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On August 11th I wrote a post titled, “Unum’s Paranoia About Recording Calls”. (Please refer to the original post.)

However, as part of the continuing saga, apparently Unum was so upset about its own recording calls allegations that it contacted the claimant’s employer who proceeded to withdraw its support of the claim and claimant!

I spoke to the claimant yesterday who proceeded to tell me, “My employer says I’m in a lot of trouble”, he reported. “How do I prove I actually didn’t record anything? Now, my claim is in jeopardy, and my employer is mad as hell.”

If you recall, Unum insisted the claimant sign a statement that he will never record a call ever again, and provide Unum with a copy of the alleged recordings. I have to ask myself what Unum is so scared of that it has to threaten its insureds/claimants to NOT record calls. Is Unum recording calls? Its voice mail message says “calls may be recorded.” Which calls? Can the insured obtain copies of all calls recorded by Unum?

It almost seems incredible to me that we have a major insurance company acting like an unprofessional spoiled brat. This is one of the reasons why I always recommend “in writing” communications only.

Come on, Unum. Your claimant told you he didn’t record anything, why don’t you just move on and play nicely on the see-saw.

 

 

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As a Unum insured have you ever noticed that there seems to be no end to the letters, requests and phone calls you receive? As soon as you send in what Unum requested, within 30 days there’s yet another letter or phone call? The concept of keeping insureds and claimants “engaged” is required of all claims handlers in one way or another.

One of the worst situations claims management has to contend with internally is that of having a “backlog of untouched claims.” Viewed as lost profits and lost opportunities for denials, backlogs can literally cost insurers millions. In order to control/prevent outlandish backlogs of unreviewed claims, processes are put in place that requires claims handlers to “touch” claims at least every thirty days. Employee performance is then evaluated to determine whether or not claims handlers can in fact manage the 250 or so claims they have in their “block.”

Unum’s process includes a series of “flups” (follow-ups) created on the Navilink system that continuously shows next steps on the “primary plan” deemed appropriate by the claims handlers or roundtable reviewers. Each day, a list of flips shows up on the handler’s desktop, basically representing work for that day. Failure to take action on a “flup” and setting a new one is cause for termination.

So says, one Unum terminated employee who shared with me she was fired and accused. of not “taking care of a flup” while documenting that she had. Oops. This can easily happen in the course of a day and a few hundred flups, but Unum’s managers take this sort of thing seriously.

The ultimate result of continuously requesting information is to keep insureds/claimants constantly reminded of where they are getting their money from and who has control over it. Frequent requests for information, phone calls, and harassing patient records requests keeps insureds stressed out – and BUSY. Claims handlers are always “in touch”, or placing insureds on their fetch list every thirty days.

Even with taking care of daily flups it is possible for claims handlers to have backlogs. Managers keep a stern eye on the chasing of information from insureds with continuous reminders, checks and threats of termination when backlogs aren’t managed well.

Again, from the insureds perspective, receiving constant letters and phone calls from insurers is harassing to the point of creating anxiety and depression. This is yet another supportive argument for not speaking with Unum on the phone. At least the phone calls seem to come to an end when you put a stop to it.

The concept of insurance “Risk Management” involves the 1)assessment of the claim and setting a “primary plan direction”, 2) identifying the probable outcome (denial), 3) reviewing steps to bring about the planned outcome, and 4) controlling what requests need to happen to bring about the desired result.

Nothing inside a private disability insurance company happens by trial and error. Assessing, identifying, reviewing and controlling is at the heart of any claims review process, not only at Unum, but other insurance companies as well.

Nevertheless, if you’ve ever wondered why you keep getting multiple letters, phone calls etc. from your insurer, it’s probably because a “flup” came due on a 30-day cycle of “keeping you engaged”, and constantly reminded where your money comes from.

 

 

 

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(One of my long-time clients recently asked me to write her story in the hopes it would help others who became addicted with pain medications while on disability. “Lisa” is not my client’s real name. The message of this story, however, can be a lesson for those who continue to take prescribed pain medications.)

