Feeds:
Posts
Comments

Archive for the ‘Uncategorized’ 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!

Read Full Post »

Can an IME physician refuse to give me a medical diagnosis and prognosis?

Those who ask this question do not understand the overall objective of insurance IMEs and IME physicians. The objective of a disability IME is to personally view the insured for the purpose of providing the insurance industry with written reports supporting non-payment business decisions.

IMEs are NOT intended to accurately diagnose, treat, or provide a prognosis for any medical or mental condition. Since IME physicians do not have a history of consultation or treatment with those they examine, it could actually be harmful for IME physicians to provide diagnoses or recommendations for treatment.

It’s important for insureds and claimants to know and accept the truth about insurance IMEs that rubber stamp management’s business decisions to deny more and more claims. If I were an insured I would not want any IME physician to give me medical advice – that’s not what they are paid to do.

Does Unum insurance have a cap?

Unum ERISA Plans pay a percentage of pre-disability earnings, 60% being the most common. However, the Plan will also stipulate a “maximum monthly benefit” such as $5,000-$10,000. While the maximum benefit is rarely reached by the employee rank and file, benefit maximums for executives are unattractive when earnings are greater than $100,000. This is why most highly paid executives also buy IDI polices to cover the additional earnings not paid from group Plans.

IDI policies pay the “scheduled amount” of monthly benefit located on the first page of IDI policies. Scheduled benefits can be increased by exercising future income increases and policies could contain COLA that will also increase benefit. Future increase riders and COLA are often limited in the number of FI allowed, or the number of years COLA is paid.

What is a mental disorder as defined by disability insurance?

For disability purposes, a mental disorder is defined as one located in the Diagnostic and Statistical Manual, DSM-5. If you want to know whether a diagnosis is classified as mental and nervous, look it up in the DSM-5 to see if it’s listed there, or ask your therapist. If it is listed, the diagnosis will be considered mental and nervous and subject to the mental and nervous provision.

I want to go to school while I’m on disability to prepare for another occupation. Is that OK?

Unfortunately, most insurers will interpret the ability to attend school and classes as having work capacity. In fact, it hasn’t been that long ago that Unum put the question about taking courses on its forms.

Each individual claim and situation, of course, will be different depending on what the impairment is, and what restrictions and limitations treating physicians are reporting. For example, if a claimant reports fatigue or chronic pain of some kind and yet is able to sit in a classroom three days a week….well, you can easily see how the insurer will interpret that as having at least part-time work capacity. Taking online classes gives you an Internet presence that can be hacked into at any time.

This is a good example of how insurance companies shoot themselves in the foot. Training for a new job will return insureds and claimants to work, it’s just that insurers do not want to wait that long. If insurers decide you have work capacity, the claim is usually denied and going to school could be one of the reasons.

Insurers wouldn’t be asking about it on forms if this were not the case.

Who was Steve Center?

Every now and then I get questions about “ghosts” from the Unum Life Insurance Company past. I believe Steve Center was President of Unum America and was one of then most strict, but colorful Unum executives. I knew him only briefly before he retired to help his wife run their Antique store in Scarborough, ME.

Who knows when Unum’s top executives actually knew about the merger with Chandler and his wise guys from Paul Revere and Provident. CEO Jim Orr III retired as did Steve Center, taking their golden parachutes with them.

Steve Center’s reputation for lining up women against the wall to check for runs in their panty hose will probably stay with him for a long time. Women employees always knew to keep extra panty hose (and heels) at their desks.

For the most part, Unum employees were afraid of Steve Center and made it a priority to stay clear of him for as long as possible.

 

Read Full Post »

Disability insurance companies thrive on information. In fact, insurers, assured that everyone who files a claim is dishonest, are paranoid that there is adverse information about you they don’t yet have.

There are only two ways insurers can obtain information about their insureds and claimants. First, they can engage in extensive surveillance and investigation, or they can ask you, or the people you know.

One form of “asking” is to require insureds to complete written “Questionnaires” that are wolves in sheep’s clothing. Unum’s update forms, for example, ask the age-old question, “Describe a typical day.” The truth is, those who are disabled rarely have “typical days” and have difficulty trying to describe patterns of living when they don’t exist.

Unfortunately, most insureds follow human nature (mostly in fear) and attempt to fill up the entire space allotted with information. This is exactly what Unum wants you to do even though it’s exactly the wrong response.

I think it’s fair to say that unless you are working and have unreported earnings, what you do with your day is not relevant to your claim or policy. The tendency of most people is to provide descriptions that include, “I get up in the. morning and have my orange juice, I use the computer, I watch TV, I go for a walk, I do my exercises, sleep for 4 hours etc.”

