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Posts Tagged ‘Unum claims hander misconduct’

Claim for Disability DeniedDo Unum claims handlers (and other insurance claims personnel) really know what they are doing is wrong?

In my opinion, yes they do. After you’ve worked for Unum for several years it is impossible to NOT know.

Targeting strategies are obvious when managers arrive at cubicles every morning with IMT sheets listing by name those claimants management considers non-compensable.(Let’s terminate the “biggest bang for the buck.”) Team and other roundtables attended by Unum’s business interests (VP of claims, attorneys, claims managers, vocational and medical reps,and  internal physicians) consider and strategize how to terminate claims that will be approved through appeals. Performance bonuses given to claims handlers who can deny the most claims, and annual percentage bonuses given to internal physicians who support Unum’s agenda to terminate claims are indications of wrong doing which deprives insureds and claimants of the right to fair and equitable claims review. In fact, no insured can get a fair medical review inside Unum – ever.

Claims handlers with tenure are often quickly terminated once they “figure out” what’s going on and begin to think outside of the Unum box. Unum’s claims process can only work when all claims handlers do what they’re told in robotic precision.

In the end Unum’s claims handlers must make a decision to continue to terminate claims they know should be paid, or quit. Keeping that in mind Unum pays these glorified Administrative Assistants a good salary to keep them hooked in and many remain because they want to stay employed particularly in this economy. Would you keep your mouth shut if you were making $50,000 a year? I wonder if it’s true everyone has their price? Nevertheless, “Yes” claims handlers know exactly what they are doing when they deny legitimate claims that should be paid. Those who stay, just don’t care.

**Point of interest…….most Unum claims handlers have insurance alphabet soup after their names, i.e. HIA, DIA, DHP etc. These insurance credentials are awarded by the Health Insurance Association of America which is an organization with a code of ethics. If you read the actual code of ethics claims personnel are to abide by, it becomes obvious Unum’s personnel cannot possibly abide by the Code of Conduct due to Unum’s claims process of deliberate targeting. Back in 2002 Gene Anderson, a prestigious New York attorney contacted  HIA and informed them Unum personnel were not keeping the prescribed “Code of Ethics and Conduct” after their credentials are earned. HIAA didn’t want to hear it, and told Gene, “We don’t need to address these kinds of problems. Don’t call us again.”  What’s the point of having a Code of Ethics when it can’t be enforced?

I think Unum is paying me incorrectly and my benefit should be more. How do I correct it?

First, you need to have all your ducks in order. Obtain a copy of your policy (ERISA group policy) and look at the definition of Monthly Earnings. Although there are several different versions, it should read something like this:

WHAT ARE YOUR MONTHLY EARNINGS?

“Monthly Earnings” means your gross monthly income from your Employer in effect just prior to your date of disability. It includes your total income before taxes. it is prior to any deductions made for pre-tax contributions to a qualified deferred compensation plan, Section 125 plan, or flexible spending account. It does not include income received from commissions, bonuses, overtime pay, any other extra compensation, or income received from sources other than your Employer.”

For the above definition of “Earnings’, obtain a copy of your last pay stub just prior to your date of disability. If you are paid bi-monthly then the last two pay stubs are required. Compute your monthly income from the pay stubs according to the contract definition. Then go to the SPD (Summary Plan Description) at the front of your policy and make note of the percentage of pre-disability earnings to be paid.

My point is that before contacting Unum, you should have all your earnings proof together and be able to support it according to the Monthly Earnings definition in the policy. Actually, if Unum IS wrong the company is pretty good about correcting it, but you need to support the amount you are claiming should be paid. On occasion, salary amounts reported to Unum are wrong and you need to go back to your employer and ask them to correct the error.

For DI insureds, look for the “scheduled amount” of the contractual benefit and add any future income additions approved in the policy.

Always be prepared to support contractually what you question with any insurance company.

My doctor really doesn’t want to speak to my insurance company. What should I do? Unum keeps calling and harassing the office staff.

Treating physicians can nip harassing situations in the bud so easily. Your physician can simply fax Unum a short letter on his/her letterhead which states the following:

“Although I am happy to provide you with medical restrictions and limitations of my patient __________________, I prefer that you contact my office only in writing with your request. I will respond to ___________ in a timely fashion and will include an invoice for my time fulfilling your request. Phone calls will not be accepted.”

Physicians have a great deal more power than they often realize. Vexatious calls to physicians’ offices can be stopped with a quick fax. Insureds and claimants have a responsibility to provide their insurers with updated medical proof of claim. This does not mean, however, that insurance companies (and their internal docs) have the right to harass any medical office.

Can CIGNA conduct surveillance?

Any disability insurance company has the investigative right to conduct surveillance – and they frequently do.

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