Posts Tagged ‘risk management activities’

Doc callUnfortunately, DCS, Inc. received notification of a denied Unum claim resulting from a phone call between a Unum physician and a treating physician. Although I’ve written about this subject many, many times there are still insureds and claimants who underestimate the clever persuasiveness of Unum’s doctors who call treating physicians with the agenda of obtaining an agreement about work capacity.

One of the many strategies of Unum’s internal docs is to place calls to treating physicians during the busiest time of the day and hammer them about returning patients to work. The phone conversation is backed up with a fax “confirmation of our conversation” which is NEVER an accurate account of what was actually said. The “stacking of the deck” by doc-to-doc calls is one of Unum’s most successful “risk management” activities and their internal physicians are quite good at intimidating other doctors and convincing them their opinions are the more accurate.

Further, treating physicians are in the business of providing patient care, not handling Unum’s harassment on a daily basis. Most physicians just want to make the problem of Unum doc’s calls “just go away” and many respond without even pulling the patient file for reference.

Mostly, however, when a treating physician throws his/her patient under the bus, it is usually because there has not been a frank conversation between physician and patient as to how phone calls from insurers are to be handled. Every insured and claimant in this country with a Unum claim should be scheduling an appointment with their physicians to discuss the possibility of getting calls from insurance physicians who have a deliberate agenda of denying claims.

What is really interesting is that during conversations I’ve had with the denied claimants, they often defend their treating physicians, “I know it wasn’t Dr. Smith’s fault, it was all Unum convincing him what to say”, “Or, I’m sure Unum’s physicians harassed him, that’s why he said what he said.” While I somewhat agree with that, I am equally convinced physicians DO know how to say “NO” to insurance companies as well.

First of all, treating physicians should not be speaking to insurance physicians on the phone due to the possible liability lawsuits and HIPPA regulations concerning electronic transmission of patient information. I would have thought physicians might feel “safer” asking for written inquires and responding only in writing. Physicians have been known to document inaccurate information in patient files; isn’t it reasonable to assume miscommunication of work capacity under duress could also take place? Unum’s docs are counting on that, actually.

Once again, I urgently suggest to all insureds and claimants that they make appointments with their treating physicians and have the ever-important conversation about whether or not to give permission for your doctor to speak with insurance physicians on the phone. These conversations never work out successfully for insureds.

It’s also important to discuss your work capacity, or lack of it, with your doctor since some physician’s are reluctant to reveal what “they really think” until they get a call from a Unum physician.

Finally, once a treating physician goes on the record by agreeing with a Unum physician, he/she cannot change that position on appeal. Physicians have a tendency to not want to look like an idiot after taking a “return to work position” previously. This limits the options insureds have on appeal to support their continued disability medically.

Unum insureds and claimants need to understand very clearly that this insurance company will do anything – strategize, coerce, harass, cajole, bully, demand, snatch, damage reputations, misrepresent, and collect what you do not owe, in order to profit by denying claims.

Please believe me when I suggest that you have nothing better to do than to meet with your treating physicians and discuss how you wish phone calls from Unum to be handled. Your claim may depend on it. Unum would not continue to make these calls if they weren’t profitable.

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