Some people include information used by insurers for immediate denial, such as, “I babysit my grandchildren, go out to dinner, I’m writing a book, set up for yard sale”, and the like. Some questionnaires are more detailed and want to know if you do laundry, mow lawns, grocery shop, hours spent on the computer etc. Disability insurance companies need to have this information so they can assess your work capacity and send your claim to the denial pile.

In my opinion, disability insurance questionnaires are designed by idiots. Since most activities currently asked about have nothing to do with policy definitions, wouldn’t it be more helpful to insurers to ask questions that DO matter? (Insurance management reading my Blog pay close attention here, you may get a spot award for these ideas!)

For the first 24 months, how about these questions?

  • Based on your last medical consultation with your treating physician what prior job tasks are you still unable to perform?
  • What treatment plan has your doctor discussed with you that includes a return to work in your own occupation?
  • Is your employer holding your job open for your return? Have you discussed a return to work with your employer? Is your employer supportive of return to work?
  • What needs to change in order for you to be able to return to work in your own occupation? (This question IS sometimes included on questionnaires.)

I really hate sometimes to give suggestions to insurance companies, but doesn’t it make more sense to ask questions that will encourage insureds to return to work, rather than trying to get them to admit they walk their dogs and do their laundry?

After 24 months questionnaires could be more relevant to the situation like:

  • Have you contacted SSA to request a copy of its “Red Book” describing return to work programs? Are you aware of SSA’s liberal return to work programs and the fact that you can work part-time while receiving SSDI?
  • Are you medically able to perform some gainful work at home that could earn part-time income and contribute to your financial support?
  • Do you need information concerning SSA’s part-time work criteria?

I think you get the point I’m trying to make. Right now insurance questionnaires aren’t designed to return claimants and insureds to work, but to challenge their credibility with deceptively obtained “snoop dogging.”

It is also true that if insurers where to ask the above suggested questions, they would also need to train their claims handlers to use the information in ways that could help people return to work. Insurers don’t want to take the time, or spend the money to do that.

Currently, insurance forms and questionnaires ask the wrong questions for the wrong reasons. Don’t fall into the trap of “filling up the page with details.” Answer truthfully what you are asked and nothing more.

Still, in my. opinion its lunacy to keep asking insureds whether they do their own laundry, walk the dog, and buy groceries. If only insurance companies were to use their heads and really try to help people perhaps they would have healthier bottom lines.

 

 

 

 

Read Full Post »

Colette of Moultrie, GA on
I established Unum Insurance through my employer in 2008-2011 and the both of them are very unethical. I enrolled in short-term disability insurance as well as long-term disability insurance paying into the program for numerous of years and suffered an injury that I still have until this day. I was injured at work and this company gave me the run around about my insurance until the day I was wrongfully terminated. I asked for reimbursement and they refused. They are deceitful and in the business of making money off their consumers.
(I wonder whether this claimant understood that Unum’s STD Plans do not pay for work injury covered by Worker’s Compensation. While I’m sure that Unum does not function fairly or works to PAY claims rather than deny, STD is generally not paid to employees injured at work. In fact, Unum has been handing off other disabilities as Worker’s Comp when in fact the disabilities aren’t work injuries at all! Inside information provided confirms that Unum’s STD reviews are slanted for the purpose of denying most of them.)
Bethany of Southside, AL on
They have every reason under the Sun to not pay my claim, I have received the run around. They are heartless. They do not want to pay no matter what. My surgeon and my PCP sent in all documentation to support my absence for a month, with it being an emergency surgery. No preexisting condition or anything that my policy wouldn’t cover and Unum still keeps coming up with ridiculous reasons not to pay when it’s obvious I could not work which was most certainly clear. No food on the table, had every reason to receive money from a company I have paid into every week. They do not care.
(This post really says it all doesn’t it? Unum has a very poor public reputation in both the US and Great Britain. Middle class ERISA employees have less than a 50% chance of having a Unum paid claim. The bare truth is, Unum STD/LTD coverage does not provide employees with any kind of financial security and should not be depended on long-term.)
Michael of Somersworth, NH on
Unum yet again has wrongfully deprived another sick/injured person of their disability insurance. I have 3 specialist physicians ALL stating my need for disability and yet Unum has wrongfully denied this based on their part-time primary care doctors evaluation. On top of this, there have been 3 employees including a supervisor and contracted physician that have blatantly lied (on a recorded line) about physicians letters claiming my ability to return to work when in fact none exist. The contracted physician created a written statement claiming that one of my specialist physicians stated that “pt is ready to return to occupation at full-time.” This never happened and infuriated my physician so much that he wrote a strongly worded letter back to Unum and the contracted physician correcting their lies. In my opinion, never trust anything an Unum employee tells you and NEVER pay for any services that Unum has to offer.
(I don’t know how many times I’ve written on the Blog that Unum doesn’t tell the truth. Yet, insureds seem to want to believe what they are told by the claims handlers. The truth is, Unum reps (and their Directors) misrepresent medical records for the purpose of denying more claims. And, it does make treating physicians furious. The problem is that Unum doesn’t care that the physician “wrote a rebuttal letter”; once the company has its mind make up it rarely changes even when they are clearly wrong. Employers need to do their homework and research Unum’s payment history for group STD/LTD. Once they do, most employers should refuse to do business with Unum unless they have a full service agreement guaranteeing certain levels of payment and customer service.)
Marie of Winston-Salem, NC on
My doctor put me off work for 3 weeks because of heart palpitations and the stress of my job. I was also put on blood pressure medication but we could not get it down. The claims expert informed me that I was not sick enough to stay off work. I asked him, “should I have ignored my doctor’s request and gone to work?” He could not answer, but he did say that everyone gets stressed at work, but it should not have kept me off work. REALLY!!? Why am I paying into this plan?!! THIS IS CRAZY! I was waiting on this money to pay my bills. REALLY!??
(This is a very common Unum complaint. There are two things Unum never accepts as cause for disability: 1) stress and 2) inability to drive. Unum’s internal policy regarding stress is that “everybody has work stress” and it isn’t a cause for disability. Also, Unum discounts reports of inability to drive except for “blindness”. This claims handler overstepped his boundary since it’s not up to Unum’s reps to to say someone can or cannot work. Unum’s reps are making more and more value judgments these days and that’s why DCS, Inc. recommends communications in writing only.)