I came to know Lisa in the fall of 2011 when she phoned me to seek consulting services for a disability claim with Unum.  Since her employer allowed her to work at home, With stern conviction, Lisa explained to me that she suspected Unum was trying to deny her claim. Diagnosed with herniated disks, failed back surgeries and chronic pain, she described situations in which she felt Unum was managing her claim unfairly. I accepted her case.

Over the next several years many issues with Unum came to light and were resolved one by one, giving me the opportunity to speak with Lisa on many occasions. I began to notice that during our phone calls, Lisa’s tone and thought patterns began to change. She slurred her speech to the point that it was difficult to understand her, and it was obvious she was having difficulty putting simple sentences together. I remember asking her, “Lisa, did you just take your medication?”, to which she replied, “Yes, I just took it.”

Additionally, I believe that Lisa began to intentionally harm herself in order to present at the Emergency Room to obtain additional opiate medication. Although Lisa suffered additional injuries from a bicycle accident and a serious fall down her cellar steps, ER personnel were reluctant to provide her with medications in addition to what she was already taking.

Worried, I went back to Lisa’s medical records and found that in 2016 her pain management doctor prescribed the following medications:

  • Fentanyl 100mcg patch
  • Oxycodone 30 mg every 4 hours
  • Oxycontin 40 mg every 12 hours
  • Diazepam 10mg
  • Cloridine 6 mg
  • Amitriptyline 50 mg
  • Ambien at bedtime
  • Valium 10 mg 2 per day
  • Adderall 2 per day
  • Ibuprofen 800 mg every 6 hours
  • Zoltran for nausea

By 2017 Lisa’s husband asked her for a divorce, and she moved to another state in order to make ends meet. As a devout Catholic Lisa mourned the loss of her marriage, middle class lifestyle, and home and added alcohol to the above mix of legally prescribed drugs. Concerned for my client’s well-being, I frequently emailed her ex-husband and expressed my concern with taking both Fentanyl and Oxycodone at the same time. Although  my concern was well received, I continued to worry that Lisa’s situation would not end well.

Lonely, and scraping to make ends meet, Lisa began a relationship with her former now married boyfriend. Her grown children deserted her, not willing to put up with her constant “highs” and irrational behavior. Unum continued to harass Lisa for more and more information adding to the stress of an already stressful situation.

Last year I received a call from Lisa’s “boyfriend” informing me that she was found unconscious in her living room and was taken to the Emergency Room – she was barely alive. Records reported that her liver and kidneys had already began to shut down. For days,  Lisa was listed as critical.

Fast forward to six weeks later I received a call from Lisa explaining that she entered into rehab for 4 weeks and had ceased taking all of the above medications. I marveled at the fact that Lisa actually sounded well, encouraged, and yes, happy. I congratulated Lisa for her recovery and told her how proud I was of her persistence to remain in rehab and get well. It was as if I were speaking to two different persons.

“Oh yes”, she said laughingly, “my boyfriend went back to his wife and guess what, Linda? I have a date tonight.”

“That’s wonderful, Lisa”, I said, “I’m so glad that you can now be happy and live your life drug and alcohol free.”

I am so proud of Lisa’s recovery and have every confidence that she will continue to live life the way she wants without the influence of drugs and alcohol.


I have no doubt but that Lisa’s story is a success among many insureds and claimants who suddenly wake up one day and find themselves addicted to their opiate pain medications. Living with a chronic pain disability is very difficult and particularly stressful in light of the many additional external stressors that happen as part of real life in general, such as divorce and desertion by one’s children.

The combination of Fentanyl, Oxycodone, and Oxycontin are now viewed as “hot cocktails” that can be overdosed accidentially. We’ve seen the stories of celebrities, who after many years of bodily abuse, take prescribed pain medications in combination that resulted in their deaths.

