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Posts Tagged ‘ssdi’

This past week I received a copy of a request sent to a claimant from Genex asking for an Authorization to release financial records. The problem was that I’d never heard of this particular claimant who is not, and never was a DCS client.

Although I’m quite sure Unum is well aware of what I do, there is no reason to be sending me copies of communications addressed to those with whom I have no association.

I called GENEX to inform them the copy they sent to me was a mistake. At first, the rep said they had no such file claim number. Later, she told me she didn’t know why I was copied on the letter. “So, you do have information concerning this client?”, I asked.

Ultimately she did say Genex was aware of the insured, but was still unclear why I had received her letter. It’s interesting to me that Genex’ letter states the following: “Genex is committed to protecting the confidentiality of any personal information you provide.” I guess we can all surmise how that works.

Apparently, Genex is back on Unum’s tool belt assisting with SSDI matters and applications. If a simple letter is sent to the wrong person, do you really want to entrust SSDI applications as well? I attempted to get in touch with the actual claimant, but I was unable to do so.

Please be advised that in my opinion Genex shouldn’t be trusted with medical records and other SSDI information. DCS, Inc. recommends local SSDI attorneys for assistance with applications for SSDI. If you wish I can explain the SSDI application process to you if you want to give me a call.

In the meantime, Genex is clearly not the way to go for the following reasons:

  • It has been reported that Genex does not always use attorneys to assist for SSDI and the process appears to be muddled and chaotic.
  • Genex either does not communicate, (in one incidence for over 9 years), or, the company makes so many calls it’s harassing.
  • Genex is the agent of Unum, and is not an advocate for you.
  • What Genex knows, Unum knows.
  • Genex’ potential lack of privacy in sharing information, or potentially losing information, and losing control of where your information actually is.

I will have more to say in the next post about privacy, but Genex is not a good bet for SSDI Advocacy and shouldn’t be used regardless of how it sells itself.

DCS, Inc. does not recommend any third-party SSDI advocates including Allsup and Advocator Group.

 

 

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Who am I talking to anyway?

Insureds and claimants report seeing different numbers showing up on their phones for verbal “interviews.” Although most Unum insureds are used to seeing the Maine area code of 207, area codes such as 617 and others are coming up on caller IDs. My guess is that Unum is once again outsourcing administrative work to other companies and agencies. DCS, Inc. recommends that all communications should be in writing anyway, therefore there is no need to be “watching the phone” to find out if Unum is calling.

This is even more important today when Unum’s reps are looking for more reasons to deny claims. Today, claimants are probably unaware who is on the other line, particularly if it happens to be a HUB investigator. if you request all communications in writing, you’ll always know who you’re talking to!

GENEX

Speaking of phone calls….Unum insureds are receiving phone calls from GENEX, a company with a long on again, off again relationship with Unum. A decade ago, Unum used GENEX to assist claimants in obtaining SSDI, but also to conduct interviews, any occupation investigations and triage claim reviews. At the time it was surmised that GENEX was a fully owned subsidiary until regulators pointed out the conflict of interest.

It’s interesting to me that since then, the actual relationship of GENEX and Unum remains a mystery. Although attorneys tried to “follow the money” in order to discredit the company, it’s still not very clear who pays what company for which service.

Claimants are reporting to me that GENEX is selling its services to aid in the application of SSDI as a mandatory service offered by Unum. GENEX’ involvement in the SSDI application process is not sold by the company as an option or choice, but as a mandatory service. Cold calls from GENEX take claimants by surprise, and again they may find themselves buying into the service without realizing what they are getting in to.

No claimant is required to use GENEX in the SSDI application process, but you wouldn’t really know it. Claimants report multiple problems with GENEX to include, no attorney involvement, lack of communication, long application wait times, and general “bungling” of applications. DCS, Inc. doesn’t recommend GENEX at all since the company doesn’t really represent you, but Unum. What GENEX knows, Unum knows. Those who wish to keep their SSDI information private shouldn’t consider using GENEX at all.

It’s also my understanding that GENEX reviews Unum’s disability claims and is involved with providing other services in addition to SSDI assistance. Getting a cold call from GENEX is also a scary thing for those who may not know who the company  is.