Read Full Post »

Although you won’t find many attorneys publicizing their stats, DCS, Inc. does so on a regular basis. I am always happy to share the successes DCS, Inc. has in managing private disability claims.

Currently, there are 970,441 reads on Lindanee’s Blog and I’m  very excited since it looks like the Blog will go over 1M by the end of the year. The Blog is a great success and provides disability claim insurance to those who manage their disability claims on their own.

Readership consists of claimants, insureds, attorneys, insurance companies and their outsourced facilities, treating physicians, British Unum insureds, and other medical healthcare providers, insurance “snoop” investigators (potential hackers), insurance claims handlers, state insurance departments and many others. I have a wide readership from not only those who need information to manage claims, but those professionals such as attorneys, who are looking for information they don’t have.

Lindanee’s Blog offers 1,682 article posts in 120 categories. The Blog receives from 350-800 reads per day, the highest being 970 in one day. The Blog has 208 subscribed followers. Clients continue to receive a monthly newsletter containing private information not otherwise published on the Blog.

My consulting practice continually shows a 98% success rate increasing on occasion to 99% overall. This breaks down to 100% success for initial applications. Currently, I have 101 clients who are receiving benefits on a regular basis. These clients receive assistance for requested updates, form completion, administrative services and consulting advice.

Since January 10 clients chose to resolve their claims through settlement using expert attorneys I referred them to. DCS, Inc. assists clients with over 20M in financial reserve. We continue to charge a yearly fixed fee, and do not engage in expensive back/forward fee structures that are particularly costly to the ERISA folks.

DCS, Inc. is a proactive and pre-emptive company. Insureds and claimants generally want to continue to receive benefits, and DCS, Inc.’s objectives are to assist clients with claim management to do exactly that. Although there can never be a guarantee of benefit approval, DCS, Inc. relies on my expert claim field experience to provide much-needed knowledgeable assistance.

It doesn’t make much sense to wait until your insurance company denies your claim before seeking assistance, this time from an attorney charging back/and forward fees. Once claims are denied it is far too late to avoid the expensive process of litigation that may take years.

Overall, DCS, Inc. and Lindanee’s Blog is a highly successful company for the benefit of insureds and claimants with private disability insurance. Our statistics indicating a 98% success rate clearly marks the difference between a claims expert and waiting for claims to be denied.

July 2017 was a very successful month. Please feel free to give me a call if you wish more information concerning DCS, Inc. and services offered to insureds. The company is doing very well.


Comment Note:

The most common impairments managed by DCS, Inc. include failed back/neck surgery, chronic back pain, chronic pain, cognitive and mental vs. physical issues. FMS/CFS, POTS, RSD, MS and HIV. Therefore, DCS, Inc. statistics are not derived from ” easy terminal” claims such as cancer or Stage IV cardiac issues.

