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One of my clients received a request from Lucens, Unum’s newest SSDI file chaser, to sign a form called “Authorization for The Social Security Administration To Release Information.” On the bottom right of the Authorization is “Form SSA-L88-OP1 (06-2014).”

In examining the form carefully, it appeared to me that something was very, very wrong. To begin, the Social Security Administration doesn’t place its form numbers on the bottom right, but the bottom left of all of its forms. Second, if you notice all SSA forms have an “Approved OMB No. at the top right of the form. And finally, no SSA form has bar codes on the bottom and right side of the page; and when I searched for the form from the SSA.gov page it wasn’t to be found.

Last year I wrote to SSA requesting to know why Unum was allowed to use its own form CL-1155 to request SSDI files. SSA responded that any authorization can be used if it meets the SSA Guidelines for Authorizations. I had no objection to that because Unum numbered its Form CL-1155, and never misrepresented its proprietary form SSA form with an approved OMB No. In fact, this was good news since DCS, Inc. could create its own form for client purposes.

However, the Lucens form uses an SSA number and is suggesting to insureds and claimants that the form is an official federal form when it is not. This kind of deception really irritates me because it isn’t necessary. Lucens could number it’s form differently, the same way Unum did and no one would be led to believe the Authorization was a real SSA form.

Please don’t be misled into thinking the Lucens Group Authorization is an official SSA form because it isn’t. It appears to me Lucens created it own form which is OK as long as the company doesn’t format it to deceive insureds.

Let me remind claimants that they do not have to sign any Authorization giving Unum permission to obtain their SSDI file. You are permitted to keep this information private. If you are harassed about it, pick up your phone and call your federal Congressman for assistance. At best, don’t be misled by the Lucens Group form; it isn’t an official SSA form even though it’s numbered to make you think it is.

Not a great start of confidence in Lucens as Unum’s new file chaser.

 

 

 

 

 

Friday Q & A

How can I challenge an insurance neuropsyche test?

Anytime an insurance company asks you to present for a neuropsyche test it is very important that you also either retain or inform your own neuropsychologist that you would like to obtain the actual test booklets and raw data (the tests themselves), for independent review and comment.

Although the  insurance industry tends to place neuropsychological tests in an “objective category”, the results clearly are NOT objective. Each insurance evaluator chooses a “battery of tests”, administers them, and compares responses to normative statistics and values in the national economy. Finally, the evaluators render an opinion as to what the results mean. Clearly, neuropsyche tests are NOT objective measures of disability, cognition, somatization, or malingering and should not be allowed to stand alone in anyone’s disability file.

Copies of test booklets, and raw data should be provided to your own independent evaluator for comment and rebuttal. If this is not done, the results will be presumed to be accurate and will stand in the record. All IMEs, whether neuropsyche or not, should be provided to treating physicians for rebuttal. Absence of comment from your physicians is presumed to be in agreement with the IME reports.

What is the percentage of income that IDI policies pay?

Individual Disability Income Replacement policies do NOT pay based on a percentage of pre-disability income. IDI policies always pay the “scheduled amount” indicated on the cover sheet of the policy. Therefore, IDI insureds are buying a fixed benefit (scheduled amount), with the opportunity of Future Option Increases at various intervals along the way.

People sometimes confuse ERISA Employer Group benefits that pay most typically 60% of pre-disability earnings with IDI policies that pay a fixed scheduled amount. IDI insureds may choose a level of coverage as long as the underwriting of the benefit doesn’t exceed actuarial guidelines for overinsurance.

In contrast, ERISA Plans pay a certain percentage of pre-disability earnings and employees may not choose their level of benefits except if the Plan is a welfare Plan and includes several levels of payment such as 50%, 60% or higher. Some employers may offer supplemental “buy-up” Plans as well, but benefits are always a percentage of prior income.

I can’t get ahold of anyone at Unum. Is Unum still a company?

I presume Unum is still a going-concern, however, I have been hearing from others how difficult it is to find someone to speak to. Settlement specialists are non-existent, and even attorneys are finding it difficult to get to the right people.

