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Posts Tagged ‘disability claim’

Sueing youDCS receives on average a total of 50 calls and 150 emails per week from insureds and claimants looking for someone to listen patiently to their claim stories specifically about Unum. (I’m using Unum in this post because it is the most frequently mentioned insurer, although it could just as well be any one of many insurers denying claims unfairly.)

Although I couldn’t possibly respond to all the contacts I receive, those I do speak with and respond to  are always frustrated enough to mention “suing Unum”, if not for benefits, for emotional distress. And yes, most Unum insureds are that frustrated, abused and angry to demand retribution.

In my opinion, suing any insurance company is NOT where you want to be with a disability claim. The process is costly,  lengthy and the odds of winning are pretty slim. Lawyers wind up with most of the profits, and most of the time dreams of multi-million dollar punitive damage awards drift quickly into the sunset.

“Bad faith” is actually hard to prove because plaintiff’s counsel must show “intent.” In other words, insureds would need to prove Unum deliberately set out to harm insureds using patterns of business practices designed to deny benefits for profit. Bad faith intent is a hard nut to crack if not impossible to prove without extraordinary circumstances.

After all, this isn’t 2002 and there are no NBC Dateline or 60 Minute Unum exposes hurling attorneys over the hump of deliberate bad faith and/or intentional “Blue Memos” used to deny benefits. Today’s attorneys are more likely to attempt to settle claims than sue for bad faith.

Don’t get me wrong, I’m sure there are extraordinary disability cases being won even as I write, but the toll of being beaten up in court, living broke for years, often isn’t worth the emotional cost of losing before deciding to move on. Going into court isn’t something insureds should plan on, count on, or do at all if it’s possible to avoid it.

Over the years I’ve noticed an interesting phenomenon to “suing Unum” conversations in that most insureds who want to sue the company haven’t really been financially harmed. They describe untold harassment, over investigation and surveillance, and frankly describe the fact that they are “just damned mad at what Unum put me through.”

My first question usually is, “Well, is Unum paying you?” And, the answer is invariably a solid, “Yes.” What follows is usually, “Unum put me through a lot and caused me so much emotional distress that I think they should pay me for that. It’s pay back time, and I want to sue Unum.”

Sometimes I think there is a general misunderstanding going on with the public as to what any disability insurer’s obligations and rights are with respect to claims.

First, disability insurers have the right to fully investigate claims on an ongoing basis; and second, if insureds and claimants are found to meet definitions of disability, claims are obligated to be paid. When claims are paid, there’s nothing to contest.

Clearly, insurers abuse their rights and discretionary authority to investigate claims and I can entirely understand how insureds and their physicians react to harassment, invasions of privacy, and continuous requests for information even after disability has been made reasonable clear.

“The claims process” such as it is, allows insurers to engage in willful ignorance of the effects and consequences of ill-health to the point of exploitation of the weakest groups in our society, namely the disabled. It is not unreasonable then to conclude that Unum’s “investigatory process” creates a secondary medical/emotional disability I call “Unum Claim Syndrome.” In fact, it’s easy to understand why insureds tell me they want payback for the emotional hardships Unum caused to them and their families.

Second, if Unum pays benefits, it is presumed no harm has been done. Imagine the insured who is now reading this post thinking, “Here I am a nervous wreck, depressed. I lost my house, my spouse left me, but because Unum is now paying my benefit, I haven’t been harmed. It’s been a long fight and I’m sicker now than when I filed my claim.”

Filing any disability claim invites insurers to conduct investigations for as long as they decide to pay you. In fact, the one thing disability insureds can actually rely on is that the insurer’s right to conduct updates and investigations as they use their discretion to do so, will never go away for as long as insureds receive benefits.

Finally, if insureds are paid benefits due, there is usually no opportunity to sue because they haven’t been financially harmed.

The best thing insureds can do to limit the emotional toll of a disability claim is to ensure that the best medical and occupational information they can afford is added periodically to the record to avoid claim denials thereby avoiding litigation altogether.