It takes some expertise to manage the types of claims accepted in my client block.

 

 

Read Full Post »

Friday Q & A

Employee Resignations?

Quite a few questions have been received by DCS, Inc. again inquiring about resignations. There is a very popular post on Lindanee’s Blog having to do with resignations – “Resignations –  A Disability No-No. Please use the search tool from the Home Page to find it.

In short, employees should never “resign” when leaving work for disability reasons. “Resigning” means “I quit.” Employees who are recommended by their physicians to stop working go out on medical leave, they don’t quit. There is a difference. For details please read my prior article as mentioned above.

What does it mean when my Unum rep changes so often?

For Unum frequent changes in claims handlers is normal and means that as a company Unum has a retention problem, although the tendency to frequently fire people causes part of the problem. Claims handlers are assigned anywhere from 150-250 claims as a “block of claims” and when they leave those claims must be assigned to someone else.

Most often at Unum, the new claims handler begins to manage newly assigned claims in different directions causing havoc and confusion on the part of claimants and insureds. Some new claims handlers are highly critical of the way the “terminated rep” managed the claims and suddenly claimants are hit with a barrage of new requests.

Not retaining experienced, qualified employees, and/or frequently firing them, always has been a part of Unum’s continuity problem. Please note, new claims handlers may appear on files when it is decided claims should be sent to the Extended Duration Unit. (EDU) Although this. used to be a good sign to insureds, today EDU claims are risk managed even when SSDI has been awarded.

In addition to the above, Unum insureds and claimants should be aware that Unum plays musical chairs with their employees making it very difficult to have one claims handler for the duration of the claim.

How do I ask my doctor for an extension of my STD?

Well….you don’t.

DCS, Inc. recommends that patients on disability provide their physicians with a copy of their job descriptions. Office visits should include discussions about what material and substantial duties (job tasks) you are unable to do. Physicians aren’t mind readers and disability is ALWAYS work related, even LTD.

When you talk about your job descriptions and what you can and can’t do, physicians usually come to their own conclusions as to whether STD should be extended or not. Keeping treating physicians informed of what you are physically or mentally able to do keeps everyone on the same page regarding validation of disability to the insurance company,

Talking openly with treating physicians about what you are realistically able to do, or not do may also prompt your physician to examine you more carefully. Always make sure your official job description is located in your patient file so the physician can refer to it at any time. Disabled patients should always keep their physicians up to date regarding functional capacity.

Unum offered me a settlement and then promptly took it back. Why?

In my opinion, Unum settlement offers are now used to open the door to extensive file investigations. In the past, asking Unum for a lump sum settlement was a safe option for any insured or claimant. However, that is no longer the case, and DCS, Inc. is no longer recommending Unum settlements as claim resolutions.

In addition, some claimants describe to me getting attorneys involved who attempt to over negotiate settlement amounts. Unum will NOT negotiate lump-sum settlements outside of court to any great extent, and will instantly withdraw offers if pushed by an aggressive attorney to up the ante.

Until the public has a better sense of what is going on in Unum’s settlement area, it’s a good idea to stay away from asking Unum for lump-sum settlements. Some time ago, I received a call from Unum’s newly terminated settlement director who informed me the financial department was being used to risk manage claims, something that wasn’t usually done.

One gentleman claimant reported to me that shortly after he asked Unum for a settlement the settlement rep requested his SSDI file through Lucens, then wanted a field visit (not required by his policy), and more recently requested an IME. Unfortunately, this claimant may lose his benefits because he asked Unum for a settlement.

This is an issue claimants and insureds need to be very careful of.

 

 

 

Read Full Post »

As a former Lead Benefit Specialist with both Unum Life and UnumProvident I’ve seen thousands of communications from claimants from every major US disability insurer. During those conversations I have been called quite a few names – some good, and some very bad. Learning what to say and not say to insurers who are looking to deny claims is a learning process and takes time.

Here are a few “tips” if you are managing your claim on your own. DCS, Inc.’s clients are not recommended to speak with any insurer on the phone, but if you take the risk and do it anyway, please pay attention.

Be brief. Anytime a claim is filed with a disability insurer, the claims handlers will attempt to interview you by phone. Unum, for example, is required to contact you for such an interview within 3-5 days of assigning your claim to a claims examiner. There is a template list of questions approved by management, and all claims handlers are trained to plan the communication in such a way to encourage you to provide information about yourself and your family.

In today’s technological terms, family member names and other information are like “gold” to insurance companies. From the data provided by you they are able to locate family Facebook sites and obtain additional information about your activities. I do not recommend participation in any social media if you are receiving disability claim benefits.