In addition, there may also come a point when pain management physicians continue to prescribe medications, not for pain management, but to manage “addiction.” Adding alcohol to the mix of strong opiates is a risk no insured should take.

Lisa and I sincerely hope her story reminds insureds to continuously discuss opiate pain medication prescriptions with their physicians. Today, there seems to be a governmental focus on controlling opiates, and yet, physicians may still be prescribing dangerous levels of medications in combinations that could be lethal.

If you have any questions concerning your medications please make an appointment to discuss your prescriptions with your physician, or pain management provider, or go to the nearest Emergency Room and ask for help.

I continue to support disability rehabilitation efforts to treat medication addiction while receiving disability benefits.

 

 

 

 

 

 

 

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Prudential Financial- Told Off By The Judge

For the last several years DCS, Inc. has been very critical of Prudential simply because, like Unum, the company doesn’t walk the talk and supports an extremely unfair claims process.

At least one judge agreed with me in the Colorado case of Michael J. Paquin vs. Prudential (CV 16-cv*-02142-RBJ). An ERISA case involving Mr. Paquin who was infected with West Nile virus, was denied by Prudential unfairly. The judge found Prudential’s review of Mr. Paquin’s claim to be arbitrary and capricious and invited Plaintiff’s attorneys to submit requests for attorney fees.

Not surprisingly, Prudential’s claims practices are primarily guided by Unum Group since the two companies often share management personnel. I have never found Prudential to operate a fair claims review process, and based on the appeals court in the Paquin case, the company clearly deserves a huge stick from DCS.

Prudential often uses Unum’s old “claims killer” physicans for their medical reviews in addition to RNs who also render reports on which denial decisions are made. The company also misrepresents actual psychotherapy notes provided to them.

Prudential – a well earned stick.

Nichols vs. Reliance Standard – No Standards – Conflict of Interest Decisions

Also, Reliance Standard was severely criticized by the judge for its “bad decision-making” in the case, Juanita Nichols vs. Reliance Standard. Adjectives used by judges in referencing Reliance Standard included “arbitrary, blind, extreme,  flawed, illogical, inadequate, inappropriate, incomplete, questionable, opportunistic, and unfair.”

The case was decided in favor of Ms. Nichols when the judge said, “When guarding the henhouse, some foxes are bound to go rogue.” Reliance Standard has no standards, and therefore is awarded a well deserved stick from DCS.

Reliance Standard also refuses to provide ERISA disclosures when it denies claims.

Northwestern Mutual and Principal

Northwestern Mutual and Principal are the only insurers recommended by DCS, Inc. even though these companies’ primary products re Disability Income Replacement Income. This means there are no STD/LTD Group insurance companies that I recommend since they are all equally unfair and egregious.

Even so, NWM and Principal are the only two carrots in the July garden.

 

 

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Unum’s financial settlement representatives are once again sending out letters offering lump-sum buy-outs for claims. In fact, one of my clients recently received such a letter. The problem is that information communicated to claimants is a confused mess that I find largely inaccurate, and misleading.

Unum’s letters to insureds/claimants really aren’t offers of settlement although they may appear that they are. Here is Unum’s wording: “Unum Life insurance Company of America may offer you $X as a lump sum payment which would be full and final settlement of your Long Term Disability Claim.”  Is this an offer? Unum says, “Maybe….”

Along with the settlement letter is a questionnaire that looks more like a “perils and hazard” questionnaire for life insurance. It asks about whether or not the claimant smokes, has diabetes or high blood pressure etc., information, by the way, that has nothing to do with the claimant’s paid disability. Settlement offers should always be based on the claim financial reserve value including impairment, age, sex etc., not whether a person smokes or not.

Unum’s letter goes on to say this, “The amount of  money invested now to pay out anticipated future benefits plus interest over the next x months has an estimated value of $X. This is referred to as the “present value” of your anticipated future benefits.” 

