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Posts Tagged ‘Unum complaints’

Colette of Moultrie, GA on
I established Unum Insurance through my employer in 2008-2011 and the both of them are very unethical. I enrolled in short-term disability insurance as well as long-term disability insurance paying into the program for numerous of years and suffered an injury that I still have until this day. I was injured at work and this company gave me the run around about my insurance until the day I was wrongfully terminated. I asked for reimbursement and they refused. They are deceitful and in the business of making money off their consumers.
(I wonder whether this claimant understood that Unum’s STD Plans do not pay for work injury covered by Worker’s Compensation. While I’m sure that Unum does not function fairly or works to PAY claims rather than deny, STD is generally not paid to employees injured at work. In fact, Unum has been handing off other disabilities as Worker’s Comp when in fact the disabilities aren’t work injuries at all! Inside information provided confirms that Unum’s STD reviews are slanted for the purpose of denying most of them.)
Bethany of Southside, AL on
They have every reason under the Sun to not pay my claim, I have received the run around. They are heartless. They do not want to pay no matter what. My surgeon and my PCP sent in all documentation to support my absence for a month, with it being an emergency surgery. No preexisting condition or anything that my policy wouldn’t cover and Unum still keeps coming up with ridiculous reasons not to pay when it’s obvious I could not work which was most certainly clear. No food on the table, had every reason to receive money from a company I have paid into every week. They do not care.
(This post really says it all doesn’t it? Unum has a very poor public reputation in both the US and Great Britain. Middle class ERISA employees have less than a 50% chance of having a Unum paid claim. The bare truth is, Unum STD/LTD coverage does not provide employees with any kind of financial security and should not be depended on long-term.)
Michael of Somersworth, NH on
Unum yet again has wrongfully deprived another sick/injured person of their disability insurance. I have 3 specialist physicians ALL stating my need for disability and yet Unum has wrongfully denied this based on their part-time primary care doctors evaluation. On top of this, there have been 3 employees including a supervisor and contracted physician that have blatantly lied (on a recorded line) about physicians letters claiming my ability to return to work when in fact none exist. The contracted physician created a written statement claiming that one of my specialist physicians stated that “pt is ready to return to occupation at full-time.” This never happened and infuriated my physician so much that he wrote a strongly worded letter back to Unum and the contracted physician correcting their lies. In my opinion, never trust anything an Unum employee tells you and NEVER pay for any services that Unum has to offer.
(I don’t know how many times I’ve written on the Blog that Unum doesn’t tell the truth. Yet, insureds seem to want to believe what they are told by the claims handlers. The truth is, Unum reps (and their Directors) misrepresent medical records for the purpose of denying more claims. And, it does make treating physicians furious. The problem is that Unum doesn’t care that the physician “wrote a rebuttal letter”; once the company has its mind make up it rarely changes even when they are clearly wrong. Employers need to do their homework and research Unum’s payment history for group STD/LTD. Once they do, most employers should refuse to do business with Unum unless they have a full service agreement guaranteeing certain levels of payment and customer service.)
Marie of Winston-Salem, NC on
My doctor put me off work for 3 weeks because of heart palpitations and the stress of my job. I was also put on blood pressure medication but we could not get it down. The claims expert informed me that I was not sick enough to stay off work. I asked him, “should I have ignored my doctor’s request and gone to work?” He could not answer, but he did say that everyone gets stressed at work, but it should not have kept me off work. REALLY!!? Why am I paying into this plan?!! THIS IS CRAZY! I was waiting on this money to pay my bills. REALLY!??
(This is a very common Unum complaint. There are two things Unum never accepts as cause for disability: 1) stress and 2) inability to drive. Unum’s internal policy regarding stress is that “everybody has work stress” and it isn’t a cause for disability. Also, Unum discounts reports of inability to drive except for “blindness”. This claims handler overstepped his boundary since it’s not up to Unum’s reps to to say someone can or cannot work. Unum’s reps are making more and more value judgments these days and that’s why DCS, Inc. recommends communications in writing only.)

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Friday Q & A

Q&A ButtonCan I file an internal complaint with Unum?

Yes, but you would be wasting your time. Unum’s complaint procedure doesn’t solve problems or issues. Unum’s responses from Richard Joseph are usually multi-page letters telling you “we did nothing wrong.” If you think about it, no insurance company is likely to admit wrongdoing anyway.

Complaints, however, to state insurance departments can make a difference if enough people complain about the same things. The complaint from one insured may not be acted upon but in combination with other complaints could inspire the DOLs to begin “Conduct Market Examinations” that could prove costly to insurers.

While state DOLs were before reluctant to investigate complaints outside of their jurisdiction (ERISA), the number of complaints received still counts. We encourage ERISA claimants to file “courtesy complaints” to state departments of insurance.

In addition, ERISA claimants should always send letters of complaint to their HR Benefit Administrators. Unum couldn’t operate for very long if employer’s pulled their Group LTD business from Unum. It’s always a good idea to let your employer, a co-fiduciary of your Plan, know how Unum managed your claim and whether or not it was denied unfairly.

Complaining to Unum, a company that openly admits it does nothing wrong, is a waste of anyone’s time.

CIGNA is giving me a hard time. Any advice?