No one really wants to pay attorneys 30% of back and 40% of future benefits to age 65, particularly if the case isn’t likely to win. Attorneys may suggest “going into court” for their own self-interest rather than “wasting their time” managing claims to their proper conclusions (benefits paid).

In my line of work, it’s very easy for me to understand and sympathize with the emotional burden insureds take on when filing disability claims. And…..ranting about Unum’s abusive claims practices is also easy to understand. Believe me, I know.

But, litigation should always be a final attempt at resolution under very extraordinary circumstances, not a first attempt. If Unum is paying your benefit on a regular basis, be thankful and don’t create future red flags that may drastically change your good fortune at being one of approximately 30% of claims Unum does actually pay long-term.

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Pin itGuardian has been on my radar quite a bit lately from not paying previous residual periods of disability, to irate claims handlers, to over-the-top investigations that cross the line into personal privacy issues.

Another insured called DCS today to report that already Guardian’s investigators have knocked on her door and she hasn’t even filed a claim yet! Notice of claim was given by a financial advisor (a story for another post) and as a result the company took off on investigating her with an impromptu visit from a private investigator who alleged “he was in the area and thought he’d  just stop by.”

I have never really regarded Berkshire/Guardian as a fair insurer, but for a long time my dealings with the company have been relatively good. Recently though the company and its representatives seem to have made a double-turn into aggressive investigation beyond what is required for investigation of a disability claim.

Unfortunately, the insured who called me today was a victim of two sources of awful information – a financial advisor who actually called Guardian to make “notice of claim” for the insured, and an attorney who refused to help complete application paperwork, but who recommended she apply for SSDI when the insured didn’t meet the criteria for SSDI. Oh my……

It has always been my experience that when a disability insurer seems to take an arbitrary left turn in “patterns of business practices”, management is redefining internal protocols to keep the liability acceptance rate down. I suspect in the last several years Guardian’s management increased its investigatory goals and practices and is redefining the claims process in order to pay fewer claims.

Guardian is really not doing itself any favors by gaining the poor public reputation it seems dedicated to have right now. Some have said that Guardian is not the company it used to be and many prospective insureds are moving over to Northwestern Mutual. Loss of market share isn’t a good thing for any insurance company.

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Knowledge is PowerFrom my perspective it is often true that insureds and claimants, and in fact their physicians, are completely unaware of the importance of medical restrictions and limitations in the evaluation of disability claims.

Although most insurers continually request patient notes, physicians rarely (if ever) include R&Ls in the notes. Lacking the specific information they need, insurers then keep asking for the same information over and over again, only to deny claims by citing, “there are no restrictions and limitations to preclude you from working.”

My reviews of most claims show that despite voluminous patient notes and recommendations there generally is not one R&L among them. Without specific R&Ls to support disability the door is left open for insurers to deny claims legitimately even when it’s clear from the combination of patient records there is no work capacity.

Let’s start at the beginning.  Definitions of disability written into private policies are really double-edged swords requiring both medical impairment AND inability to perform one’s occupation, job, or any other jobs for which insureds have training, education and experience. Therefore, the burden of proof required to receive disability benefits is both medical AND occupational.

The occupational “proof” of private disability consists of “medical restrictions and limitations precluding work”. From the insurers perspective without R&Ls there is no payable disability claim.

“Restrictions” are defined as work or life activities insureds should NEVER do. “Limitations” are defined as “work or life activities insureds can do, but only to a limited extent. And, all good intentions aside, many physicians themselves are not aware of these definitions and rarely write them in patient records or on disability forms.

Without knowing the importance of medical R&Ls insureds (and their physicians) continually send in patient notes and then wonder why the insurance company “doesn’t get it.” There is no such thing as a disability claim without medically supported R&Ls addressing medical diagnoses AND why the impairment precludes patients from working.

Eventually, insurers get tired of requesting the same information and getting the same answers when the dots aren’t connected between medical disability and the inability to do one’s job.

Most insureds who have access to their medical records will say, “Well, it’s clear from my medical records that I can’t work.” Well…..no it isn’t.

