculation to deliberately generate cash flow. It’s insurance fraud, and it needs to be addressed legally.

In my opinion, Unum Group is not to be trusted in any manner when dealing with disability claims, including any other review process related to indemnity products. As I described in prior posts, inside information indicates the company is silently doing away with many of its departments while cloaking the fact they no longer exist. How can you trust a company like that?

Employees are also terminated as the company outsources work to companies like Lucens, also partners in recalculating financial information to meet Unum’s goals and objectives. It’s unfortunate, but in my opinion Lucens, as a company, will eventually inherit Unum’s very poor public reputation as collaborators in Unum’s schemes. When you take on the world’s worst disability insurance company as a client, there is a certainty of future negative goodwill.

In any event, Unum is requesting financial information for the purpose of recalculating offsets and overpayments for the purpose of collecting huge overpayments by reducing benefits to $0.

If this is happening to you please send me an email; I may have more information to provide at a later time.

And, by the way, those claimants who have opted for estimated SSDI deductions from benefits may also be at risk. There have been a few reported cases that Unum deducted estimates for SSDI from benefits, denied claims, and won’t give the money back even if claimants weren’t awarded SSDI at the time of the denial.

General consensus from several reputable sources indicates it’s better to have Unum chasing you for recovery of overpayment than the other way around. While DCS, Inc. supports timely repayment of what is owed, it’s no longer a good idea to opt for estimated deductions for SSDI.







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Unum’s Scamming Again

In nearly two decades Unum Group continues to fail in creative imagination! When caught red-handed by the multi-state regulators in 2004, Unum didn’t improve it’s claims practices, but became an old mare of a different color and continued its abuse of authority under different titles, names and practices.

One of Unum’s old “scams” being reported is to send files for financial review only to have them emerge from Aesop’s Fables accounting methods alleging claimants owe exorbitant overpayments, sometimes in the hundreds of thousands of dollars.

A recent case reported to me describes a claim situation where Unum alleges a claimant owes $316,000 because his employer changed its group plan from a $10,000 max benefit to a $6,000 max benefit. Upon further investigation I found out that Unum alleges the claimant’s employer specifically wanted the change “retroactive.”

First of all, let’s take a look at a few things we need to know here:

  1. Employer’s can only change the writing of their group Plans during the annual enrollment period. Plans may not be changed at any other time during the year.
  2. When employer Plans ARE changed, either a written Amendment is issued to the old policy with an effective date, or a new Plan is issued with a new effective date.
  3. The policy in effect as of the claimant’s date of disability is the policy that is adjudicated. While employers may in fact change the provisions of their Plans in the future, the new changes do DO NOT affect a prior policy.

Disability policies are subject to contract law. Therefore, when a claimant files a claim, the policy that was in force as of his/her date of disability is the policy that is used for the duration of the claim. New Employer changes to future Plans with different Effective Dates of Coverage have no effect on prior claims.

Therefore, if the claimant in this case has a Plan with a $10,000 max benefit with an Effective Date of Coverage prior to, or on his date of disability, Unum cannot make any future employer changes to the Plan “retroactive” as it alleges.

This is a situation that makes me wonder if the individuals reviewing Unum claims are    competent or not. It’s not rocket science here – the policy in force as of the claimant’s date of disability is the policy that is adjudicated.

The malicious attempts of Unum to force claimants to repay money that is not owed, at least in my mind, is deliberate fraud. Unum immediately reduces monthly benefits to $0 to recover its alleged overpayments and claimants are caught helpless by a Robber Baron profiting from its own internal financial scams.

As an expert in this area, and also considering Unum’s “suspension” of benefits tactics, I suspect the company may have a cash flow problem. Why would the company “suspend” benefits for little cause, and also allege large overpayments in order to reduce benefits to $0? This isn’t a financial reserve problem, but a cash flow problem.

Anyone who finds themselves victimized by Unum’s financial scams should insist on seeing calculations, spreadsheets, and other data that proves Unum has a right to recover money from their benefits.

In my opinion, this is insurance fraud and is well-deserving of a RICO case involving racketeering. It’s not fair to claimants, and it needs to be addressed in the courts of public opinion.


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