CIGNA is another one of the insurance “bottom feeders” that is so paranoid it won’t even disclose the full name of those who manage claims. The company was hit with a multi-state settlement agreement in 2013, but like Unum, continues to ignore its promises of changes agreed to. Claims handlers aren’t smart, and managers know less than they do.

CIGNA’s claims process includes making calls to treating physicians. Even though CIGNA’s policies do not require doc-to-doc calls as proof of claim, CIGNA uses no-contact as cause for denial. This is a breach of contract.

The best thing to do with CIGNA is make sure you get everything in writing and stay on top of the process every minute. CIGNA has been cited in several lawsuits in 2016, so it’s best to keep a journal and document everything. The DOL in Maine was a lead regulator in the 2013 CIGNA multi-state and complaints can always be sent there as well.

What is Unum’s Extended Duration Unit? Should I be concerned?

Unum’s EDU lost it’s significance three years ago when management sent it’s best claims handlers there to “deny as many claims as they could.” Therefore, although claims are still sent to the EDU, they are also “risk managed” even though benefits have been paid 10-15 years in some cases.

Many claimants were hurt financially as a result of Unum’s “arbitrary and capricious” denials from the EDU. Remember, these are claims that have been awarded SSDI and liability to maximum duration was at one time accepted by Unum.

Today, it doesn’t matter. Unum will deny any claim it can get away with whether it is in the Extended Duration Unit or not. There is no longer a “safety zone” for Unum insureds and claimants, and claims are eternally targets for denial.

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More Unum Complaints With Commentary

ComplaintsJacqueline of Mahwah, NJ on Jan. 14, 2017

I had an 18-month policy with UNUM paid for through employee deductions. Before I became ill I knew nothing about this company or their practices. My illness was of a mental nature so my policy was limited to 18 months (something HR forgets to tell you). Most policies are limited to 24 months and that is when they want you gone!

The claim represented harassed me on a weekly basis, spending 30 mins or more asking questions like: How do I spend my day, do I watch television, who cleans my house and so one. I take a lot of anti-depressants and anti-anxiety meds so I could not even think straight. They not only harassed me but sent my therapist and psychiatrist weekly questions. The rep even faxed my one doctor a form saying, “Sign this so your patient can go back to work!” The physician phoned me at home asking if I told UNUM that I was going back to work. I told him no, he said it was very sneaky of UNUM to fax this form as he is a very busy doctor and does not have time to look over every single insurance form. My therapist old me she has never ever been sent so many forms to complete and she has been in practice for over 35 years!

Yesterday, after 24 months of disability I logged on the UNUM website, apparently my claim is closed with no denial letter or explanation. I called UNUM Carrie out of the ME office but she was not available, how convenient. I asked why I could not access my documentation online and a customer service rep said he did not know and that it was just a coincidence, really.

I am quite relieved about being denied, even though I have never received a formal denial. No more phone calls from Carrie, no more harassment, no more added anxiety. I am absolutely positive they receive incentive bonuses on how many cases they can deny. How do I know? I was a no-fault adjuster for 34 years… the only difference is I never harassed claimants to the point that UNUM does. No point in getting an attorney as I think it would cost more than UNUM pays me. I will however make an Insurance Department complaint about UNUM’s practices as it borders on BAD FAITH.

(This is a situation that occurred quite frequently even a decade ago when I worked for Unum Life and UnumProvident. Mental and Nervous claims are immediately targeted and projected for denial. In fact, once coded on BAS (Unum’s pay system), Mental and Nervous Claims go away automatically, and it is possible a really ding bat claims handler would not notice a denial letter was required.

Actually, two letters are required by Unum – one about three months before the M&N denial asking if there is additional information to be considered for physical disability, and then the denial letter giving claimants their appeal rights under ERISA.

The issue of Unum contacting treating physicians and therapists to persuade them to return patients to work is. not a new one. Unum frequently contacts treating providers and proceeds to convince them patients can work. I’m glad to see here that the therapist immediately contacted his patient. Many Unum claimants actually feel relieved when no longer connected to Unum.)

Lavanya of Aurora, IL on Jan. 12, 2017

After suffering severe sciatica for years, I finally convinced myself that it was time to go for back surgery as my situation has gotten worse over the summer of 2016. I could not stand or walk for more than “10 sec”. I couldn’t sit and lay down in any position desired. It was true living hell. MRI showed Disc herniation with impingement on Sciatic nerve root. In Oct of 2016, I went for the microdiscectomy and laminectomy, during which it was found out that there were disc (L5-S1) fragments in the nerve canal causing significant narrowing of nerve canal, hence the pain and numbness in the leg. Surgery was successful. I could walk without limp, and my leg started gaining strength although there was pain from the surgery itself. It was ordered recovery for 8-12 weeks.

Ten days after the surgery, I got a call from UNUM if I could return to work. I was caught with surprise as my short-term disability and medical leave were approved through the end of the year (11 weeks) and my surgeon recommended 8-12 weeks of recovery depending on how quickly I recover. I made a call to my UNUM case representative and she tried to explain to me that note from my prior doctor’s visit (a week after the surgery) said I had no pain, hence I should be able to go back to work. Politely I explained to her that I was still on narcotic painkillers and no way I was in a position to sit and work and that I have not recovered.