Unum has been chaotic for quite some time now. The company continues to terminate groups of employees while outsourcing a good amount of the claims process to other companies, and countries. There is very little about Unum that is reputable these days and no one should be surprised when they can’t find someone to speak to. I’m guessing it’s much worse than that.

Who is G4S?

G4S is an investigative agency retained by insurers to conduct surveillance and field interviews. Additional information about the company can be found online, but in short, insurers hire the company to conduct investigations.

Although the name G4S sounds like “you’re in for it”, I’ve found the company to be your everyday run-of-the-mill insurance investigative resource.

 

 

 

Guardian seems to be staying in the news lately as the company’s focus on “credibility investigation” reaches over-the-top levels. While no one disputes the right of any insurance company to fully investigate claims, Guardian’s practices exceed investigation levels that would normally be required to determine insureds are “unable to perform their own occupations.”

A good case in point is the insured who was injured as a result of an automobile accident several years ago and who recently claimed disability due to various shoulder muscle tears etc. According to the information I have Guardian’s investigators actually hunt down the driver of the “other car” who promptly said, “the accident was no more than a fender bender and no one got hurt.”

Seems to me the “at fault” driver might have a conflict of interest in reporting a “no one’s hurt” accident, but I have to wonder why Guardian took this line of investigation. If the insured’s medical information certifies the insured’s inability to perform as a dentist today, then what would it matter what the driver of the other car reported?

Guardian also tends to interview ex-spouses, a deliberate attempt to sully insureds’ reputations and credibility. Investigators “show-up” to interview peer workers, or accost them in parking lots with requests for written statements. There does not appear to be any logical reason to investigate the way Guardian does, and in my opinion, it crosses the line of prudent, normal and customary disability claim review.

Guardian’s investigations always seem to focus on credibility in lieu of whether or not insureds meet the definitions of disability in their policies. The company performs complex financial calculations regarding “residual” disability even when insureds are not residually disabled. Misrepresentations of policy provisions are immediately apparent, with little expectation of Guardian reversing its position.

Guardian’s claim investigations obviously have set priorities to investigate to deny rather than investigate to pay. This is the primary difference between fair and equitable insurers and those who seek to discredit insureds at all costs. DMS, Disability Management Services, is also a company who often investigates “credibility” in addition to contract provisional standards.

I can’t tell you what’s happened to Guardian in the last several years, but it’s all been downhill. Professionals looking for private disability and business protection coverage should look more toward Northwestern Mutual products and avoid Guardian’s insane investigations.

 

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.

 

Have you ever wondered how Unum and other insurers seem to find out things? Not only are insurance companies hacking into Facebook, Twitter and LinkedIn accounts, but they seem to have other ways of finding out information about you and your claim. Insurers all stick together regardless of whether their actions are ethical, legal, or not.

Recently, an insured who was injured in an accident received a third-party settlement in which was written a non-disclosure statement. Suddenly, he gets a letter from Unum demanding repayment because his policy offsets “third-party settlements.” Apparently, Unum was sent a copy of the insured’s settlement check either by Traveler’s or State Farm.

In my mind a non-disclosure statement actually means non-disclosure. My guess is that since Unum knew about the insured’s injury they probably contacted both Traveler’s and State Farm and asked to be copied on any settlement. Or, Unum could just have contacted the insurers and asked for information. I’m not discounting other “investigative” means Unum has either, but either way, non-disclosure is still non-disclosure.

It’s not that the insured wanted to hide anything either. But, Unum found out about the settlement quickly which means it already had “information and search” available to it. Upon further investigation it was discovered Traveler’s or State Farm sent Unum a copy of the settlement check. They would not have done this if Unum hadn’t inquired or had an inquiry set up.

Other leaks often come from predictable sources such as ex-spouses with axes to grind, or neighbors when Rover winds up too often on their side of the fence. Today, it seems as though everyone is looking for wrongdoing even when there isn’t any.

Insureds can find themselves in trouble when other family, friends and former co-workers see them loading cases of soda in your trunk and call the Social Security Administration to make a report. (This actually happened.) Today, SSA does have the means to conduct surveillance and place any recipient under investigation.