DCS, Inc. recommends local, specialized SSDI attorneys who have knowledge of, and have worked with, county administrative SSDI judges in the state. There is no requirement that any claimant must use GENEX services, and “no”, you need not take their calls.

At one time Unum actually told claimants they would not allow a reduction of the 25% attorney fee in repayment calculations unless GENEX was used – an unfair and discriminative trade practice. To my knowledge Unum no longer does that, and claimants can choose who they want to represent them.

I recommend local experienced attorneys who represent YOU, not an outside third-party looking to benefit from an offset.

By the way, I don’t recommend ANY outside third-party for SSDI assistance. This includes Allsup and Advocator Group.

 

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Friday Q & A

Q&A ButtonDo I need GENEX, Allsup or other companies to help me file for SSDI?

No you don’t, and we do not recommend them. In my opinion insureds and claimants are far better off retaining local SSDI attorneys who have experience presenting in front of the county Administrative Law Judges. Since SSA regulates how fees are to be paid for all advocates, attorneys do not get paid until SSDI is approved.

National firms such as Binder and Binder send out attorneys from other states to represent you and have no experience in front of the local ALJs.

Besides, I’ve been hearing horror stories about GENEX lately relating to inefficiency, using paralegals and not attorneys, not returning calls, harassing claimants etc. What is unfortunate is that many insurance companies “sell” GENEX and Allsup to insureds as though they have to use these services when they really don’t. They may tell you that the service is “free” because insurers will deduct the 25% attorney fee from what is owed back.

What disturbs me and a few attorneys out there is that we don’t know where the kickbacks are. Does Unum pay GENEX a fee, or does GENEX “kickback” some of the 25% fee they receive from SSA to Unum? How is GENEX paid and where are the special interests? What is the relationship exactly between GENEX and Unum, or The Hartford and Allsup?

Information from reliable sources also indicates resources:

  1. See the insurers as client and work in their best interests. This means sharing with insurers any information, good or bad, they obtain in “representing” the client.
  2. They mostly do not use attorneys, so like Binder & Binder, no privilege attaches to communications.
  3. They advocate for SSA under the “grid rules.” Instead of arguing the claimant lacks any full time work capacity, the grid rules allows for benefits with sedentary or light work capacity that in turn enables insurers to terminate upon the change in occupational definition.

In my opinion, claimants are much better off using local SSDI attorneys as advocates from the beginning. They are all equally good because SSDI, SSI is all they do. SSDI and SSR can be applied for online and a local attorney can help you through the process. It makes no sense to me at all for insureds and claimants to use GENEX, Allsup or any other service provided by insurers who are looking for additional sources of information from which they can deny claims.

If you are already trying to manage a disability claim by an unfair insurer why would you want to use one of their services? Local SSDI attorneys are the best choice. Insurers will also deduct the 25% paid to local attorneys when the approval letter from SSA states a fee has been paid.

I’ve been surveilled several times this summer. What are they looking for?

Unfortunately, “surveillance” is a normal and customary consequence of receiving disability benefits. And, of course, summer is the perfect time to do it. The purpose of surveillance is to permanently document what is called “inconsistency of report”. This means the insurance company is attempting to prove that you are able to physically and mentally engage in activities over and above what you and your physician have reported.

Clearly, insurance companies do not totally accept medical restrictions and limitations reported from treating physicians because in their opinion treating physicians “advocate and exaggerate” patients’ inability to work. Therefore, they watch you for three days, usually on Thursday, Friday and Saturday, to decide for themselves whether your activities are consistent with those reported by your doctors.

Although most insureds tell me, “I don’t care, I don’t do anything wrong”, that’s obviously not the point. Insurers exaggerate their own conflicts of interests to not pay claims by misrepresenting what they see and record on CDs. To insurers, just coming out of your house could be interpreted as sedentary work capacity. Therefore, “not doing anything wrong” isn’t the point at all.

Summer is the perfect time to conduct surveillance because this is the time when claimants may be inclined to push the R&L envelope. As long as insureds are receiving benefits the possibility of surveillance at 400 yards exists! Claimants are recommended to abide by the medical restrictions and limitations given by physicians and to use common sense when surveillance is spotted.