A few days later, I get another mail that my claim was extended for 2 more weeks, and that I need to prove why I can’t go back to work. After making several calls (she would never answer her direct line) and number of voice mails, I talked to someone on the Main line to have her contact me. Then she called me telling that Doctor’s office didn’t send them restrictions. I asked her if she has requested the same, apparently they sent number of pages for the doctor’s office to fill and never made it clear what exactly they needed. I was extremely furious because I was in pain, disabled, and then these people made me feel insignificant and I had to convince them that I need time to recover after an illness and doctor’s order is not enough. They needed restrictions as to what was keeping me off work. Obviously “being in pain after surgery” didn’t count as a valid reason to them. What kind of insurance company is that?

I firmly told her that I was not to return to work till I had my follow-up with my surgeon in Dec. Then another mail that my claim was extended till the date of my follow-up appointment. In the meantime, I contacted my employer and HR and I explained them the harassment I had to go through at the time when I expected some empathy from UNUM. Reading from elsewhere, they do that to cancer patients too! Repeatedly asking them what is stopping them from returning to work while they go through the cancer treatment.

Finally it was day of my follow-up with surgeon. I asked my surgeon if I could go back to work, he said I could if I can. This was on a Thursday. Then I called UNUM the next morning (Friday). Again multiple calls with no response to the same agent. Left a voicemail and reached someone over the main line to tell them that I was going back to work on Monday. They asked me a series of questions, and there was the end of it. My disability claim was going to end and I was returning to work. Keep in mind that I was still recovering, just well enough to be returning to work. I was glad that I was done with UNUM. A week or so later, I receive another mail asking for documentation from Nov to Dec, proving why I had to stay off work. I ignored as I had already been working for over a week. A few days later, another mail asking for documentation, ignored again.

Then last week, another mail saying that my claim has been closed and was approved only till Dec 8 (Thursday) as last doctor’s visit note had indicated no complications and that I was doing well and that they received a return to work note on Dec 15 but they only approved till Dec 8. Dec 8 is Thursday, Dec 9 is Friday, the day of the call. Dec 10, 11 – Weekend. Dec 12 – return to work. But they only approved till Dec 8th.

It’s amazing how they think they can decide how long a person should recover post-op better than a medical provider. The vocabulary made me rethink what is “well” and what is “ability”. “Your job requires only sedentary physical ability hence, we are closing the claim.” Is pain hindrance to physical ability or mental ability? I obviously need mental ability with higher IQ and specific skills to perform my job, not just sedentary physical ability to be able to sit at desk all day long.
If you expect someone to go back to work 2 weeks post-op while on pain meds just because your job only requires sedentary physical ability, that is lame. I have no doubt someone would sue them because of their obstruction in post-op recovery and harassment they put them through.

(What Lavanya is describing here is Unum’s use of a medical recovery software called Medical Advisor that lists all possible standard recovery dates for impairments. Unum began using this software as a “stop-gap” to allow handlers to make medical recovery decisions without doing RN “walk-ins.” The program also allows claims specialists to set Expected Recovery Dates (“ERD”) without requiring someone to validate or micromanage the process. Remember, ERDs aren’t recovery dates at all, but “denial” dates.

In combination with Medical Advisor, ERDs and the “hop skip” process of STD, short-term disability quickly becomes a Unum complicated mess. Recovery software does not take into account that each individual heals at different rates and in most instances is inaccurate. Unum loves it because the recovery dates are listed at the earliest, not the latest.

The use of this software makes claims miserable for Unum’s customers because of having to explain every two weeks why they can’t go back to work.)

Harvey of Swindon, Other on Dec. 9, 2016

We had “Unum” as our Dental Benefit work provider, which was previously known as NDP which they took over from Capita in the UK. Every single claim was a hassle. If you had two dental appointments close together (I hate dentist so like to get the pain done and dusted quickly) for 2 separate teeth, they would class this a single course of treatment. Every claim was a quibble. Even though the dentist had filled in the form detailing that is was a separate filling and/or other treatment it was quibbled over, wasting the dentist’s time and my time. I would never sign up to Unum again as part of a corporate dental plan. Everything is the bottom line, no empathy, so feeling or understanding, just questioning every time every claim. Don’t bother with them, go elsewhere.

(It isn’t comforting to know that Unum’s unfair tactics jump into the management of other products as well. We all know Unum’s LTC product was a disaster that cost the company $42M in damages. This complaint points out the dangers of signing up for “Unum package” deals offered as part of an employer’s Group Plan. Products such as Accident, Life, Supplemental, Dental and Hospital Indemnity are often available to employees.

If Unum acts like a duck and quacks like a duck on its disability products I think it’s a pretty good guarantee its quackery on other products is a sure bet and not worth the extra premium.)

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dissatisfiedMelissa of Boca Raton, FL on Oct. 21, 2016

Unum only paid 5 weeks of short-term disability for pregnancy (coverage did not begin until 7 days after delivery). I had a cesarean section delivery and was expecting the 8 weeks of disability recommended in the state of Florida but Unum denied payment after 5 weeks and denied an appeal after providing additional documentation. I had an upper respiratory infection prior to delivery and while hospitalized for the delivery I was diagnosed with pneumonia. I was discharged on time but required continued care under a pulmonologist. It complicated my recovery but it didn’t matter to Unum. Given what I paid into the policy, it would have been wiser and more cost-effective to put the money into a savings account.