To begin, there are actually several reserve figures recorded – a claim reserve without interest, and claim reserves with interest. Money put away to pay claims earns interest that reduces the liability for claims on Unum’s Balance Sheet. Why would the +interest financial reserve be used when interest earned reduces the cost of claims? Interest earned belongs to Unum; why would the company pay out the present value of “interest”? It doesn’t.

This is an inaccurate presentation of financial reserve, and the only saving grace is that most claimants/insureds probably wouldn’t understand it, accurate or not. Unum’s settlement offers are essentially a percentage of the current “present value” of future claim financial reserve value. (Not including interest.)

What was also interesting to me was that Unum’s “settlement letter” doesn’t mention future value (financial reserve value) at all. Actual figures presented would have to be taken on “good faith”, or assumed to be accurate. What the figures represent and how they were calculated is not explained very well.

For this particular claimant, Unum offered 66% of the present value, using a discount of 4.35%, the current Moody’s Composite Corporate Bond Rate as of June 2018. Since Unum rarely pays out any amount greater than 80% of the financial reserve, the deliberately undisclosed figure to the insured is the “financial reserve.”

In my opinion, Unum has always been secretive about its financial reserves because of its tendency to “under-reserve” claim liabilities thereby engaging in something called “Off Balance Sheet Financing”.  At one time, Unum alleged it did not keep claim financial reserves, which we all knew at the time to be untruthful.

When I was employed by Unum you had to take a two-part course in order to be recognized as a “Settlement Specialist.” Today, I’m finding that Unum’s “kinda offers” are smoke screens subject to “hazard and peril” underwriting, probably for the purpose of increasing mortality values if a person smokes, drinks, has diabetes, or was recently hospitalized.

But, premium is not paid based on life insurance underwriting. To increase mortality values based on poor personal habits, impairments other than those claimed for disability purposes is in my view entirely inappropriate and “cheating” the value of claims. Again, in my opinion, if the SEC and state regulators audited Unum’s financial reserves, they would probably have cause for alarm.

Because of Unum’s inaccuracies, DCS, Inc. is not recommending Unum settlements at this time. However, there are many people who are jumping at settlement opportunities (sometimes pushed by attorneys), to “get out from under” Unum’s awful claims management processes. While certainly understandable, a bad deal is still a bad deal.

Remember too, that Unum’s letters are NOT settlement offers per se and the company can refuse to offer any settlement after additional investigation. You can never trust what they say exactly.

My advice is to be very cautious about insurance settlements, make sure the lump-sum meets future needs, and is basically a well-presented fair deal.

Any settlement inaccurately presented doesn’t get off to a good start.

 

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Although Lindanee’s Blog has been around for more than a decade, I have always been very free in allowing various groups such as those from Fibromyalgia, CFS, etc. to use information I’ve written in various articles and blogs.  However, it would appear once again, that I need to consider protecting my “intellectual property” from attorneys writing books about disability insurance.

In the beginning, Lindanee’s Blog was intended for educational purposes, to “enlighten” the public and provide information equal to that of the insurance companies making decisions on private disability claims. The Blog began as a series of articles published in Jim Mooney’s online newsletter called “Inside UnumProvident” and eventually moved into it’s own space called “Lindanee’s Blog“.

On average I receive perhaps 50 calls a month from Blog readers, insureds, attorneys, physicians and lawyers asking questions about the claims process and very rarely do I charge for my time or expertise unless they come on board as a client. I have always been willing to help those in need regardless of who they are and proably give out more free information than any attorney.

Recently, it came to my attention that an attorney is writing a book about disability claims sponsored by the American Bar Association. Much of the book is very similar to the thousands of articles I’ve written on the Blog and elsewhere, sometimes in the very format I used in my articles. My ideas also seem to show up on various attorney’s websites as well.

This didn’t surprise me; attorneys have used my information without compensation going all the way back to my whistleblower days from 2001-2004.

In 2001, shortly after I was asked by a 60 Minutes producer to participate in a sequel to the original TV expose of Unum, an attorney published one of my signed notarized affidavits about Unum on the Internet, and all hell broke loose, but not in a way one would expect.