How is it that Unum can deny my claim when my doctors certify disability?

The easy answer here would of course be, “Because they can.” Disability insurers have complete “discretion” to decide who does and does not get paid and most of you already know they can deny for little to no justified reason. There is admittedly a “conflict of interest” in acting as both reviewers and payers of claims. In combination with adverse provisions written into the policy, claimants have the deck stacked against them from the beginning.

The product of disability coverage is flawed and corrupt. But, disability insurers can deny claims over and above what any treating medical resource reports or recommends simply because they can. (And, I might add, US insurers are too afraid to fight the system to enforce oversight and regulation. Nothing will change when insureds are so fearful they insist on being anonymous. Anonymity won’t change insurance corruption.)

Is the Maine attorney general still harassing you?

Unfortunately yes. The Maine Attorney General working in conjunction with Unum, is attempting to eliminate third-party, non-attorney assistance to insureds and claimants so that Unum can deny more claims. Mind you, Unum is not attempting to stop assistance provided by neighbors, peers, parents and the like, just professionals who know what they are doing. Since I know all of Unum’s internal secrets the ball and chain seems to have settled on me.

Nevertheless, DCS is prepared to defend all consultants on this matter and we’ll just have to see what the outcome is. Maine is a bossy state and generally tries to “legislate” in the negative. In other words, very seldom will laws and state regulation be favorable to Maine citizens, but rather attempt to limit or restrict freedoms that for other states are presumed. Facetiously I don’t think it’s unreasonable to say that everything except for tourism and logging is illegal in Maine.

This stems from the fact that the Maine Attorney General is unregulated and operates in Maine without any checks and balances – a potential restriction on the personal freedoms of Maine citizens.

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DQ&A Buttono I have to give my insurer my SSDI overpayment?

DCS received several questions related to SSDI primary and dependent social security overpayments this week. There are already several good SSDI posts on the blog. If you search SSDI from the Home Page you will find them.

The short answer here is that “of course you have to pay back insurers if your policy is “integrated”, meaning it contains offset or reduction provisions for both primary and secondary social security disability awards.

Most people don’t realize that the disability insurer “fronts” SSDI awards by paying 100% of the claim benefit (at the claimant’s request) with the understanding that once SSDI is approved, insureds will pay back the money. Most claimants sign Payment Option Forms agreeing to pay back the “front” money once it is received from SSA, and then later refuse to do so.

The problem is that some claimants wake up one day and find more money in their checking accounts than they have ever seen in one place-ever. And, they  don’t want to give it back.

Individuals receiving disability are already living with 40% less money, bills have stacked up, prescriptions haven’t been purchased for a while, and the truth is, some people just don’t want to pay back  SSDI money once they agreed to.

DCS supports that if claimants agree to pay back SSDI overpayments by requesting to receive full benefits while SSA is reviewing claims, then the money should be paid back to insurers according to signed Payment Option Agreements.

Claimants need to understand upfront that they receive 100% of their benefit only because the insurance company offers to “front” the SSDI money while waiting for SSA’s decisions. Some insurance companies refuse to do that an actually reduce benefits with estimates from the beginning.

Unum, for example, put an end to claimants not repaying SSDI awards and changed its Payment Option Form giving it voluntary liens over assets and property if the money isn’t paid back. If you sign one of these POF form, then Unum can, of course, recover the overpayment by taking your assets (probably with a court order.)

Claimants who do not want to pay back SSDI overpayments should opt for reduction of benefits for an SSDI estimate from the start; then, SSDI overpayment money need not be paid back.

Agreeing to pay back SSDI overpayments in order to receive full benefits, and then refusing to pay back the money makes claimants do things they ordinarily wouldn’t do.

Reviewing and managing disability claims fairly works both ways. Claimants can’t expect insurers to treat them fairly in every aspect only to refuse to pay back SSDI overpayment money after agreeing to be paid 100% of the benefit.

I don’t understand why DMS changed my date of disability and refuses to pay me for a prior period of residual disability. I don’t have a clue, do you?