When I tried to cancel my policy upon my return to work I was told to call back because the system was down. I called back and was told my policy was canceled and that a letter was sent. I followed up a week later because I had not received a letter and found out that the policy was not canceled and canceled it again. I received an email confirmation when signing up and received an email when I filed an online claim, but they could not send me an email to confirm cancellation. I am disgusted with this company and will never purchase a policy through them again. It is a scam.

(This sounds suspiciously like using Medical Advisor software to determine recovery periods. We’ve been hearing from some of our Unum sources that Unum STD is engaging in practices designed to eliminate claims “sooner rather than later.” On the other side of the fence we are also hearing from more claimants that they want to either withdraw their claims or get out from under the policies they purchased. Unum isn’t demonstrating a competency level normally expected from disability insurers either.)

John of Goshen, IN on Oct. 7, 2016

Aug. 19, 2016 I had abdominal surgery for the 6th time. We knew, and the doctor knew this was going to be a lengthy recovery. The process started out great, people on the phone were delightful and helpful. Things spiraled down from there. On 8/26 I received my normal paycheck for working up to 8/18. Unum stated given the nature of my surgery, I should return to work 8/30. I received a letter stating that following the 7 day waiting period I would receive a check for 3 days at 60% of my rate. I contacted my doctor to submit the necessary paperwork, to which they complied. 3 days later I called to check the status and I was informed the paperwork was insufficient. No one called me, they said I would receive a letter.

Long story short, the doctor’s office re-sent paperwork 4 times with a tentative return to work date of Oct. 1. 3 weeks later I was paid a portion of what Unum owed me. For an insurance company, they “lose” paperwork a lot! People at the call center are hopeless, and my account specialist is a joke. The best part so far is the letter I received stating I was released from my doctor to return to work on 9/22/16. They have yet to produce documentation to prove that. They are FRAUDS. Short term disability is free through my employer, and good thing, because I will NEVER give this company a penny of my money… I am ready to seek legal counsel.

(As above, it seems clear Unum’s competency to manage claims is worsening. This is why DCS clients always obtain their own patient notes and paperwork and submit with several back-up confirmations. Although Unum isn’t the only company to lose paperwork (CIGNA and Aetna), it is becoming increasingly clear that the company’s former excellent customer service under Jim Orr III’s leadership is a thing of the past. More and more Unum insured and claimants are having difficulty proving disability. It is even harder when Unum’s negligence causes claims to be denied when it is not the claimant’s fault.)

Demetra of Astoria, NY on Oct. 3, 2016

My employer uses Unum as our short-term disability vendor. I have been with my employer for over a decade and after many bouts of stress/anxiety/panic and depression, I decided with the advice of my doctors and the support of my boss to take some time off to deal with these issues. I love my job but it is stressful and my work/life balance is compromised. I wanted to take time off to get in a better mental place so I can be an efficient and clear minded employee.

I opened my claim for STD in mid August with all the appropriate paperwork from my doctor. It took a thousand calls from me (none from them) and 6 weeks of pure aggravation in the end to only have my claim be denied on grounds of it being work related! UMMM… isn’t that what I stated from day one? Shouldn’t have someone at Unum communicated this ‘work related’ exclusion clause to me? It would have saved me weeks of aggravation and hence, deeming my leave useless as I was still stressed out and suffering from anxiety attacks due to being in disability limbo. The worst experience ever!

(Actually, this situation was reported to DCS by a reliable source describing “work related” allegations as a scheme to push claims back to workers’ compensation. Since Unum’s STD does not pay when claims are work related, Unum is now abusing that fact to allege sickness is “work related injury” and is denying claims when there has been no “catastrophic work event”. STD claimants are told to file for workers’ compensation even when the cause of disability is sickness and not a work place injury. In fact, this Unum scheme was previously reported to DCS as much as six months ago. This claimant is unfortunately believing what Unum told her, but depression is generally not due to only one thing, but rather a combination of life circumstances at the time. This might be a good lesson to know that not everything Unum says is accurate but is said in self-interest.)

Loretta of Maple Shade, NJ on Sept. 8, 2016

I’ve been an RN Case Manager at Hahnemann Hospital, part of Tenet Healthcare, since September 2003. I have had to use the Unum disability insurance (the only option we’re provided with) for any medical leave since being hired, and have had many more negative interactions than positive ones. I have had chronic back pain since an MVA in 1991, which I was desperate enough to make go away that I agreed to a 2-level spinal fusion in 1/2003 (even though I knew there was a really good chance that it wouldn’t help!). I was right, it didn’t help, and when I tried to get my employer (Horizon Blue Cross of NJ) to set me up to work from home (which other nurses doing my same job were already doing! ), she instead fired me for being absent! I started working at Hahnemann a few months later.

Since 2006, I’ve had the misfortune of having to use Unum multiple times for short-term disability, and I’ve had problems with my payments for more half of those periods of disability. Since I returned to work after all but present episode, I was eventually able to start bringing in money again by returning to my job. This time, however, I’m in a different position. I’ve been getting treated for osteoarthritis in my knees, hands, wrists & fingers for years. At this point, I’m no longer able to tolerate hours of computer, mouse, charting & writing anymore, and & meds I’ve been taking all these years make me a little drowsy, leaving me in danger of being fired for sleeping on the job!