Many attorneys came out of the woodwork and used my signed affidavit to allege I was an expert in their cases without me knowing about it, or being compensated for it. Unfortunately, I had to discredit some of Plaintiff’s attorneys when in various depositions Unum asked me under oath if I knew I had been named as an expert in various cases. I had to say, “no”.

Other attorneys called me on a daily basis until it was clear they had all of the inside poop  I could give, and then swiftly dropped me like a hot potato. I quickly stopped doing expert work when in one of the last Unum depositions I had to ask for the judge to be contacted because I wasn’t being defended by the Plaintiff’s attorney I worked for.

At the time, although I was accepted as a credible lay member of the attorney group ERISA Esq., once these attorneys had all of my information, they accused me of being a “mole” and ousted me from the group, alleging that since I wasn’t an attorney I shouldn’t be there. Sixteen years ago, I was considered the most valuable source of private disability information – that is until I stopped making huge amounts of money for bad faith attorneys.

Believe me, someone should have made a whistleblower movie!

Although I had been instrumental to attorneys nationwide in winning their bad faith cases at the time, (86 cases in all), many of the attorneys unknown to me continued to use my signed affidavits without my knowledge.

Therefore, I’m not really surprised that a great deal of my published works are “snatched”, winding up in the coffers of attorneys who are now writing books. The funny thing is, I can’t count the number of attorneys who contact me even today for advice and guidance regarding disability insurance – and I never charge them a fee.

It’s not easy to be a whistleblower, but I do think as far as attorneys are concerned I’ve more than paid my dues.

I probably should have copyrighted my articles a long time ago, and believe me, I’m looking in to it now, having been burned before so to speak. In addition, I plan on publishing my own book regarding claims management including many articles previously published on the Blog.

Most sources looking to use my articles and blog posts contact me and ask me for permission. Thank you for that courtesy, and while I’m happy to give permission for educational purposes, I’m not happy about my ideas, writings, information, and ultimate expertise used by attorneys to make money.

I suppose in my anxiousness to help insureds obtain benefits they were entitled to, I never really considered that my expertise and articles would be taken and used for gain by others. However, in the future I am taking the necessary steps to copyright all of my material including Lindanee’s Blog.

My book will be published sooner than anticipated, and of course, it will be copyrighted. In the future, I won’t be reluctant to protect what I write. I will continue to help individual insureds/claimants obtain the legitimate benefits they are entitled to.

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Friday Q & A

Is Sun Life a Unum company?

No, it isn’t. However, as it turns out, many terminated Unum employees, including Unum’s lawyers, eventually wind up hired by Sun Life. The same situation exists between Unum and Prudential. This is why both Sun Life and Prudential have very similar Unum claims practices.

In like manner, I find The Hartford also has very similar claims practices because management from the old Unum Duncanson & Holt must be hanging around. There is no doubt but that Unum Life, UnumProvident and now Unum Group are writing the script for many other insurers. If you look at the written communications much of the same language is used.

The Hartford is now requesting copies of SSDI files and financial data, a clear copy from Lucens and Unum.

Does Unum pay claims?

Of course it does, but clearly not at the 80% rate it advertises. All insurance companies pay claims, but all insurance companies also “risk manage” the rate they pay claims in order to show company profit at certain levels. Unfortunately, this means targeting legitimate, payable claims for denial in order to keep the LARs (Liability Acceptance Rates) low, consistent with the 60% underwriting payout used to cost premium.

More realistic estimates of Unum’s payout rate would be around 30-40 percent.

How long does it take to sue Unum?

Assuming attorneys do not “settle” claims, which seems to be the  preferred action these days, it can take years to sue any insurance company for private disability. No one should be looking to sue for private disability since even if claims are won, it’s the attorneys who walk away with most of the benefit. In some cases, ERISA benefits to claimants are actually reduced to less than 30% of pre-disability earnings.

The smarter thing to do is to avoid denial by listening and acting upon good advice.

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