I think I have an answer to your question since it sounds as though you may have made one of the most common mistakes in filing disability claims, especially for residual prior periods. Depending on how “late” the filing is for a prior period and/or whether “prejudice” is involved, I’ve found that explanations for non-payment are far less complicated.

Insureds and claimants fail to understand that they just can’t walk off the job on their own say-so; employers cannot force them to file disability claims; and, work hours cannot be reduced just because you want to reduce your hours. The only one who can certify cessation of work, or reduction in hours for disability claim purposes is a treating physician.

The most common offenders of “just walking away” or reducing hours are self-employed physicians, dentists and other executives as well as ERISA folks, but on a much lesser scale.

In order for disability claims to be successful, insureds and claimants should be able to demonstrate medical histories of worsening medical impairments culminating in a PHYSICIAN documenting that he/she is recommending “no work” by providing specific “restrictions and limitations” precluding work at all, or recommending reductions in work hours or tasks.

This type of patient record will also produce a “date of disability”, or the date when the physician is recommending cessation of work. Disability insurers will use either the day after the last day worked, or the first date of treatment as the official date of disability.

Most insureds actually do the opposite by first “walking away from work”, or reducing hours, and then seeking medical assistance by demanding physicians document a date of disability after-the-fact.

For prior periods of disability this isn’t going to work because insurers can’t find a connection between cessation of work and certification of medical disability. Insureds should first consult with their treating physicians by providing copies of their job descriptions with explanations as to those job tasks, or hours, he/she can no longer do or perform.

Only a physician can certify disability by recommending cessation of work totally, or reductions in hours due to medical impairment. Walking off the job without the recommendations of treating physicians poses disability claim problems in determining dates of disability justifiably related to medical disability.

Insurers will refuse to pay for prior residual periods of disability by moving “dates of disability” forward to “first dates of treatment”, or dates when physicians document disability recommendations.

It’s not a good idea for any insured or claimant to “walk off the job” or voluntarily reduce hours without the recommendations of treating physicians and documented medical restrictions and limitations. This “procedural rule” if you will applies to all insureds and claimants who file disability claims.

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Woman CallingLast week DCS, Inc. received several interesting calls from insureds reporting information of particular interest. In keeping with Unum’s ongoing strategies regarding SSDI, one claimant reported Unum began harassing her with phone calls immediately after she repaid “a huge lump-sum” SSDI overpayment.

“Unum’s rep called me everyday last week. It’s pretty strange Unum waited until I sent them a check and now all hell has broken loose!”

Negative reports regarding Unum’s SSDI procedures are not new, in fact this consultant was an expert witness in a qui tam case ten years ago regarding Unum’s forcing all claimants to apply for SSDI even though they didn’t meet the criteria of SSA. Although the case was eventually won, Unum’s involvement with SSDI has escalated over the years. In my opinion, Unum’s (and other insurer’s) treatment of SSDI is probably an example of one of the most abused concepts of estoppel ever allowed by law.

The definition of “estoppel” is “a rule of evidence whereby a person is precluded (estopped) from denying the truth of a statement of acts he has previously asserted. Or, a legal law that prevents a person from asserting a claim or fact that is inconsistent with a position that the person has previously taken.” (The Free Dictionary)

Unum, and all other insurers, literally force claimants to apply for SSDI knowing full well to qualify claimants must be “totally and permanently” disabled from performing any occupation in the national economy. Therefore, insurers are alleging all insureds are “totally and permanently disabled” at that time even when they are not.

Subsequently, once Unum benefits from SSDI awards through offset reductions and repayment of SSDI retroactive lump-sum awards, the company denies claims outright by alleging claimants are not totally disabled. If that’s not a legal estoppel I don’t know what is. (If there are any attorneys out there reading this blog, please send me a private email and weigh in on this topic.)

I’m not really understanding why attorneys don’t argue the point more often and ask the question, “Is this claimant totally disabled or not? First, Unum asserts claimants are totally disabled in order to profit financially, and then suddenly the company denies claims taking the opposite point of view in order to profit again. What’s wrong with this picture?

