July 7, 2014
VIA CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Mr. Donald Beaudette
The Benefits Center
Post Office Box 100158
Columbia, SC 29202-3158
RE: Unum correspondence dated June 16, 2014
Unum Life Insurance Company of America
Claim No. ***
Policy No. ***
Dear Mr. Beaudete:
Every time I receive mail from Unum, the responses are “requested” under the threat of a loss of benefits. This causes a lot of anguish — from anger, to anxiety, to fear — and automatically makes our relationship adversarial. I’m sure Unum is aware of the fear its communications provoke in the disabled population, as its processes appear actually designed to do so.
Unum’s latest correspondence comes with the following, familiar threat:
“Unum will deny your claim, or stop sending you payments, if the appropriate information is not submitted.”
I guess Unum is the sole decider of what is “appropriate information”?
So, face losing my benefits (and an eviction), or comply with Unum’s demands?
I am so very tired of being bullied. And yet, as a disabled person, I feel extremely vulnerable picking a fight with Goliath (I mean, Unum). A little bit of recent research on Unum and its practices has caused enough fear in me to copy this letter to the people who are supposed to be making sure Unum abides by the 2004 multi-state settlement agreement — the people who are supposed to be protecting people like me.
What follows are my responses to Unum’s latest correspondence, received via regular mail on June 21, 2014.
I will begin with my definitions:
1. Definition of Unum
Unum is a mega-corporation that’s sole purpose is to create profit for its shareholders. The purpose of any and all activity by Unum employees and contractors is to search for reasons to deny claims and sever benefits to meet the goal of creating profit for the corporation.
Experts see Unum’s processes as favoring the insurer, and representing a conflict of interest, since the insurance company acts as both payor and reviewer of the policies it sells.
I believe this blog post explains your processes both thoroughly and succinctly:
2. Total and Permanent Disability Are the Same Thing
“The definition of disability under Social Security is different than other programs. Social Security pays only for total disability. No benefits are payable for partial disability or for short-term disability.
‘Disability’ under Social Security is based on your inability to work. We consider you disabled under Social Security rules if:
You cannot do work that you did before;
We decide that you cannot adjust to other work because of your medical condition(s); and
Your disability has lasted or is expected to last for at least one year or to result in death.”
Ballentine’s Law Dictionary defines a permanent disability as one that “will remain with a person throughout” his or her lifetime, or he or she will not recover, or “that in all possibility, will continue indefinitely.”
3. Definition of My Disability, Intractable Pain
A pain state in which the cause of pain cannot be removed or otherwise treated and which in the generally accepted course of medical practice no relief or cure of the cause of the pain is possible or none has been found after reasonable efforts that have been documented in the physician’s medical records.
4. Definition of Intractable
Oxford Dictionaries: Hard to control or deal with: intractable economic problems, intractable pain.
MedicineNet.com: Intractable: Unstoppable. For example, intractable diarrhea is diarrhea that can’t be stopped, even with medication, and intractable pain is pain that can’t be stopped, even with medication.
The Free Dictionary: Difficult to alleviate, remedy, or cure: intractable pain.
Synonyms: Unmanageable, uncontrollable.
5. Definition of Degenerative (as in Degenerative Disk Disease, one of the causes of my constant pain)
Google: adj. (of a disease or symptom) characterized by progressive, often irreversible deterioration, and loss of function in the organs or tissues.
Merriam-Webster: medical : causing the body or part of the body to become weaker or less able to function as time passes.
6. Definition of Health (Regular) Care
In America, health care is a privilege, not a right — it is a luxury, not a necessity. But it should not be a requirement, as Unum contends, especially for the permanently disabled. For instance:
a. Wearing glasses is painful, and I might alleviate this daily pain by undergoing laser surgery — if I were willing to have eye surgery and also willing to pay for it — neither of which are true. The amount of pain that might be relieved is not worth the money for the procedure’s cost or risks; and
b. Recently, I suffered nerve damage in my left index finger during a test for eczema. (The test of which proved to be painful, expensive, and useless to me.) When the pain is sharp, it sends referred pain throughout my hand. I could seek treatment for this nerve pain, perhaps with a steroid injection — but the cost of the treatment, its potential for short-term relief, and the long-term risks, are not worth it.
7. “What information is needed as proof of your claim?” (Page 2 of Unum’s letter)
It is my contention that all information has been provided to Unum for proof of my disability claim, as evidenced by Unum’s eventual approval of same in 2007.
This proof includes information provided by numerous doctors, Guardian Life Insurance Company of America, and the Social Security Administration.
And I continue to provide updated information, as Unum has continually demanded, including a recent lengthy personal interview with your field representative.
I understand why Unum continues to request information, but I’m beginning to believe that no amount of information will be sufficient. Ever.
8. Unum’s Re-evaluations/Re-certifications
Considering the above definitions of my disability, please provide Unum’s legal basis for requiring continual re-certifications of same, specifically for the disease of Intractable Pain.
9. “You must be under the regular care of a physician in order to be considered disabled.” (Page 2 of Unum’s letter)
Please provide Unum’s legal basis for this claim.
From the Consumer Bill of Rights and Responsibilities that was adopted by the US Advisory Commission on Consumer Protection and Quality in the Health Care Industry in 1998:
“You have the right to ask about the pros and cons of any treatment, including no treatment at all. As long as you are able to make sound decisions, you have the right to refuse any test or treatment, even if it means you might have a bad health outcome as a result.”