Unum insists on obtaining SSDI files when claimant are not under any obligation to provide them. There is an information war going on between insurers and insureds because insurance companies believe everyone is filing claims for secondary gain and not keeping them informed.

Insureds and claimants should consider that there isn’t any information out there that can’t be had – legally or illegally. After all, investigators aren’t supposed to peep in your windows but they still do – they just communicate the information verbally and never put anything illegal in writing.

Don’t be surprised when insurers pop up with information you thought was unobtainable. Anything is possible in today’s insurance environment.

 

 

 

As a disability claims consultant I can certainly understand how it could happen that insureds become so angry and frustrated with the claims process that they can’t see anything else except to “make them pay” and “admit everything they’ve done to me.” Although “seeing red” when it comes to managing a disability claim is a common reaction to abuse, anger, rant and non-cooperation doesn’t move claims forward at all.

The fact is, the disability claims process IS frustrating, harassing, and comes at a time when insureds aren’t feeling well and find it difficult to put up with claims handlers who just won’t pay claims. Unfortunately, once insureds really get angry, everything insureds do or say becomes suspect and claims fall into what seems like a bottomless pit of going nowhere.

Some insureds actually act counter to provisions that specify their obligations to meet criteria of Plans or policies. Not too long ago DCS was forced to fire a client because he refused to arrange to go to an IME despite my recommendation that he should go. This particular insured also did not provide the insurance company with the “whole truth” and therefore I could not continue to assist him. The reason? According to this insured, the insurer (Northwestern Mutual) was dishonest and was trying to “trip him up.”

In addition, we’ve come across some claimants who suspect everything, demand repeated proof, and accuse insurers of “lying”, and engage in “letter wars” that also gets them no closer to claim decisions. Most of my readers know I would be the first one to tell you that disability insurers are dishonest and delay or deny payment of claims. At the same time, constantly arguing small “who done it” points is trivial and in general puts insureds on a merry-go-round they can’t easily get off of.

Although insurers should base their investigations and opinions only on the unique facts of claims, there is credibility and “appearance of honesty” suspicions that arise referred to as “red flags”. Constantly contacting claims handlers (remember we do not recommend communicating by phone), and arguing, or engaging in “letter wars” isn’t productive to the claims process and will most likely produce denial decisions.

Therefore, while I validate anger reactions of insureds and claimants to the disability claims process, I certainly do not recommend engaging in constant rants with insurers. Recently, a new client came on board with major issues concerning Guardian. By the time he made a call to DCS he mistrusted everything the company did to date, had not been paid, and was in tears during most of the call.

During our conversation he reiterated that he wanted “proof” of this, and “admission of wrongdoing”, and “statements in writing” etc. It also became apparent during the call that his impairment was due to Bipolar and cardiac issues. One thing was certain – he was so mistrustful of Guardian and had been harassed to the point of desperation by the time he contacted DCS, that his only motivation was to “make them pay for what they did to me.”

“I want every damn thing they owe me”,  he said, “and I want to put them out of business.”

The unfortunate missing part, however, is that this poor insured still had not been paid benefits due to him. Within several days, DCS was able to work with the insured to the point that together we were able to support his claim medically, and he received a $40,000 check in the mail. I could not get him to stop crying.

In this case I think Guardian brought most of the anger and suspicion upon itself by demanding a field interview with both the claims handler and a field investigator (Guardian calls them “Technical Consultants?’) showing up to ask questions of someone diagnosed with Bipolar Disorder. Of course, this interview wasn’t going to go well and it didn’t. This is an example of what I mean when I say, “disability insurers know very little about disability.”

Also, well-intentioned, but inaccurate information provided by friends and neighbors can also incite one to wrath and isn’t always helpful either. Insureds who file disability claims need accurate information about the claims process, not opinions from those who really aren’t “in the know.”

Instead of acting upon anger, overreaction and suspicion, insureds and claimants should be more focused on “solving the problem” which in most cases is “paying the claim.” Insureds who find it difficult to calm down and act accordingly could benefit from having a consultant sort through what’s needed and getting the job done.