Aggressive risk management (including harassing phone calls everyday) shortly after lump sums are paid back is obvious to any knowledgeable person looking at Unum’s claims process. Of course coincidentally, this report of harassing phone calls occurred just prior to the end of Unum’s April month-end profitability reporting. (Harassing phone calls can be easily stopped by requesting “all future communications in writing.”) Unum may have also been hot to terminate this claim by the end of April.

Claimant’s have also been reporting to DCS that they are suddenly receiving SSDI “update requests” shortly after Unum obtains copies of their SSDI files, or denies claims. This is consistent with reported information that Unum is positioning its influence within SSA to feed back information.

On second glance this consultant is now wondering how Unum is able to do that without specific authorization. But guess what? A close examination of Unum’s new Authorization forms allows it to disclose YOUR information to the Social Security Administration. This means if Unum conducts surveillance, or engages in “snoop dog” Internet activities, interviews neighbors etc. it can then provide that information back to SSA. (I encourage all Unum insureds and claimants to pull out the last Authorization signed and verify that your signature allows Unum to feed SSA file information about you.)

You will find this information under the heading, “I also Authorize Unum to disclose information to the following parties….” Although I haven’t examined Authorizations from other insurers it is entirely possible they all say the same thing even though no other insurer I know of is actually providing info to SSA other than Unum, potentially. Claimants may want to reconsider giving permissions to insurers to provide SSA with file information.

Unum’s obsession with SSDI for profitability sake is an ongoing battle claimants have been fighting for many, many years. Ten years ago attorneys were “all hep” to challenge SSDI lump-sum repayments, and rights to offset and collect under ERISA, but now I gather all that has been left as just one more “lost cause” among the worthy.

Unum’s abuse of the system is worse, not better, particularly using a new Payment Option Form that gives the company a voluntary lien over assets and bank accounts if lump-sum repayments are not made.

SSDI, repayments, and Unum’s harassment to deny claims after recovery of offsets is a hot topic of phone calls to DCS. Perhaps claimants should rethink the process and what they can do to protect file information from being forwarded by Unum to any outside third-party.

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RemindersUnum continues to target HIV, Anesthesiologist, and RN claims

If the number of calls received by DCS, Inc. is any indication Unum is apparently not changing direction in identifying “target groups” vulnerable to easy denial.  Callers identify frequent Unum updates, phone calls, and requests for more and more information while they continue to suffer from a long list of secondary impairments caused by HIV/AIDS.

Due to improvements in new medications and cocktails, Unum’s philosophy is that once HIV insureds are stabilized they can go back to work and I’ve no doubt that some HIV patients can. However, although newer drugs for HIV potentially extend the life span of those affected, most drugs by no means eliminate side effects or a long list of other symptoms such as severe diarrhea, polyneuropathy, dizziness, blurred vision, and fatigue. Unum’s medical reviews have also suggested that those with T-Cell counts of 200 can go back to work when the medical community cautions increased bacterial infections possible with those results. Unum fails to accept that even with the newer medications for HIV, symptoms do not automatically disappear sufficient to be able to return to work.

Anesthesiologist claims are Unum targets because most anesthesiologists rotate from hospital facilities and are expected to have on-call hours far beyond working 40+ hours per week.  Unum often refuses to accept the fact that unless anesthesiologists are able to continue on-call duties, they  will not be able to work in their own occupations. Although some anesthesiologists become opiate addicted Unum’s internal reviewers allege they can return to normal duties once rehabilitated by in or outpatient care. Sending anesthesiologists back into the same surgical environment rife with opiates actually encourages physicians to start using again. Still, Unum targets anesthesiologist claims because they are most often independent contractors.

In the disability claim world RNs have the worst luck. Unum’s vocational reviewers often document that Registered Nurses can do a wide range of sub-occupations when in fact they cannot. Many RN claims are denied at the change in definition for this reason. Nurses who are not trained in patient care cannot just change directions and begin providing patient care. Likewise, an ER nurse probably won’t be hired as a school nurse without additional training. Unum is totally blind to the fact that “one size does not fit all” in the nursing profession and that just because insureds are RNs they don’t necessarily have the training “to be all to all.”