I didn’t receive the check for the initial 6 weeks I was out (which included a 2-week elimination period that I was paying extra to reduce from 4 weeks) until AFTER I was initially scheduled to have returned to work! I was the one who put the paperwork into the fax machine at the doctor’s office for the first 6-week extension of my leave. I gave them a few days to work on the records, and then discovered on the website that they had closed the claim! I called them, and went back to the doctor’s office to resubmit everything to them through the end of July, and waited again for something to happen. Nothing did, so again I called, and uploaded the chart info myself to ensure they couldn’t deny receiving them.

The day after the records were uploaded, Unum generated another letter again asking my doctor for his records. When I called to tell them that both the office & I had submitted the requested information. I was then assured that the information was received & was being reviewed. Today, I dropped off my prescription for my pain meds and found out that my health insurance, which I sent almost $1,300 to Tenet to keep intact just after receiving the payment from Unum for June, 2016 (that I didn’t receive until the last week of AUGUST!). I have to now deal with the Tenet benefits department to see if there is anything that I can do to get this mess fixed.

My doctor wonders why my normally average blood pressure has gone into the stroke (200/100) range! The people at Unum have no conscience; they’ve received specific notes from my doctor noting that my blood pressure has been too high for him to give me steroid injections in the joints in my fingers, which has not happened to me before this summer.

(This is really a terrible situation and is a major sign of Unum’s constant downsizing and eliminating employees from the company. I’ve heard rumors that perhaps Unum may be sending its customer service to India, but I’m not sure that’s going to solve the problem. I do think there is a valid complaint here regarding receiving late payment when extra premium was paid to reduce the EP. Unum is now having a major problem with obtaining paperwork from physicians. Clearly, it isn’t the claimant’s fault if Unum can’t find what they request. Notice that most of these complaints have to do with Unum’s STD, a very common complaint these days.)

Reposted from consumer affairs.com with added comment from me.

________________________________________________________________________

Someone who can helpDisability Claims Solutions, Inc. is a fee based, national consulting organization that provides expert claims management services to those with private insurance. I offer free initial consultation. If you are interested in becoming a DCS client, please feel free to visit my website at: http://www.disabilityclaimssolutions.com

  • Telephone: (207) 793-4593
  • Fax: (207) 274-2331

Detailed information can also be viewed on this website by clicking the Tabs at the top of Lindanee’s blog Home Page.

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Unum Complaints with Commentary

Complaints(Reposted with commentary from consumer affairs.com)

Loretta of Maple Shade, NJ on Sept. 8, 2016

I’ve been an RN Case Manager at Hahnemann Hospital, part of Tenet Healthcare, since September 2003. I have had to use the Unum disability insurance (the only option we’re provided with) for any medical leave since being hired, and have had many more negative interactions than positive ones. I have had chronic back pain since an MVA in 1991, which I was desperate enough to make go away that I agreed to a 2-level spinal fusion in 1/2003 (even though I knew there was a really good chance that it wouldn’t help!). I was right, it didn’t help, and when I tried to get my employer (Horizon Blue Cross of NJ) to set me up to work from home (which other nurses doing my same job were already doing! ), she instead fired me for being absent! I started working at Hahnemann a few months later.

Since 2006, I’ve had to misfortune of having to use Unum multiple times for short-term disability, and I’ve had problems with my payments for more half of those periods of disability. Since I returned to work after all but present episode, I was eventually able to start bringing in money again by returning to my job. This time, however, I’m in a different position. I’ve been getting treated for osteoarthritis in my knees, hands, wrists & fingers for years. At this point, I’m no longer able to tolerate hours of computer, mouse, charting & writing anymore, and & meds I’ve been taking all these years make me a little drowsy, leaving me in danger of being fired for sleeping on the job!

I didn’t receive the check for the initial 6 weeks I was out (which included a 2-week elimination period that I was paying extra to reduce from 4 weeks) until AFTER I was initially scheduled to have returned to work! I was the one who put the paperwork into the fax machine at the doctor’s office for the first 6-week extension of my leave. I gave them a few days to work on the records, and then discovered on the website that they had closed the claim! I called them, and went back to the doctor’s office to resubmit everything to them through the end of July, and waited again for something to happen. Nothing did, so again I called, and uploaded the chart info myself to ensure they couldn’t deny receiving them.

The day after the records were uploaded, Unum generated another letter again asking my doctor for his records. When I called to tell them that both the office & I had submitted the requested information. I was then assured that the information was received & was being reviewed. Today, I dropped off my prescription for my pain meds and found out that my health insurance, which I sent almost $1,300 to Tenet to keep intact just after receiving the payment from Unum for June, 2016 (that I didn’t receive until the last week of AUGUST!). I have to now deal with the Tenet benefits department to see if there is anything that I can do to get this mess fixed.

My doctor wonders why my normally average blood pressure has gone into the stroke (200/100) range! The people at Unum have no conscience; they’ve received specific notes from my doctor noting that my blood pressure has been too high for him to give me steroid injections in the joints in my fingers, which has not happened to me before this summer.