You will also be asked “What happened?” “Name your treating physicians.” “What are your prescribed medications?” “What other income do you have?” “Have you applied for SSDI, Worker’s Comp etc.?” And so on. Of course, insureds should always answer questions honestly but do not elaborate. Don’t offer any explanations beyond what is being asked. Answer only what is asked and stop. I know that’s extremely hard, since your first instinct is to want the claims examiner to believe you. Remember, the claims examiner’s agenda is to close your claim if they can. Toward that end, everything you say can be used against you. Answer only the questions asked, then stop talking. Remember, DCS, Inc. does not recommend speaking with any insurance company on the phone.

Resist the temptation to tell the story of your life. I am reminded of one scenario in particular that happened so often in the Unum claims department.

The claims handler calls the insured for the initial interview and the claimant begins to speak in what seems like an endless story of his/her life. In that conversation, he says “It’s going to be hard for me because my wife was just diagnosed with leukemia.” Well, its likely Unum will say you filed a disability claim because you want to take care of your wife. Anything not directly related to your impairment should not be discussed with your insurer. Remember, an insurance company cannot hold against you what you do not say.

Here’s another example, “ My wife is working, so I’m taking care of my kids.” Or “ I’m taking care of my grandchildren.” I cannot stress enough how often that kind of information is held against insureds.  In addition, DO NOT WRITE LONG LETTERS TO Unum or any other disability insurer. The assumption is, if you can type or write long 10-15 page letters, you can work. Resist the temptation to send any communication more than 1 page to Unum. You are not obligated to tell the insurance company anything that is not directly related to your insurance policy and your impairment. No family information should be given and nothing not addressed in your policy should be discussed.

ABC – “Always Be Cool. As I mentioned in the intro to this article, I have been called everything although my favorite was “Attila the Hun.” I’ve listened to profanity, anger, tears, frustration, threats, desperation, phone slams, you name it, and if you can think it, I’ve probably been called it. The truth is, though, the claims handler knows something you don’t. When you lose your cool, Unum’s in control and you aren’t. Please don’t ever let an insurance company control you or your claim.

Since everything is documented, anything you say, and the manner in which you say it, will be held against you. Disability insurance companies are not concerned with what you say, or, call them. They just want your claim to go away.

Insurers generally are only concerned in using what you say as a reason to peg you as a “nut” and support your claim for denial. Whenever you feel like calling the claims examiner names, or telling Unum to “stuff it,” go into a closet let it all out, then write a short, polite letter discussing only the facts of your claim, limited to one page, making sure to keep a copy. You are talking to an insurance company who does not care what you call them; they don’t care what you think; and, clearly they don’t care if you get paid or not.

Never download medical information from the Internet and send it in. Why not? Unum doesn’t care. They won’t read it. It may get pitched. It will be used against you. If Unum has made a decision to disregard the opinions of your primary care physician, why would they care about medical information YOU downloaded from the Internet about your impairment? Technically, if you send it in, it is supposed to be a part of the Administrative Record (your claim file). I had an attorney from Unum’s legal department tell me once “All this downloaded information means is that the claimant’s attorney knows how to use the Internet and save PDF documents.”

Unum is scanning and imaging all paper now in Chattanooga, so it would be interesting to see just how much of  downloaded “stuff” from the Internet is actually scanned on the permanent record. (Image) When it was an “all paper claim” most of this information “hit the can.” If your occupation was as a Secretary, for example, sitting at a computer, downloading, and printing a lot of paperwork to send to Unum could be interpreted as work capacity. Don’t bother, no insurance company cares how much you can download from the Internet.

Maintain a journal. Getting angry will not serve you well when dealing with any disability insurer. Make sure you start a journal or diary and keep records of all conversations you have with Unum or any other company. Ask for names of Consultants, Managers, Directors, Vocational and Medical reviewers and document the substance of every conversation and call you have and receive from your disability insurer. Sometimes the claims examiners are not professional with you, so make sure you document those conversations as well.

Document, document, document. DCS, Inc. uses Evernote to document all activities on client claims. You should do the same if you are managing your disability claim alone.


I know it is difficult enough trying to get a disability claim paid these days. It’s a frustrating process. But, name calling, accusations, anger and profanity just come back to haunt you in the end. Some insurers even questions whether or not insureds should be in counseling because of the way they behave when speaking with the insurance company.

Engaging in such conversation gives the insurance company control over you and your claim. Don’t give them that kind of power. DCS, Inc. clients have a much easier road in this regard since they have the expert help needed to navigate the system safely.

 

Read Full Post »

Older Posts »

%d bloggers like this: