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Archive for the ‘Social Security Disability’ Category

GENEX and other third-party SSDI chasers like Allsup and Advocator Group, are getting more criticism as insurers are putting pressure on claimants to sign up for GENEX services.

Unum actually has a long history with GENEX going all the way back prior to the Multi-State Settlement Agreement when the company was a wholly owned subsidiary of Unum. At the time, Regulators were of the opinion there was a conflict of interest and GENEX split off from Unum, became its own company, and returned as Unum’s paper chaser and advocate assisting claimants with applications for SSDI.

GENEX’s services are marketed to the ERISA folks as a “free” service. Attempts by attorneys looking to chase down the money trail between Unum and GENEX proved to be unproductive in various lawsuits. We simply don’t know who gets the 25% fee from SSA, or who pays for what in the connection between GENEX and Unum.

In any event, the issue today involves GENEX’s frequent calls to claimants chasing business often on a daily basis until claimants respond. Although a great deal of pressure in placed on ERISA claimants to “sign-up” what isn’t told to claimants is that they do not have to use GENEX for SSDI assistance.

In fact, DCS, Inc. never recommended GENEX, Allsup or Advocator Group to assist with client applications for SSDI, and for very good reasons. Reports from claimant customers allege that for most applications claims are processed by paralegals, SSA deadlines are missed, and non-responsive GENEX reps often do not keep claimants informed of their SSDI status.

There is, of course, the obvious. These organizations keep insurers informed and give access to all SSA information. In my opinion, these three organizations are back-doors to SSDI disclosure and clearly GENEX provides Unum with all of the information it needs to bring claims into question.

For example, it is suspicioned that GENEX recently informed Unum a claimant owned several condos bringing on red-flag inquiries as to additional income. In reality, the condos are held in Trust and represent “passive rental income”, but Unum won’t see that aspect of it.

Claimants are being pressured and squeezed to sign up for GENEX when services aren’t that great and the main motivation is to create a direct link for Unum with SSDI file information, even when claimants refuse to sign the SSDI Authorizations.

Recently, when it became clear a claimant did not want to use GENEX, Unum decided arbitrarily to offset and reduce benefits for an estimated SSDI award. Seems a bit punitive to me – either the claimant sign on with GENEX or we’ll estimate SSDI benefits, a clear violation of Unum’s ERISA Plans and potentially an unfair trade practice.

Nearly all Unum’s “offset” provisions say that Unum will NOT offset for estimates as long as claimants continue the process to apply for SSDI including all appeals. Now, apparently, if claimants don’t sign up for GENEX, Unum is willing to risk Plan violations in order to benefit from reduced financial reserves when estimates are coded into the BAS payment system.

It’s simple, Unum thinks you’re stupid, and sadly the company gets away with it! Once again, there are provisions in Unum’s ERISA Plans clearly stating Unum won’t “offset an estimate” when claimants have attorneys and are continuing with the appeals process. Clearly, claimants who do not have copies of their ERISA Plans, or who have not read them, wouldn’t know the difference.

DCS, Inc. recommends that all claimants retain local, specialized SSDI attorneys. These attorneys are all equally good because that’s all they do. They also are familiar with the regional administrative law judges if claims reach that level of appeal. Fees are all paid on contingency so claimants pay nothing until they get paid therefore there is no out-of-pocket initial cost to claimants.

In addition, claimants have a specific source of reference and can contact their attorneys at any time for SSDI status. I was also informed after the initial publication of this article that  retaining your own attorney creates attorney-client privilege meaning Unum has no access to information you provide to your attorney. That’s a good thing!

Feedback concerning Advocator Group has all been negative. Allsup has authorizations allowing them to have access to claimants’ bank accounts. None of the three services seem to be what they say they are.

And YES, you can notify Unum and GENEX you no longer want to use their services, but I strongly suggest doing this before and initial SSDI decision is made. Local attorneys may not want to jump into applications during appeals. although my experience is that many attorneys will take the cases.

In my opinion, all three organizations represent the insurer, not you. Claimants are much better off with local attorneys of their own who can be held responsible for their work. By the way, claimants who aren’t satisfied with their SSDI attorneys can write to SSA and have fees reduced. It’s my understanding that GENEX paperwork asks you to waive some of these rights.

DCS, Inc. does not recommend third-party companies as advocates for SSDI. This also goes for national SSDI attorneys advertising on TV and/or YouTube.

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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.

 

 

 

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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.)

 

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DCS, Inc. received many calls this month regarding Unum’s SSDI paper chaser, Lucens, and its frequent requests for signed Authorizations to obtain SSA information. In recent weeks, it appears the company is sending out second notices, particularly to Unum’s claimants who have been on claim for quite some time.

This makes sense. SSDI calculation errors are probably more likely for someone who has been on claim a long time, sometimes 10 years or more. You may recall it was my opinion that Unum is chasing every nickel and dime due to overpayment miscalculations, and increases in earnings due to additional earnings.

Claimants are still panicking about these requests to sign Authorizations. If you read your ERISA Plans, there is no Plan burden of proof that any claimant must turn over their SSDI file to Unum. I’m assuming those who receive SSDI have already provided Unum with a copy of the original approval letter, probably years ago.

Besides, no one should be signing a Lucens Authorization valid for two years. Unum is also after the SSA Form 831 to find out under which listing the applicant was approved. It’s not rocket science to figure out that Unum is after Mental Health listing so that it can limit benefits to 24 months. This is in addition to attempting to recalculate a fictitious overpayment over many years of offsets.

If you would like more information concerning this reminder, please contact me directly.

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What’s the difference between 60% of indexed pre-disability earnings and 80% whether you’re working or not?

This IS a very confusing ERISA Plan provision for some. 60% of   pre-disability earnings is the amount of your benefit. Although some Plans pay 50% and even 66.6667%, the most common payout is 60% of pre-disability earnings.

Then, “indexing” comes into play when calculations are made for “Residual” or part-time   benefit calculations. (I’ve explained indexing in detail in another post on this blog.) The general concept of “indexing” is to adjust pre-disability earnings for inflation, even though in today’s terms inflation does not equate to large amounts of money.

The 80% mentioned in most ERISA Plans relates to maximum part-time earnings to remain on claim. In other words, claimants must maintain a 20% earnings loss in order to keep receiving partial earnings. Another way of looking at this is that claimants cannot earn over 80% of their pre-disability benefit and still remain on claim.

Can a Functional Capacities Evaluation be ordered without a doctor’s prescription?

In general “no.” An FCE requires significant physical exertion on the part of the insured or claimant. Insurance companies typically request IMEs for those who have FMS, chronic back pain, or those who report limited physical endurance.

FCEs can put certain individuals at risk for injury or severe exacerbation of symptoms. Therefore, the practice has always been for insurers to contact treating physicians and ask for a prescription, or “buy-in” for FCEs. However, the insurance industry’s abuse of the process enlightened physicians to refuse to write FCE prescriptions.

Insurance companies aren’t stupid either. They often try “sneaky” tactics such as contacting physicians who haven’t treated insureds in a long time, or contacting doctors without insureds knowing about it. Sometimes facilities administering FCEs work with insurers to not require prescriptions.

Beyond this explanation, insureds should contact me if they have any additional questions about what to do in these situations.

What’s the skinny on Lucens?

Apparently, Unum’s third-party paper chaser, Lucens is continuing to harass claimants to sign Authorizations to obtain SSDI information. DCS, Inc. received several calls last week asking about Lucens and SSDI Authorizations.

Let me say once again that there are NO Plan or contractual provisions requiring claimants to provide any insurer with copies of their SSDI records – financial or otherwise.

Therefore, if you don’t want to sign the Authorization, you can “just say no.” Unum is looking for two things, 1) financial records to re-calculate offsets to allege, “you owe us money”, and 2) evidences in the SSA listing that claims were approved in whole, or in part, for mental and nervous illness.

Those who want to keep their SSA information privileged need not sign any Authorizations to release SSDI files, and claimants should so inform Lucens they “respectfully decline.”

 

 

 

 

 

 

 

 

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Who am I talking to anyway?

Insureds and claimants report seeing different numbers showing up on their phones for verbal “interviews.” Although most Unum insureds are used to seeing the Maine area code of 207, area codes such as 617 and others are coming up on caller IDs. My guess is that Unum is once again outsourcing administrative work to other companies and agencies. DCS, Inc. recommends that all communications should be in writing anyway, therefore there is no need to be “watching the phone” to find out if Unum is calling.

This is even more important today when Unum’s reps are looking for more reasons to deny claims. Today, claimants are probably unaware who is on the other line, particularly if it happens to be a HUB investigator. if you request all communications in writing, you’ll always know who you’re talking to!

GENEX

Speaking of phone calls….Unum insureds are receiving phone calls from GENEX, a company with a long on again, off again relationship with Unum. A decade ago, Unum used GENEX to assist claimants in obtaining SSDI, but also to conduct interviews, any occupation investigations and triage claim reviews. At the time it was surmised that GENEX was a fully owned subsidiary until regulators pointed out the conflict of interest.

It’s interesting to me that since then, the actual relationship of GENEX and Unum remains a mystery. Although attorneys tried to “follow the money” in order to discredit the company, it’s still not very clear who pays what company for which service.

Claimants are reporting to me that GENEX is selling its services to aid in the application of SSDI as a mandatory service offered by Unum. GENEX’ involvement in the SSDI application process is not sold by the company as an option or choice, but as a mandatory service. Cold calls from GENEX take claimants by surprise, and again they may find themselves buying into the service without realizing what they are getting in to.

No claimant is required to use GENEX in the SSDI application process, but you wouldn’t really know it. Claimants report multiple problems with GENEX to include, no attorney involvement, lack of communication, long application wait times, and general “bungling” of applications. DCS, Inc. doesn’t recommend GENEX at all since the company doesn’t really represent you, but Unum. What GENEX knows, Unum knows. Those who wish to keep their SSDI information private shouldn’t consider using GENEX at all.