(DCS has never recommended the use of Unum’s Internet portals or apps. To begin, it’s our understanding there is tracking software there, but my major objection is that it is unclear whether any activity taking place on the portal is actually placed in the Administrative Record or file. In addition, Unum’s customer service is extremely poor. I do not recommend using Unum’s website portals or apps. It’s a recipe for administrative disaster.)

Edris of Freeport, NY on Aug. 30, 2016

I had major stomach surgery 2 months ago and under my doctor’s orders was scheduled to be out for 6 weeks. Unum paid my claim for 4 weeks and decided that they were not going to pay for my additional 2 weeks because I was able to go back to work. Who the hell do they think they are?? If my doctor says I need to be out, an insurance company, who does not know me or my circumstances has no right to deny my claim!!! I have just filed an appeal and I am waiting to hear back. If the claim is denied again, I am calling my attorney. Unum is an insurance company, not a team of surgeons who know what a patient needs. My company and I pay money into the insurance company for my STD… It’s not their money!!

(Unfortunately Unum still uses MDA, a desktop medical recovery period data base that provides claims reps with estimated periods of recovery. Any software data base available today shouldn’t be used to make decisions that involve financial reserves and profitability. I can understand that perhaps MDA might give Unum’s medical staff some guidance, but using the software to deny claims using standard recovery periods for all insureds and claimants is an unfair claims practice. Each individual’s medical situation is different and claims decisions should be made considering the recommendations of medical treatment providers.

Unum was a great supporter of ATOS, a similar data based used exclusively in the UK (without human intervention I’m told), and it was a disaster in that the decisions made by ATOS, the computer, actually resulted in the death of persons entitled to welfare benefits. Anytime Unum intervenes to set up claim review systems, it is usually a scheme to make more money.)

Kim of Tyrone, PA on Aug. 27, 2016

I have it for short term and as a supplemental insurance! I pay 86.00 a pay for supplemental and they deny to pay claims and they take 2 weeks plus to pay. Please please do not purchase this insurance, you will have nothing but heartache! I had bilateral hand surgery, they refuse to pay for the second surgery. Lucky before I had them done I called and they told me they would pay for both hands, so since the phone call was recorded they had to pay!! Then my last week off work they would not pay me cause (even though the doctor said I wasn’t able to return to work) they refused to pay my last week off!!!

(This sounds like Unum’s STD management and the use of MDA to cut off people’s benefits in accordance with standardized recovery periods in the MDA data base.)

Greg of Quakertown, PA on Aug. 18, 2016

I had an accident which caused head trauma. At the start Unum paid the claim. My doctors and specialists all said that I was unable to work in letters to Unum. About 3 months in, Unum stopped paying claims. They stated it was under review by their doctors (who never saw me). After 90 days, they ruled against all doctors that were treating me and said I could work. Which was funny because I had to have help doing just about everything. So I appealed; 90 more days, then they said they needed another 90 days. Appealed denied. Hire an attorney before 2nd appeal. The story quickly will change from Unum.

(It is getting to the point that it’s clear to the general public at large that Unum is now the company of “NO”. Nothing has changed since the Multi-State Settlement Agreement and Unum continues to abuse its discretion in nearly every way it can. Employees need to take this information back to employers with requests to change Plans at the next annual enrollment period. If employers refused to buy Unum’s LTD products, the company wouldn’t be able to stay in business very long.)

N. B. of Plano, TX on Aug. 16, 2016

I had to go out for a major surgery and my company uses UNUM for their short term disability. I have never had such a horrible experience with a company. This is my first time ever going out on STD in my life and this company has badgered me, harassed me and made my recovery stressful. The doctor has specifically stated that the “full” recovery for this procedure is 6 weeks. The doctor has provided them with every document they need to support my claim.

Now, according to their “chart” my recovery is only allowed for 4 weeks and they just sprung thus surprise on me today, now I have less than a week left before I go back to work. My representative, Tracy is horrible. I can never get on touch with her, and when I opt out to a Tissot speak with someone, nobody knows what is going on. Thus company is deceitful and under no circumstances does your representative try to help you. I’m still on pain meds and cannot drive. Not only that but, since my surgery was on my stomach, it’s still swollen and I cannot wear anything with a waistband for longer than 2 hours. But, according to their chart, I’m recovered and need to report back to work.

I’m not trying to work any system or take advantage in any way, but I do feel like they are trying to screw me and I have to “prove” that I’m not able to work. This company and every associate I have dealt with is horrible… Especially Tracy put of Portland,ME. When I asked to speak to her supervisor, she says she wasn’t allowed to give put her information but I can call the 800 number and ask for Sheryl. Why would the supervisors isolate themselves like that? Or, why would Tracy lie? If you need rest in order to recover from anything, don’t expect it when you deal with UNUM.

(This situation is terrible and I’m sorry you had to go through all of this. Again, Unum is obviously using MDA to determine standardized recovery periods, and it’s unacceptable. I agree that Unum’s claims reps are unprofessional and rude. Unum claims reps are the bottom rung of administrative review, do not have autonomy to make claims decisions, are harassed by their managers to deny more and more claims, and generally are so stressed out they may not realize what planet they are on.