Unfortunately, over time Unum becomes somewhat of an expert in discrediting claims for the above target groups.

Multiple questions concerning repayment of Primary and Family SSDI overpayments.

Once again DCS is receiving numerous calls and emails concerning repayment of SSDI retroactive lump sums. Detailed information can be found on this blog about the subject and I defer to those posts. However, once again, please find a short version of information concerning SSDI overpayments.

  • Yes, insurers may deduct or offset Primary and Family monthly awards from disability benefits if the LTD policy says they can. (And, most of them do.)
  • Yes, insurers have the right to be repaid for any lump sums they have “fronted” you while you were waiting for SSA’s decision.
  • Yes, you do have to pay the money back if you have been receiving unreduced benefits and have signed a Payment Option Form agreeing to pay it back. If you do not want to “give back” the SSDI retroactive award, then opt to allow your insurers to reduce your benefit with an estimate while you are waiting for a decision from SSA.
  • Yes, insurers can reduce your benefit for SSDI awards to children and dependents if the policy says they can. This also means they can expect to be repaid for dependent lump sums as well.

DCS, Inc. encourages all claimants to obtain copies of their LTD Plans and to prepare themselves, knowing in advance, how much money will be available after SSDI offsets. In reality what seems to be happening is that claimants have no idea how their Plans work, nor do they understand about “Other Monthly Income.” If you have questions in this area please search the Home Page on this Blog for “Social Security” and read the detailed posts.

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Stop and ThinkThis week I had the opportunity of speaking with two prominent attorneys, one in California and the other in Florida. Both attorneys are knowledgeable, high-profile counselors with a great deal of experience with Unum Life, UnumProvident and now Unum Group.

One attorney told me, “Unum isn’t any worse than any other US insurer and the company is cleaning up its act”; the other said, “Unum is really awful and I’m still looking to file a RICO (Racketeering) case against it.” The dichotomy of these two differing points of view from attorneys who should know what’s going on is puzzling to say the least.

The question I’m asked most often is, “What IS going on with Unum these days?” Well, let’s take a look at what information I have access to by reading thousands of Unum letters, files, documents, and receiving emails and phone calls. Then, decide for yourselves what you think Unum is up to.

Voodoo Medical Reviews

Unum’s denial letters appear to reject any and all recommendations from primary care physicians in addition to rejecting FCEs, vocational reviews, and any other objective data obtained or submitted by anyone outside of the company. Although in 2004 Unum was required to consider the opinions of treating physicians by the multi-state settlement and RSA amendments, the company refuses to consider a consensus of medical opinion when it is not obtained, or paid for by itself.

Relying solely on Unum’s internal opinions is an unfair claims practice recognized by state regulators but Unum carries the process one step further by attempting to create the illusion of credibility by engaging in a hierarchy of medical review with multiple internal reviewers. One denial letter I read cited internal medical review by no fewer than four Unum physicians each one agreeing with the review before it. The obvious picture Unum creates is that the more opinions that can be obtained, the more credible the denial is. 

The problem remains, however, that whether Unum renders one or four medical internal opinions to back-up claim denials, ALL opinions are still Unum’s. It is very easy to render adverse decisions when the only opinions considered are Unum’s.

Therefore, we know by virtue of the omission of consideration and weight of any outside medical points of view that Unum is engaging in deliberate deception to deny claims by creating the illusion of credibility through multiple physician reviews that “stack the deck” against fully qualified treating physicians and their patients. The attorney looking to file RICO charges may point to this evidence at some point in the future.

Reliable Inside Information

Occasionally employees victimized by rounds of Unum’s age or gender related firings contact me and describe the company’s internal process as prejudicial and biased. One Unum employee described management as those “consultants” who in lieu of going to jail in 2004 were promoted as Directors and Managers and continue to force handlers to engage in unfair practices.

Not surprisingly, this is isn’t the first time I’ve heard of the corruption of Unum’s middle claims management who seems to pressure employees to deny everything in sight. Not long ago, one employee also shared that “Quality Compliance” audits and control over claim documentation kept the rank and file in check by making sure no information got into claim files that was adverse to Unum.