It’s also my understanding that GENEX reviews Unum’s disability claims and is involved with providing other services in addition to SSDI assistance. Getting a cold call from GENEX is also a scary thing for those who may not know who the company  is.

DCS, Inc. recommends local, specialized SSDI attorneys who have knowledge of, and have worked with, county administrative SSDI judges in the state. There is no requirement that any claimant must use GENEX services, and “no”, you need not take their calls.

At one time Unum actually told claimants they would not allow a reduction of the 25% attorney fee in repayment calculations unless GENEX was used – an unfair and discriminative trade practice. To my knowledge Unum no longer does that, and claimants can choose who they want to represent them.

I recommend local experienced attorneys who represent YOU, not an outside third-party looking to benefit from an offset.

By the way, I don’t recommend ANY outside third-party for SSDI assistance. This includes Allsup and Advocator Group.

 

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Unum’s new reactive strategies with Lucens and SSDI is to remove as much benefit from claimants’ pockets as possible. The newest process involves offsets from benefits for SSDI money that hasn’t yet been received for dependent coverage.

Unum’s ERISA Plans allow for an offset (reduction) of monthly benefits for amounts awarded for both Primary and Family SSDI. The newer polices also say that Unum can reduce benefits for amounts “entitled to” as well as received.

Unum’s new process is to calculate overpayments for both Primary and estimated Family SSDI benefits at the same time even though most families have not even applied for dependent awards. This means that overpayment amounts communicated to claimants are actually more than they received for Primary awards alone.

Therefore, Unum will not only reduce monthly benefits for Primary SSDI, but for dependent awards even though they have not been applied for yet. In addition, the overpayment relative to the expected dependent awards will be deducted from benefits as well.

While technically Unum has the right to do estimate offsets it is clearly unfair to do so. Claimants cannot repay what they haven’t received yet. In addition, the tone of Unum’s SSDI letters is threatening to say the least. In fact, ALL of Unum’s written communications have become unfriendly, and threatening. Insurance companies in general, including Unum, are beginning to sound like the corner mafioso demanding a 10% vig.

It is important that all SSDI applicants realize their dependents under 18 are entitled to half of the Primary awarded SSDI amount and apply for dependent awards along with the initial application. You can be sure that Unum will offset from your benefits amounts for dependent awards when YOU are awarded whether you’ve actually received the dependent retroactive award or not.

Those who wait to apply for dependent coverage will be financially harmed until they receive the retroactive dependent money and turn it over to Unum. Unfortunately, it is still true that Unum could collect every dime alleged to be owed to them and still deny claims.

Unum’s letters are also deceptive when it refers to overpayment due as “a overpayment agreement”. There has been no agreement! Unum calculates the overpayment and then demands, via a very threatening letter, repayment. If it doesn’t receive it, Unum removes any monies owed anyway. There is no AGREEMENT, or meeting of the minds as to what is alleged due and how it should be paid back.

But wait – read this…….Here is a direct quotation from one of Unum’s repayment letters:

“The repayment agreement [no agreement, more like a demand] is based on your current overpayment balance of…. If your overpayment balance increases for any reason in the future we may revise this repayment agreement. [Unclear. SSDI COLA is NOT a future offset from benefits, or is Unum planning on making more mistakes?]

Watch this…“Additionally, if your claim ends [is denied] with a overpayment balance due, your full final net benefit will be applied to reduce the overpayment rather than be issued to you. If there remains a overpayment balance after applying your final benefit, you will be responsible for full repayment of the remaining balance within 30 days of the date your claim ends. [If Unum denies your claim and a overpayment is due you still have to pay it back.]”

Simply put, if you die on January 20th, your surviving spouse is owed 11 days of monthly benefit plus 3 x gross benefit for Survivor Benefits. If a overpayment is still outstanding, Unum will take both amounts before paying the surviving spouse what’s left over.

And finally, “If your net monthly benefit increases for any reason [COLA, Employer Accommodation, Child Care Reimbursement, etc.] the net monthly increase will also be applied toward the overpayment until it has been paid in full.”

Based on the above actual letter sent to a claimant, it is clear Unum intends to take everything if a overpayment is due. Positioning overpayments as a repayment agreement is also deception, although Unum’s Payment Option Form is proof claimants intend to repay  SSDI overpayments when due.

And, by the way, inceases in SSDI for earnings will increase Unum’s offset.

Even in situations where claimants want to avoid SSDI overpayments with estimates Unum still takes them to the cleaners. Estimated amounts removed from monthly benefits are not reimbursed to claimants if Unum denies the claim. The company rationale is, “the claimants would have been entitled to SSDI for the period we paid the claim.” No refund of estimates allowed!

Hey Unum …. WOULD have been approved is not the same as APPROVED. Again, out-of-contract strategy designed to collect as soon as possible and place claimants in a harmful position financially. Don’t ever make the mistake of thinking any disability insurance company cares for your health, well-being, or state of finances!

The message here is that Unum’s ERISA folks are going to get screwed for SSDI overpayments and estimates in addition to many other things Unum does to target and deny legitimate claims.

It is always important to be aware and act smart when dealing with disability claims. If you have any questions with your own situation please feel free to give me a call.

 

 

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