Unum’s claims reps also shield their Managers and Directors from customer contact. I wonder at times if Unum’s claims reps really “get” the fact that they are used by the company as a buffer to safeguard Managers and Directors from information that may be discoverable. Although Unum claims managers have knowledge of financial reserves and use that information to make claims decisions, claims reps do not have access and therefore can deny any prejudicial conduct based on profitability. Unum’s claims reps are no more than glorified Administrative Assistants and that probably makes them more contentious than ever! In any event, Unum’s conduct and that of its representatives contributes to Unum’s horrific public reputation.)

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Q&A pointerHow do I find work with a medical restriction?

Unfortunately, we live in a society that discriminates against the disabled and elderly. Unlike other countries that provide opportunities and work options for disabled workers, employers in the United States hire only the young, gym-healthy, good-looking, thin, and  highly educated.

The fact that Wal-Mart hires the disabled doesn’t speak well for the company either. Disabled workers are taken advantage of with low pay, limited benefits, not to mention that most people joke about “being a greeter at Wal-Mart.” In the end, Wal-Mart targets disabled and uneducated workers because they are more apt to settle for low pay and nonexistent benefits. I cringe every time I see the very elderly reduced to bagging groceries at my supermarket.

Corporate employers target young, beautiful people. Although the corporate executive who told HR “not to hire uglies or fatties” received public criticism for his comments, the reality is that in America those who are less than perfect have a hard time getting jobs.

However, medical restrictions, unless physically obvious, need not be disclosed to future employers, if the restrictions can be managed outside of work. For example, some restrictions limiting numbers of hours worked, can be resolved simply by applying for part-time work instead of full-time.

Keep in mind those applying for jobs are expected to be truthful on applications, and if specifically asked should disclose certain physical conditions that require employer accommodations, or other work limitations such as lifting, carrying, traveling and social interaction.

Bottom line, disabled workers have a hard time in America finding employers who are willing to hire them. The Americans with Disabilities Act (ADA) is no more than lawful lip service from a law that gives deference to employers, not employees. Very few ADA lawsuits are actually won.

Social Security has a trial work period with rehabilitation if disabled workers want to go that route. Many state agencies have resources available to assist the disabled in finding work. In some respects, “where there is a will, there is a way.”

Therefore, it is very important for the disabled and elderly to be persistent and insist that they be given consideration for jobs. Admittedly though, it’s a hard place to be since finding employers who hire “less than perfect” individuals may take some time. Unfortunately, jobs in America are also competitive as well.

How long do I need to go back to work before going back out on disability?

First of all, if you think you will need to “go back out on disability” then you shouldn’t go back to work in the first place. One of the worst things claimants can do is repeatedly go back to work and then back out again. I’m not really supportive of people who actually “plan” disability claims either.

However, employees who go back to work with the same employer will still be covered by their group LTD Plan as long as the “minimum number of hours worked provision is met.” For example, if a claimant returns to work 20 hours per week part-time but the minimum hours worked provision requires 30 hours to remain covered under LTD, then the LTD coverage stops, and no future claim will be covered.

Employers often do not inform employees they don’t have their group LTD coverage anymore – something to be very careful about when returning to work part-time.

Claimants who return to work full-time with the same employer are subject to the “recurrent provision” in their policies. This means if they are unable to continue working for 6  months, they are permitted to go back on claim without having to meet another Elimination Period. Of course, insurers will make you wish you had not done this by requiring a preponderance of “proof of claim” in order to pay benefits again.

When claimants return to work with another employer, they are of course, subject to a new Waiting Period and Pre-existing Condition provisions. Most group policies have a 3/12 pre-existing condition provision requiring employees to work for 12 months prior to filing any disability claim. Even then, there is a 3-month look-back from the Effective Date of Coverage to determine if there was any treatment, prescriptions etc. for the claimed disability.

Therefore, it’s likely that even with a new employer if a claimant was treated for a disability in the past, the claim could be considered pre-existing if claims are filed sooner than 12 months after the Effective Date of Coverage. There are other versions of pre-existing provisions, so it is always a good idea to check Plan provisions before “planning” a disability.

When I file a complaint against Unum with the EBSA can I also file a complaint against my employer?

Yes, you can, but you should keep in mind the limited jurisdiction of the Department of Labor. The DOL may choose to deal with fiduciary issues and ERISA requirements, but has no jurisdiction over EEOC or Human Rights employment complaints. There are a few exceptions such as wage and hour violations, omission of job postings etc., but in general the DOL deals only with federal requirements and laws in the workplace. Upon inspection, most complaints filed against employers have to do with issues more pertinent to EEOC and state Human Rights Commissions issues.

Employees do not have forever to file EEOC or Human Rights complaints, so it’s always a good idea to file a complaint as quickly as possible.

I live in California. Can Unum reduce my benefit for SSDI or dependent coverage when I haven’t even been approved yet?

No they can’t. California does not permit insurance companies to offset SSDI benefits until you actually receive them, assuming of course, that you are cooperating with the process of applying and appealing as required by the Plan.