In any event, ranting and arguing with insurers doesn’t result in timely payable claims. Again, although I validate the feelings of anger and frustration with an impossible claims review process, I do not recommend constant suspicion on the part of insureds that makes them appear uncooperative, out of control and vindictive.

Ranting and arguing with an insurance company causes those who are reviewing claims to conclude, “the insured is crazy”, and creates “red flags” that lead to the lion’s share of investigation. While Unum might just laugh and go on investigating, Guardian is more apt to investigate more intensely and be suspicious of everything that happens moving forward.

Perhaps you may not have thought of this situation in these terms, but there are only two decisions insurers can make as a result of filing a claim – pay the claim, or deny it.

A successful outcome is when an insurance company pays benefits under the terms of the policy. Arguing and ranting and trying to get the reps fired isn’t going to give you the claim result you are looking for.

 

Friday Q & A

Why does Unum want SSA Form 831 so much? The company is hounding me to sign an Authorization to get my file. Do I need to do that?

There are quite a few really good posts on the Blog about Unum’s scam when it comes to obtaining SSDI Files. If you do a search from the Home Page I’m sure you may find more detailed information.

Although the company alleges it, “wants to give your claim every consideration”, the truth is Unum does not. In fact, Unum’s obsessive attempts to obtain SSA Form 831 are more related to denying mental and nervous claims limited to 24 months. Form 831 is a form that is kept in each recipient’s file at SSA and includes the listing codes benefits were awarded for as well as the name of the DDS (Disability Determination Specialist).

In the past, former employees describe Unum’s abuse of form SSA 831 by using the information to try to contact the DDS. Now you know why Unum’s SSA Authorization is valid for two years.

I’ve been asked by Unum to have a neuropsychological evaluation. Why?

Unum seems to have a focus project going on targeting mental health and cognitive impairment claims. I’ve heard from several people who tell me Unum’s on a neuropsyche test rampage. Although neuropsyche tests are considered “objective”, the test, administered by doctors paid by insurance defense, is actually as opinionated and biased as you can get.

The evaluator chooses a “battery of tests” not necessarily to evaluate impairment, but to evaluate the insured’s “intent, motive and secondary gain” issues more than anything else. This is particularly true for FMS claims where IME evaluators deliberately do not choose tests that diagnose the disease at all.

In any event, the IME evaluator compares the scores from the raw data (test) and compares the tests to population normative data. Then he/she writes an opinion report based on the results. How objective and non-biased is that?

In my opinion, neuropsyche tests are primarily insurance defense tools to provide employers and insurers with documentation to not hire employees or deny disability claims. It’s a multi-million dollar “gotcha” game paid for by the insurance industry.

Prudential neuropsyche tests – are they a put on?

In continuing with the above discussion, I haven’t had a chance to talk about Prudential all that much lately. Still, I consider the company #2 bad boy after Unum Group.

The company does not have its own mind; it has a Unum mind. Many ousted Unum employees wind up at Prudential. The company hires old “claim killer” Unum IME and peer reviewer doctors to review claims.

When it comes to neuropsyche tests Prudential retains IME facilities who “coach” its doctors on what tests to choose and how to write reports. Some of these organizations actually “grade” the IME reports written by its doctors. IME reports written by doctors who are coached as to what they should write remove all defenses of the insured to ever receive benefits. Prudential truly uses these facilities to “stack the deck” against claimants.

Prudential uses medical reviews written by non-specialized Registered Nurses to deny claims. The company insists on reviewing mental health records in order to pay claims even when therapists don’t want to provide them.

Next to Unum, Prudential is another company to stay clear of if you are an employer looking to spend employee benefit dollars wisely.  Prudential disability benefits wouldn’t be a benefit to employees, but a casualty soon or later.

Are disability insurance companies subject to HIPAA?

No, the aren’t. In fact, disability insurers are explicitly excluded as a defined entity in the law. However, the doctors who provide medical records to Unum ARE subject to Unum and need to abide by the law.

This is why doc-to-doc calls between insurance doctors and treating physicians should not take place. Using the phone is an electronic submission of health information. Treating physicians should make note of that.