In fact, insurers will “snatch” and misrepresent patient notes to their own favor when specific R&Ls are missing from the file. The work “subjective” is used by insurers over and over again to create the illusion that there really is no medical evidence per se other than what insureds tell their doctors. (It’s all in their heads!)

Insureds and their treating physicians should never present insurers with the opportunity to decide for themselves what medical records mean because of the conflict of interest on the part of insurers to deny claims and increase profitability.

Therefore, insureds should always discuss the importance of including medical R&Ls with their doctors. Again, all good intentions aside, a notation on an APS statement, “Patient is totally disabled” is NOT a medical restriction because it does not address why the “total disability” precludes the patient from working.

Insureds and claimants should always present their physicians with copies of job descriptions so that together discussions can take place about which occupational tasks and duties patients can no longer do, or have difficulty doing.

It is always a good idea for both patients and physicians to agree on:

  1. Primary and secondary diagnoses.
  2. Treatment plans
  3. Medical and occupational R&Ls
  4. Statements of whether or not the patient is at Maximum Medical Improvement (MMI).
  5. Allowable activity levels included as part of the physician’s treatment plan.
  6. Medication side effects
  7. Prognosis

Without all of the above clearly indicated in the record, private disability claims will be problematic. DCS clients are provided with assistance to ensure that R&Ls are present in the disability file and that treating physicians understand the importance of notating reasons why insureds are unable to work.

The important thing to remember is that it is not enough to just provide medical records as proof of claim for any disability claim. Medical information should always “connect the dots” between medical disability and the inability to perform one’s job. Without R&Ls insurers presume there is no medical support for disability and often deny claims.

This is probably one of the most important posts you will ever read concerning disability claims.

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Very important read and something to think about for the future of disability claims.

http://www.sfchronicle.com/business/networth/article/Bill-would-let-companies-secretly-record-some-6246589.php

Bill would let companies secretly record some phone calls

Authored by freshman Assemblyman Evan Low, D-Campbell, the new bill originally would have let companies secretly record a wide range of calls on cell phones and cordless phones.

Authored by freshman Assemblyman Evan Low, D-Campbell, the new bill originally would have let companies secretly record a wide range of calls on cell phones and cordless phones.
A bill that would let companies secretly record phone calls with current or former customers for up to 20 seconds was approved by the Assembly Committee on Public Safety Tuesday.

AB925 passed along party lines, but not in a way you might expect. The five Democrats voted in favor of the bill, which was opposed by consumer groups and endorsed by business groups including the California Chamber of Commerce. The two Republicans on the committee voted against it.

California is one of a dozen states that prohibit, under most circumstances, the recording of phone calls without the knowledge and consent of all parties. A person who does not hang up after being told a call will or may be recorded is presumed to have given consent in California.

California’s law was created in 1967 and applied to all “confidential communication” carried on between people in person or by “telegraph, telephone or other device, except a radio.” Confidential is defined broadly as “any communication carried on in circumstances as may reasonably indicate that any party to the communication desires it to be confined to the parties thereto.”

Even so, the “confidential” requirement makes it nearly impossible to bring class-action lawsuits against a company because the company could argue that each call was not confidential, said Richard Holober, executive director of the Consumer Federation of California.

To strengthen privacy rights, in 1992 the Legislature passed a law that required all-party consent to all calls that involved a cellular phone or cordless landline, whether or not the subject matter was confidential. That left nonconfidential calls between landlines as the sole type of communication that could be secretly recorded (there are exceptions for law enforcement, prisons and a few other entities).

The new bill originally would have let companies secretly record a wide range of calls on cell phones and cordless phones. Authored by freshman Assemblyman Evan Low, D-Campbell, it would have amended the 1992 law to exempt “A nonconfidential communication between a person or business and a current or former customer of the person or business, or a person reasonably believed to be a current or former customer, regarding their business relationship, including, but not limited to, communications regarding billing, provisioning, maintaining, or operating the product or service provided by the person or business.”