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George of Astoria, NY on July 8, 2013
Unum paid my Long Term Insurance after medical problems stopped me from doing my job. I was paid $1,200 a month for the first year. Then my payments after a year STOPPED! I was approved for SSDI, and Unum stated I owed them money. It took a little more than a year and Unum started sending me my payment checks again, but reduced the amount from $1,200 to $479 a month. Said it was an offset due to my receiving SSDI. Now last year, SSDI gave me a cost of living raise ($18.00), so Unum reduced my monthly payment to $359.. I moved from NJ to NY on 6/29/12, after my mother’s death. I was her caretaker. Now Unum stopped my check again. Their reason was, “We couldn’t get in touch with you.” Claimed they sent me mail, but I did not respond.
Irene of Ashley, OH on May 29, 2013
The surgeon who did my total knee joint replacement stated that I required three months off work for recovery. Unum did pay the first month and a half, but now has stopped paying on my short term disability claim. Unum’s representative, Karen **, stated, “That’s too long,” as though she knows better than my doctor how my knee is healing, and she also did not have enough information, even though the surgeon’s office and the hospital’s physical therapy department have both sent my records to her. Very frustrating, after I have faithfully paid my disability insurance premiums to Unum for many years. I filed a complaint with the Ohio Dept. of Insurance, but it is difficult to be optimistic.

Why can’t insurance companies keep their part of the agreement?! I paid them for years, and now it is only fair that they pay what is rightfully due to me.

Laura of Delray Beach, FL on Feb. 4, 2013
 Unum exploited my mother’s Alzheimer’s to deny her claim. They accepted the initial application from a neighbor of my mother for disability through Alzheimer’s, assuring the neighbor that the best thing was to get the claim in ASAP so it could be paid back to its effective filing date. My mother went along and signed for the neighbor. When I (as POA) challenged the authority of my mother’s case to the neighbor, Unum challenged my authority. In the interim, Ed ** of Unum obtained information from the neighbor that they used as a basis for delaying validation of her disability. He had assured the neighbor that he was working to get mom’s claim processes back to the filing date. Then Unum put a spin on it and used it against us. Mom recently died and we collected only a fraction of her benefits.
Stephen of Berlin, NJ on Oct. 21, 2012
Unum’s processes are designed to slow or prevent claims: Under a doctor’s care, I began taking 3 drugs prescribed for Hepatitis C in September 2011. The doctor said he would put me on short-term disability immediately, but I choose to try to continue to work for as long as possible. My employer was informed and understood that I would most likely not be able to continue work for the 9 months of treatment. After 2 weeks, the side effects started to appear – anemia, fear, anxiety, etc. I made it 2 of the 9 months before I could no longer take the side effects. I called Unum prior to the 2 months in an effort to be proactive & understand their process for STD. They basically said, “Call back when you stop work.” The day I decided I could no longer work, I called Unum. I had already missed a few days the previous week due to the meds. Unum said I must have 5 consecutive days out before STD benefits could begin. I said ok since I didn’t know any better. 5 minutes after that, I notified my employer who told me Unum was wrong and that the 2 days out the previous week could be used toward the elimination period.

I called Unum back. They basically accused me of trying to perpetrate a fraud. I relented & took the 5 days PTO. That was just the beginning of the rollercoaster ride to hell with Unum! I think Unum uses a script as well as processes & procedures purposely designed to slow &/or prevent someone from collecting STD/LTD. I am a quality manager, & I can tell you from experience, there is no other possible reason for the dissatisfaction with Unum other than their processes which ensure the results Unum wants.

I relented on the 5-day elimination period, even though my employer told me again that it doesn’t mean 5 consecutive days! Everything seems to go ok for the 1st few months, though Unum constantly sends me letters telling me I have a new point of contact within Unum “there to help me” etc. Total BS! So as I approach the initial arbitrarily set due date for review, I called Unum. The phone rep said, “Your claim is scheduled to be cancelled tomorrow.” So, I called the rep assigned to my claim who conveniently was not in the office. In the meantime, I have gotten sicker & sicker, as the months have passed. I now have severe anemia & numerous physical & emotional side effects as well leaving me unable to do much of anything other than exist & take pills all day. So after numerous phone calls, Unum told me it was a mistake & that their own phone reps don’t know what’s “really” going on with a claim & that I should not call them but always call the point of contact in the letter.

This scenario repeated itself 3 times while I was on STD. I stayed on STD for 26 weeks (my limit) & then went on LTD for about 12 days. I then returned to work since the treatment was complete. During the 6 months on STD, I eventually had to resort to sending threatening emails to Unum as well as notifying my employer of how I was being treated & that Unum was attempting to deny/prevent me from collecting money which my company said they will provide through my employment contract. None of that seemed to matter with Unum. My boss told me she knew of another person in our company with the same story.

Now, in my office, a co-worker has been diagnosed with cancer. He is fighting for his life. I told him what to expect from Unum, but he thought I might be exaggerating. Not anymore! He is getting the exact same treatment from Unum down to the words they say! Unum is working just as hard against him, who is most likely dying, as they worked against me!

After reading about all the class action lawsuits against Unum, it seems they have not learned! Unum & its employees are a disgrace! They are what is wrong with this part of the healthcare system. They should be forced to pay & then forced to go out of business with all of the employees barred from holding a job in this area again! If we had these types of consequences for them, similar in impact to the processes they use against us, then maybe they would change! Warning: Buyer, beware. Stay out of the disability system at all costs!

Linda’s Comments

This information was obtained from: http://www.consumeraffairs.com/insurance/unum.html

Although these types of comments could potentially go on forever, I think we all get the point here.

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