posted December 2, 2002
UNUM/Provident's poor claims handling tactics have taken their place in the news via Dateline NBC, Sixty Minutes, Portland Maine's newspaper the Press Herald, and, of course, the Chattanoogan. UNUM/Provident refers to these investigative TV news programs and the local newspapers as "tabloid news organizations." I don't think that is how you portray your newspaper.
I might also mention that I reside in Maryland, but I read the Press Herald and Chattanoogan every day to stay current on local news about UNUM/Provident.
The reason they have been receiving all this publicity is because there are thousands of claimants who are either denied long term disability payments or have had their payments stopped (without proof or justification). We have joined together to educate the public about how they deceive, lie, manipulate and commit fraud against their policyholders.
When a person becomes ill or is injured and cannot work, their physician recommends a period of recovery. It could be short term, long term, or permanent. For those who are fortunate enough to have disability coverage, they don't have to worry about the loss of their income. Their disability insurance will cover it. As UNUM/Provident says on their web site "You will have peace of mind" should you become ill or injured. This is far from the truth. Most claimants experience excuse after excuse as to why UNUM/Provident shouldn't or won't pay their claim. Many are too ill or injured to fight back so they give up. That's what UNUM/Provident wants them to do.
Claimants who are covered under the Employee Retirement Income Security Act (ERISA) are mishandled the most. Since ERISA does not permit the client to seek punitive damages or lawyer fees, UNUM has little to lose in a lawsuit. Punitive damages could go into the millions of dollars, far more than payment of one's claim. How convenient for UNUM/Provident. It's a win-win situation for them.
For those who don't know, your medical, life, auto, and homeowner's insurance are governed by ERISA. This is why we should support the need for a "Patient's Bill of Rights."
There are many diseases that UNUM does not recognize as disabling. They include Fibromyalgia/Chronic Fatigue Syndrome, Rheumatoid Arthritis, Lupus, Multiple Sclerosis, Cancer, Chronic pain, and in some cases, severe heart disease and quadriplegia. They consider claimants with these and other diseases/injuries as psychosomatic. How would you like to be told you're imagining your pain/disease/injury or that your pain is manifested by depression? UNUM/Provident does it all the time. Then they say disability is determined by symptoms, not the disease/injury itself. We agree with that but UNUM does not follow this guideline.
Here is how they deny claims. First, they get or have you get all your medical records from every one of your treating physicians. A Claims Analyst (no nursing or medical degree) will then decide if you're denied or referred to a nurse or physician for further review. Usually the nurse completes a review and then presents it to a physician. The physician then decides how he can deny the claim. They might say there is insufficient medical evidence in your medical records, even when there is. Or the doctor may decide there is clear evidence of disability, but to avoid approval, he will recommend that you have an Independent Medical Examination (IME) with a physician they choose. In the majority of cases the physician will spend one hour taking a medical history and completing a physical examination. Naturally, the physician (who is paid quite well) finds that the claimant is not disabled and can return to work. If he does find you disabled, he will still say that you are capable of working in menial jobs far below your education, experience and pre-disability earnings. In summary, the records from you own doctors are ignored and only the findings from the IME doctor are used to make a decision. Does this sound fair?
They also send claimants for a Functional Capacity Evaluation (FCE) to the Physiatrist/Physical Therapist they choose. This test measures how well or how much you can push, pull, lift, reach, bend, stoop, crawl, etc. If you can complete just one of the tests, you are considered employable. My wife worked as Medical Administrator. It involved a lot of phone work, typing, sitting, walking, and occasionally, standing. Most of the tests done at the FCE don't relate to her "sedentary job" as UNUM calls it.
If you're lucky enough to be found totally disabled, you'll receive your monthly pay. But then, you receive a letter (with no explanation) anywhere from several months to a year later advising you that you are no longer disabled. (As I said to my wife when this happened to her, "I will have to recommend UNUM/Provident for the Nobel Peace Prize because they have cured you!"). If you disagree you start all over as stated in the above two paragraphs. It's a constant harassment by UNUM/Provident. Mr. Chandler's comment "Where there were mistakes made on specific claims, adjustments have been made. We are working to do a better job of communicating decisions on claims with our customers" is ridiculous. How were they able to identify what the mistakes were and fix them so quickly? This is just another cover up.
He also states that only two to three claims out of 400,000 have mistakes. I disagree with that. Between Sept 9, 2001 and Oct 10, 2002, there were more than 755 (this is when I stopped counting) federal litigation lawsuits file against UNUM/Provident. There are many more cases that have been settled out of court, sealed by the court, pending in state courts. There are cases that were erased from the court records. There are cases that come with "gag orders" which means the client and attorney cannot talk about the case with anyone. This is how they get their low numbers. Some of this information is easily accessible on the Internet if you wish to explore it.
Past and present employees of UNUM/Provident confirmed on Dateline and 60 Minutes that there are incentives to deny claims. It could be the cake and ice cream or pizza party or monetary bonuses. Why would the employees make this up? Current employees with a conscious obviously dislike deceiving claimants, so they spoke up with anonymity for fear of losing their job. We know this must be big if two top TV shows did an expose. Why? Because we have been trying for years to get this information out to the media without success. When Dr. McSharry filed his lawsuit against UNUM/Provident, the media began to listen.
I have a copy of an internal memo from UNUM/Provident from several years ago that confirms their desire to deny as many claims as possible. California and Georgia state insurance commissioners are conducting an investigation on UNUM because of many complaints. UNUM was recently charged a $5,000 fine for refusing to provide Georgia documents they requested for their investigation. This is chump change for UNUM, but it shows that they have something to hide.
We, the people who are having our disability claims denied, certainly have no reason to lie about what UNUM/Provident is doing to us. We are very honest. Everyone's story is the same and it certainly isn't a coincidence.
Ken Englert
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