Two dozen groups including consumer advocates, privacy-rights organizations and labor unions opposed the bill, according to the bill analysis. In a statement, they said it would “sacrifice well-established privacy interests.”

Shortly before Tuesday’s vote, Low amended his bill to provide a narrower exemption for secret recording. A mockup of the amended bill exempts only “the initial 20 seconds of a telephonic communication between a business and a current or former customer, or a person reasonably believed to be a current or former customer.”

That means a company could secretly record anything, confidential or not, in the first 20 seconds of an incoming or outgoing call that involved a cell or cordless phone and an actual or presumed customer or ex-customer.

Consumer groups say the existing law is fine as is, well understood and does not need fixing. “Why tinker with an important and long-standing California privacy law?” said Beth Givens, director of the Privacy Rights Clearinghouse.

Asked what problem AB925 is intended to fix, Ben Golombek, a spokesman for Low, said, “We had had heard from a couple local businesses in our district. In some cases, they had problems where they are making calls to customers/consumers. They didn’t know if they were calling a landline or cell phone. We saw there was a discrepancy in the law.”

He said the bill is intended to bring the 1992 law into compliance with the 1967 law. “This will ensure and require that a business that is calling needs to disclose that the call is being recorded. It will allow them to have up to 20 seconds to share nonconfidential information,” such as a greeting, their identity and reason for the call,” Golombek said.

The mockup of the bill that was passed, however, does not say that companies could only record nonconfidential information in the first 20 seconds without consent.

Holober sees no reason companies ever need to secretly record anything. A caller needing a 20-second preamble could simply identify himself or herself, state the nature of the call, request permission to record and then start the recording, he said.

The only groups that registered support for the bill are the Chamber and TechAmerica, which represents technology companies.

In an e-mail, Chamber policy advocate Jeremy Merz, said, “We support this legislation because it is sensible public policy that maintains notification protections while reducing class action liability for innocuous introductory conversations where there is no harm to the consumer. In other words, it maintains consumer protections while reducing frivolous litigation.”

The committee members who voted in favor of the bill: Chairman Bill Quirk, Low, Miguel Santiago, Richard Gordon and Reginald Jones-Sawyer Sr. Voting no: Vice Chairwoman Melissa Melendez and Tom Lackey. The bill now goes to either the Assembly floor or its appropriations committee.

Kathleen Pender is a San Francisco Chronicle columnist. Net Worth runs Tuesdays, Thursdays and Sundays. E-mail: kpender@sfchronicle.com Blog: http://blog.sfgate.com/pender Twitter: @kathpender

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Mental and NervousOver the years I’ve written many articles concerning the dangers of allowing a disability claim to overtake your every daily thought, action, and emotion. For most, becoming disabled for a medical reason is heartbreaking much less having to file insurance paperwork and put up with harassment and intimidation.

Recently, I had the opportunity of speaking with a young woman who had become so obsessed with her disability claim that she actually spent much of her day attempting to locate errors in her medical records which were being generated by electronic software by a huge medical facility. I assured her this could be a fight she wouldn’t easily win, but the obsession was so deeply rooted, she suggested perhaps she should teach her physician’s office staff how to correctly use its new medical software.

Other insureds spend a great deal of their day researching on the Internet in an effort to find that exact court case, article, or opinion that would absolutely prove he/she has a credible claim. Days, weeks, and then months are spent chatting about disability on all of the various disability forums, fibromyalgia or CFS networks.

Although it is important to know as much as you can about your own medical condition, I think we can all agree the Internet is perhaps NOT the best source of information about disability claims. Everyone has a story to tell and each claim situation is unique from everyone else’s. Still, there are those who spend endless hours on the box searching for interesting scuttlebutt, that for the most part is probably inaccurate for their own claim situations.

Today, many insureds and claimants sign up for Internet web portals to send and receive information from insurers even when they know there is tracking software connected to the portal so that insurers can follow all Internet activity. A few claimants reported to me they visit this site at least 20 times a day to reassure themselves all is well with their claims. My personal experience as a consultant is that insurance web portals are not always up to date and cause more worry and concern than not.

