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Posts Tagged ‘Unum’s unfair claim practices’

IntegrityI seem to be getting quite a few questions lately about Unum’s unfair claims practices. Indeed Unum’s lack of professional integrity is well-known particularly since 2008 when multi-state regulators stopped watching. Despite UNUMProvident’s attempt to re-define itself as Unum Group, complete with a new logo, the company has made no effort to “walk the talk” and review claims fairly. In fact, the company’s claim process is worse than its ever been!

Unum management’s failure to devise a fair and equitable claims review process that is also profitable is responsible for the company’s tragic public reputation among its insureds and claimants. Other businesses with comparable poor reputations eventually go out of business. Still Unum operates without customer loyalty since most insureds who know the company best, like it least.

Unum Group’s core business is selling group STD/LTD to employers and managing state disability plans. Without this business Unum could quickly join Enron as one of America’s most unlawful corporations breaking bad. What distinguishes Unum Group from other national insurers is that the company continues to “target legitimate claims” for denial, and then manages those same claims to obtain back-up to support the business decision of not paying them. There is no evidence I’ve seen that any other insurer actually “targets” certain claims that should be paid in order to deny them.

What is it exactly that makes Unum so publicly disgraced? Although this is indeed a long list, I’ll try to list the most outrageous.

1.  Unum refuses to consider any and all medical treatment patient notes, and/or medical restrictions and limitations provided by any source other than their own internal reviewers. It is very easy to deny claims when the only opinions considered are its own. Unum’s internal medical staff, including RNs as well as physicians, receive annual percentage bonuses to support the company agenda of denying claims. Physician’s who do not write Unum supportive documentation are quickly terminated and discredited with peers. Unum’s Quality Compliance Department oversees all proper “documentation” and makes sure it is always supportive to Unum’s interests.

2.  Unum misrepresents its motive and intent when demanding signed SSA releases to obtain SSDI files. Arrogantly, Unum contests SSDI approval decisions by alleging it obtained “more recent” information that SSA didn’t know at the time of the award, and therefore, they are legally allowed by multi-state regulators to “ignore SSA’s determination.” Unum is dishonest in its communications when informing claimants it is requesting the Authorization “so that it can give your claim every possible consideration.”  Unum needs to have SSDI files to protect its backside with regulators, however, the company doesn’t come close in considering SSDI decisions before making their own liability determinations.

3.  Unum abuses the 24-month Mental & Nervous provisions in group policies by alleging physical impairments are “self-reported” and are subject to benefit limitations. Fibromyalgia, chronic fatigue, Lyme disease, and chronic pain are targeted as limited to the 24-month mental and nervous provisions in policies. Although the State of California cited and fined Unum for such abuse, the company still refuses to pay FMS and CFS claims beyond 24-months.

4.  Unum’s CPAs engage in deliberate fraud by “making-up” imaginary overpayments and then demanding repayment. In some cases, Unum’s outsourced CPAs resort to conducting IRS-like audits, requiring an overabundance of financial proof of claim which is unreasonable. Large overpayments cannot often be backed-up by Generally Accepted Accounting Principles (GAAP) and are largely attempts to recover monies not owed. These practices withhold payable benefits for long periods of time forcing claimants and insureds to retain forensic CPAs of their own to get it straightened out. Of course, benefits are immediately reduced to $0 when the alleged overpayment is reported by Unum’s CPA, thereby reducing the financial reserve for profitability reporting.

5. Unum outsources its IMEs to organizations which do not meet acceptable standards of cleanliness, and refuses to allow witnesses or audio recordings of the IMEs to take place. Unum’s current track is to blame it all on the  IME physicians whom the company claims won’t allow witnesses or recordings. IME physicians are often rude, unprofessional and dishonest.

6.  Unum continues to misrepresent its requests for field visits by not informing insureds and claimants there are no contract provisions requiring insureds to submit to such an interview. Letters and communications are written in such a way to give the impression field interviews are mandatory when requested, and not voluntary in some cases.

7.  Unum’s internal physicians conduct doc-to-doc calls which intimidate treating physicians into agreeing with Unum’s agenda of returning everyone to work. Doc-to-doc calls often misrepresent Unum’s view and follow-up letters are NEVER an accurate accounting of what was actually said during the phone interview.  Unum’s internal physicians are forced to support Unum’s agenda if they want to remain employed, or better yet, receive their annual bonuses.

8.  Internally, Unum engages in employee age, gender and health discrimination. Those who “age” and have eventual tenure are fired for “poor performance” in order to maintain a “youthful” work force which is predominately male. Unum also engages in human rights violations and has been known to toss out its employee’s personal belongings on the street.

9.  Unum engages in vexatious and harassing phone calls to both claimants as well as their physicians. The goal is to wear-down physicians into giving in to either provide paperwork, patient records, or a release to return to work. Physicians can literally “fire” their patients because of Unum’s harassment and intimidation of those involved in reporting or certifying disability.

10.  Unum is becoming chaotic and inefficient due largely to the company’s downsizing and outsourcing its “risk management” to organizations which cannot meet reasonable deadlines. Unum’s appeal department often sends out letters asking claimants to sign, giving permission for the company to exceed ERISA deadlines. No claimant should ever sign or give permission to exceed an ERISA deadline.

11.  Unum now actively “risk manages” all claim in its Extended Duration Unit and denies claims paid for 5, 10, 15, 20+ years. In particular, Unum uses SSDI awards to discredit continued payment of long-term claims, and demands field visits and IMEs from claimants with paid-benefits in excess of 20 years. These practices are obvious abuses of arbitrary and capricious discretionary authority and most likely will not fare well in the courts.Unfortunately, though claimants will still be without benefits while Unum’s wrists are slapped for engaging in unfair arbitrary practices.

The above represents the most egregious Unum claims review practices, but certainly it is not an all-inclusive list. Unum’s continuance of unfair claims practices rightfully earns the company’s reputation as an “unlawful organization.” The company is not well-liked by its customers and certainly lacks any customer loyalty from those with Unum disability claims. Employers are also beginning to back away from a company who isn’t treating its employees fairly.

In addition, there is some indication that Unum is overturning its denials and paying claims with considerable interest and fees. In any case, it’s clear that among all of the national disability insurers, Unum tops out as the worst. There is no evidence the company exercises any ethical standards of review, or has any professional integrity when it comes to making fair and equitable claims decisions.

Once again, state regulators – Maine, Massachusetts, and Tennessee should take another look at Unum by engaging in a Conduct Market Examination to determine the extent of unfair abuse. Unum Group isn’t a reputable company and employers need to consider carefully before buying into a Plan which is administered unfairly. DI professionals should also consider alternatives such as Northwestern Mutual to meet their personal and business needs.

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