Finally, we also know from reliable sources that Unum’s settlement area was also directed to “risk manage” claims for denial when it becomes apparent they can do so. Phone conversations, and other investigatory means are used in the settlement department to obtain information to support denials in lieu of “providing insureds with available options of settlement.” We also know Unum manipulates present value calculations when claims have been under reserved as was pointed out last year to one of my clients.

IMT sheets and the “Rule of Threes” was also reported to DCS in 2012 although it’s unclear whether Unum still utilizes the practice. IMT sheets were allegedly provided to claims handlers containing names of insureds selected by management and QC to terminate as “the biggest bang for the buck.” IMT sheets were clear evidence of “targeting” specific claims for denial.

The “Rule of Threes” was a process whereby Unum claims handlers worked to obtain return to work releases and other reports not supporting restrictions and limitations. When they had three sources of denial support, claims were terminated.

Clearly, there are strategies and internal claims review processes that former employees report as unfair and discriminatory.

SSDI – Deliberate Interference

During the last several years Unum has systematically created a strategy of interfering with a federal agency and an entitlement paid for by the American people. The following has gradually taken place in plain sight.

  1. Unum obtained permission from the SSA to use its own File Authorization Request Form in lieu of Federal Form-3288. Unum’s version of the Authorization to obtain SSDI files adds permission to release Federal Form 831 that contains diagnosis codes and the name of the DDS who made the approval decision. Unum’s version also provides that the form is valid for 2 years. Occasionally under threat of termination, Unum sells obtaining SSDI files as “we want to give your claim every possible consideration.”
  2. Unum changed its Payment Option Form to include giving the company voluntary liens over all insureds’ assets if they do not pay back the retroactive overpayment.
  3. Unum begins to send out denial letters stating that the company does not need “to consider” SSDI decisions because it was able to obtain more current information SSA didn’t have when they made a decision to approve claims. Unum “suggests” insureds are no longer qualified for SSDI.
  4. Evidence indicates Unum obtains SSDI files on a hunt for mental and nervous listings it can use to limit claims to 24 months even when it’s clear the primary cause of disability is physical, not mental.
  5. Claimants who receive Unum denials are reporting that they receive “SSDI Review” forms shortly thereafter even when the initial SSA approval does not mention timely SSA reviews. (Is Unum forwarding their own opinions back to SSA?)
  6. Unum appears before the US House Ways and Means Committee offering its assistance in the identification of fraud.

What is more egregious is that the SSDI process at Unum now looks like this:

  1. Forcing all insureds and claimants to apply for SSDI under threat of reducing benefits if application is not made.
  2. Coercing claimants to sign the new POF form under threat of termination of claim even though the form is asking claimants to agree to something potentially adverse to them.
  3. Coercing claimants to sign CL-1155, Unum’s own Authorization form to obtain SSDI files requesting Form 831 and validating the authorization for two years.
  4. Once SSDI files are obtained, claims may be limited to 24 months if mental and nervous listing are used by SSA to award benefits.
  5. Unum alleges that it is excluded from considering SSDI decisions when making its own because it obtained more current information SSA didn’t have at the time of the approval and claimants may not be entitled to SSDI at all.
  6. Once SSDI is approved Unum uses the threat of the new POF form to re-coop overpayments, and then denies claims using multiple internal reviews to support claimants can work.

Clearly, the attorney seeking cause for RICO against Unum will be taking a long and hard look at the above. The evidence is out there, all the attorneys need to do is gather it.

The above points made in this post are only the tip of the iceberg. Regardless of which side of the fence attorneys comfortably settle on, it is clear that Unum is not operating in “good faith and fair dealing.” Are other insurance company’s doing the same things? In my opinion, not quite.

It is also my opinion that since Unum’s demutualization in the mid-80’s the company has never been able to devise ways to pay claims fairly AND make a profit at the same. I doubt Unum’s profitability picture would be in the black if the company were stripped of its deceptive claims practices.

However, given the above information (a mere mention given all of Unum’s strategies), YOU decide for yourself what Unum’s up to and which attorney you would throw in your towel with.

 

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