Individual obsessions over disability claims stems from the insureds fear of losing benefits by compensating with endless defenses obtained from perceived credible sources such as the Internet, or listening to others who have no experience in dealing with the process. At times it may seem as though you think of nothing else but your disability claim the entire day, or perhaps you found yourself talking about your claim during a recent family social gathering. Although most family members support your disability, hearing about it at every opportunity gets a bit overwhelming even for them.

It is not uncommon to lay in bed unable to sleep as you ponder the wording of your next 5 page letter to the insurer, or a next conversation with a physician you need to ask to complete a medical form. Other insureds create very sophisticated, complex spreadsheets to keep track of medical appointments, checks received and not received, conversations with claims handlers, receipts of postage, patient notes obtained, lab reports sent, etc.

It is incredible sometimes to see the complex three-ring binders some insureds spend time putting together containing every conceivable calculation, and aspect of their claims. Although these actions aren’t necessarily bad, it is often when the accumulation of detail crosses the line to obsession behavior that causes the claim to become a secondary disability or additional medical impairment. Therefore, insureds not only have to deal with taking care of themselves medically, but have also created what is tantamount to a full-time job taking care of their disability claim.

After working in the business for 22 years now it no longer surprises me to speak with prospective clients who tell me their disability claim is a source of exhaustion to their daily lives. One gentleman I spoke to provided me with a 10 page list of court cases against Unum he thought would be helpful for his case even though Unum hadn’t denied his claim yet. Court cases are only useful if an insured is in court making arguments before a judge or jury, and it does take some legal know-how to cite a case appropriately to different legal situations. Court is definitely NOT where insureds and claimants want to be, or should strive to be.

Litigating disability claims is something that should be avoided at all costs, therefore, spending a great deal of time on the NET researching court cases is a waste of time. Citing court cases to a unknowledgeable claims handler won’t support the continued payment of benefits because he/she won’t know what you are talking about.

Based on my experience in speaking with and assisting with disability claims I believe obsession behaviors that take up most of the insureds time stem from the following feelings, emotions and actions:

  1. Absolute total fear of losing financial support where no other source of money is possible. There is no Plan B to provide funds if claims are denied.
  2. The desire to be constantly reassured nothing is wrong with the claim becomes an obsession.
  3. Overwhelming feelings of “I have to DO something every day to prove my claim is legitimate.” Or, I have to continuously defend my claim in order to get paid.
  4. Accepting the burden of having to prove disability over and over again with a preponderance of detail and complexity. Having the idea that the insurance company will deny the claim unless a great deal of time and energy is devoted to “the care” of the claim.
  5. Some insureds attempt to compensate for time lost at work. In other words it becomes confusing as to how to spend one’s time when not working. Having a disability claim often becomes a “fill in” for work activity while not actually working. “Working” on your claim keeps you busy and occupied during the day.
  6. Feelings that unless you have actual voice contact with the insurance company the claim won’t be paid. This is often outwardly demonstrated by the desire to call the claims handler every day or several times a day. Frequent calls to insurers cause insurance “red flags.” Insureds should never speak directly with claims reps but instead request all communications in writing.
  7. Searching out and consulting an overabundance of physicians in various specialties far beyond what the impairment(s) actually requires for regular and appropriate treatment. Constantly convincing doctors you have what you say you have.
  8. Finding yourself tearful or sad everyday. Living with a depressive weight on your shoulders or sick feelings when the disability check is late.
  9. Unproductive sleep due to racing thoughts about the disability claim and what your next steps should be.
  10. An inordinate amount of attention is given to discussing the disability claim particularly with family and in social settings. Constant preoccupation with your claim by talking about it at every opportunity.
  11. Constant, relentless worry that produces physical symptoms such as stomach cramps, sleeplessness, tearfulness, sadness, palpitations, hands shaking, etc.
  12. Situational stress and worry around the time checks and benefits are due. Jittery feelings until you verify the money is received.
  13. Overthinking your actions – “Did I do the right thing?” “I shouldn’t have said that!”
  14. Obsession with attorneys, “If I just had an attorney on my claim everything will be OK.” This idea may be untrue and costly.

If more than one of the above feelings or activities sound familiar it may be that you have a secondary diagnosis called “my disability claim.” Perhaps some of the suggestions below might be helpful to enable you to find a quality of life unrelated to managing a disability claim.

  • Avoid procrastination in responding to the insurer’s requests for additional information. You are only required to provide the insurer with information it asks for. Respond to its requests promptly and only answer or give what you have been asked to provide. Once you have, let it go and don’t constantly volunteer non-related information.
  • Have a Plan B that you can rely on if the insurance company denies or terminates benefits. Knowing where alternative resources are goes a long way to quiet fears of being left without benefits.
  • Try to intellectually grasp the concept that regardless of what you do or not do while on claim, if the insurance company wants to deny benefits it can and most likely will. Preparing complex records and archiving detail relative to a claim provides no more protection against claim denials than just providing what is asked for.
  • Try to take at least an hour or two out of each day to enjoy an activity without thinking about your claim. Indulge yourself with a walk, or any other activity that makes you smile and feel the joy of being alive. Smile a lot and laugh.
  • Don’t attempt to become an overnight whiz-kid on the subject of adjudicating disability policies and claims. I’ve been in the business for 22 years and I learn new things everyday. If you find yourself unable to manage the complex paper process – obtain help!
  • If reading about your medical impairment scares you, then stay off of the Internet. Sometimes those who visit Web MD on a regular basis may come to believe they have symptoms from every conceivable disease there is. Consult with your physician and listen to his/her advice. No one’s claim or medical disability is the same and Internet information doesn’t apply specifically to your disability. Solutions to your disability and claim won’t jump off any Internet screen.
  • Think positively. I know there is a great deal of negative information out there about disability claims, and I’m probably guilty of communicating some of it from my blog. However, even Unum, Prudential, CIGNA and Aetna doesn’t do EVERYTHING WRONG. It’s not over until it’s over. Do not try to second guess what any insurance company will do in the future – you’ll always be wrong.

Having a disability claim is stressful enough without dwelling on its management to the point of obsession. You have a life other than your disability claim. The best strategy is to take control, manage what you need to, and then let it go and put the extra attention and time into feeling well and finding wholeness. And….if you can’t then find help available to you.

When obsession with a disability claim BECOMES A SECOND DISABILITY it’s time to stop and rethink what your quality of life should be. There is more to life than setting yourself up with obsession and constant dedication to a process that clearly is one-sided. Instead, enjoy your days, and find joy in living.

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QuestionsLindanee’s Blog is a very popular website with more than 1,000 posts containing information of concern to those with private disability insurance. The blog receives over 800 reads per day and recently readers have been placing calls me to with questions concerning their claims.

As most of you know, DCS, Inc. is a consulting corporation owed by Linda Nee to provide insureds and claimants with case management services. The blog has 178 subscribed members, 1,000 articles, and over 900 comments.

One of my closest attorney friends, now deceased, once told me that if I were a lawyer I’d be a rather poor one. I wish I could help everyone resolve their disability claim issues, but of course I can’t. Therefore, my time and expertise must be dedicated to those who retain my services and expect me to work on their behalf.

As a result, I may not be able to return the hundreds of calls and emails I receive each week from those looking to just ask questions. If there is a topic you would like to see addressed on “Friday Q&A”, please send me a private email and  I’ll be happy to answer your question anonymously at the end of the week. Although I am flattered that insureds and claimants consider me a valuable source of information, it is impossible for me to return all of the calls I receive each week.

For those who are looking to retain me as a consultant and wish to discuss their claims, please feel free to contact me. I will try very hard to continue to write articles of interest, therefore, your first inclination should be to search the blog to see if your question has already been addressed.

Thank you to all of you who support DCS, Inc. and the work we do to try to educate the general public as to the private disability claims process. I will continue to write and post articles to help you as best I can.

Please email me your questions so that I can post them on Friday’s Q&A and help all others who may have the same question.

Thank you.

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Quite a few questions came in this week about Unum.

Can Unum ask for back-pay from an auto accident? (This question is asking if Unum can offset benefits for money received from an automobile accident.)

Yes, they can. Some, but not all auto policies include benefits specifically for disability if injured as a result of an automobile accident. Unum may offset ONLY THAT PORTION THAT PERTAINS TO DISABILITY money or settlements received. There was a case in Pennsylvania where Unum insisted on taking an offset for all money received as a result of an accident, but in reality, the only benefit Unum can offset are payments from the auto policy explicitly paid for disability resulting from injury due to an auto accident. Other money received i.e. for auto repair, damages etc. is not recoverable by Unum (or any other insurer.)

Why is Unum making me feel guilty about not working?

Actually, all disability insurance companies have the deliberate effect of making insureds and claimants feel guilty about their sickness and inability to work. Insurers do this because it is a proven fact that if and when insureds feel guilty enough about filing a disability claim, they will do anything to return to work including, talking their doctor into releasing them to work prematurely, or even returning to work sick. The insurance company wins anytime it can close a claim, so in their view, “why not make people feel guilty, most of them are malingerers anyway?”

Disability and not being able to return to work is not a moral dilemma, it’s a business transaction. Insureds and claimants often forget that either they, or their employers, actually paid a premium to cover the risk of losing one’s income due to injury or sickness. Unum isn’t paying your benefit out of the goodness of their heart and pocket, you or your employer paid money to cover the risk.

Therefore, the matter of disability insurance is solely a business transaction. If you were to buy a pair of shoes from Wal-Mart, but later discovered they were too small and had to take them back, would you feel guilty?

Disability insurance is a business contract and condition, and I’ve said many times that disability insurers actually know very little about human disability. Unum, in particular, makes people feel “bad” through the tone of their letters, the tone of the claims handlers on the phone (which is why no one should speak to any insurance company on the phone), and their highly publicized poor reputation as a “criminal organization.”

I know it is hard at first, but please don’t let any insurance company make you feel guilty for applying for benefits when either you, or your employer paid for the product. You have a right to make application for disability benefits, and if you meet the eligibility conditions and definition of disability then you should be paid. Insurance companies like to make people feel guilty because they profit from it. Don’t put yourself through that.

Does Unum have to pay for travel to and from the IME?

Have to? No, but they will. Unum and other insurance companies presume the policy wording of “at our expense” to include travel although it isn’t mentioned directly in the policy. It makes sense to me insurers do not argue about paying for transportation because some insureds and claimants cannot literally afford to get there. Unum will either offer to arrange for transportation, or will reimburse for mileage at the current federal tax mileage rate. Of course, Unum verifies mileage using Google Maps or some such and then applies the tax mileage rate to figure reimbursement. If Unum has forced you to travel a very long distance then you should also expect to be reimbursed for food, and lodging, and any other reasonable costs incurred while traveling to and from an IME.

What about Unum and Colorado PERA and (Virginia Retirement System VRS)?

These two state-run Unum retirement systems are train wrecks! Unum doesn’t pay claims. I’m not sure whether these two states have given Unum the word to be overly aggressive, but one year the late attorney Jon Holder and I tried to figure it out and filed complaints to top executives in these states. Although some of the leaders of the retirement system seemed sympathetic to those who weren’t getting paid, PERA and VRS decision makers sided with Unum.

In the end, it became very clear that those who work for the state in Colorado and Virginia should not put too much confidence in their own retirement and disability plans managed by Unum. State employees actually have a much better chance of receiving SSDI and SSR from jobs they had prior to working for the state rather than their own PERA or VRS plans. As long as these plans remain under Unum’s control, individuals should probably consider working for private corporations so that if anything happens they at least have sufficient quarters to apply for SSDI and SSR when the time comes. Working for the state ( in CO and VA) isn’t such a benefit anymore. (No pun intended.)

 

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