10. “We may request that you send proof of continuing disability indicating that you are under the regular care of a physician. This proof, provided at your expense, must be received within 45 days of a request by us.” (Page 2 of Unum’s letter)
Let’s start with this fact: I am not sick, I am disabled. If I’m sick, I might need to see a doctor; since I’m disabled, I might need to see a doctor if I get sick. In other words, just because I am disabled, that does not mean I am sick and need to spend money on doctors, treatments, or tests. Been there, done that.
I spent 25 years (and all of my money) seeking help from the medical industry — and pain specialists and their “treatments” almost killed me. Now, Unum is requiring that I seek treatment again from the medical industry — services I neither want or need. In fact, it is only Unum’s needs that we are talking about here. And I don’t understand why I have to pay for a corporation’s need to make a profit.
I will need Unum’s definition of “regular care,” specifically for the disease of Intractable Pain (please refer to my definition of IP). What kind of doctor or specialist is Unum requiring that I see and “provide at my expense” (for the purpose of filling out one of its many forms, this one for updating disability status)?
I have contacted numerous doctors in Albuquerque, asking office staff if the doctor will complete this form, and how much it would cost. Since I am not seeking any ongoing treatment from these doctors, it appears it is very easy for them to turn down my business.
One doctor’s office informed me that it only handle worker’s comp claims, and advised me to hire an attorney. One doctor’s office said it no longer worked with patients who had disability coverage through Unum. One doctor’s office never responded.
It appears to me that Unum is requiring that I pay for an Independent Medical Examination, which is a very expensive undertaking, and one that seems totally unnecessary in my case. Since I am covered by Medicare, is Unum asking Medicare to cover the expenses of an IME, specifically for Unum’s needs? If so, I will need to communicate directly with CMS and determine beforehand if this expense is covered or not.
Please provide Unum’s legal basis for requiring that these continual and unnecessary requests for updated “proof” of disability be provided, and at my expense. Because as I see it, the only basis for continuing to harass me — and demand that I pay for services I neither want or need — is for fishing expeditions so that Unum can search for ways to sever my benefits.
11. “Restrictions and limitations preventing you from working” (Page 1 of Unum’s letter)
These have been provided over and over again, and only increase as time passes. This continual request for information, in my opinion, can only be defined as harassment of the disabled.
12. Doctors and Pain Patients
Please provide Unum’s definition of “generally accepted medical standards, to effectively manage and treat” the disease of Intractable Pain.
And if Unum can find a pain specialist who disagrees with my home treatment plan, previously and thoroughly detailed in Unum’s file, please let me know.
Because I am an expert on the management and treatment of Intractable Pain, I know that “generally accepted medical standards” for the treatment of pain only include those expensively accessed through the medical industry — and all of these “standard” treatments (including both the under-treatment and over-treatment of pain) are actually killing people, in case this is news to Unum:
A total of 43,000 deaths were reportedly caused by opioid dependence in 2010. Based on the information of each death, it’s likely that opioid users are more likely to die 46 years earlier than non-users. https://news.vice.com/article/un-drug-report-america-still-loves-weed-while-the-world-is-hooked-on-pills
I understand that Unum will profit off of my death, and would be happy to see me again seeking treatment back in the medical industry. But, as a pain patient, I have the right to refuse ANY treatment, both under state and federal laws. Besides which, any pain specialist worth his salt would advise a long-term IP patient to create an at-home treatment program — especially considering not too many pain patients can afford to keep paying for short-term and ineffective treatments.
In fact, your field representative mentioned that Unum has a problem with its belief that my condition is not improving — is this really any of Unum’s business? Is Unum going to next tell me how many more treatments I must try, and continue to try, to be considered disabled?
So, please, be very plain in your definition: Is Unum requiring that I go back to seeking expensive, harmful, and useless treatments through the medical industry? Is that the only way the corporation “proves” that the disabled continue to be disabled?
I would really like to know in advance, for budget purposes, how much money Unum expects me to throw away every year within the medical industry.
And since ignoring medical recommendations from primary care physicians is a common theme with Unum, I sure hope its one and only suggestion for the type of doctor I am being required to see is not a primary care physician.
“Two-thirds of U.S. physicians are now specialists, well above the level in other rich democracies, where roughly half fall into that category.” http://newsinteractive.post-gazette.com/longform/stories/poorhealth/
Finding access to a doctor that still takes Medicare, will work with Unum, and would be willing to take on an Intractable Pain patient may prove to be difficult.
And I’m just wondering how Unum handles patients who’s treatment plans consist solely of prayer. Is there a religious exemption that can save me from Unum’s continual harassment? Perhaps under the now-infamous Religious Freedom Restoration Act?
13. Requests for Documentation
Although I have previously received a copy of the policy, it did not come with the signature page. Please forward a copy of same.
Unum’s field representative indicated that I have the right to a copy of his report from the site interview. Please provide same.
14. HIPAA and the ACA
Unum’s Authorization Form CL-1021-AUTH (04/13) states:
“The privacy protections established by HIPAA may not apply to information disclosed under this authorization, but other privacy laws do apply.”
It goes on to state:
“If I do not sign this authorization or if I alter or revoke it, Unum may not be able to evaluate my claim(s), which may lead to my claim(s) being denied.”
All of Unum’s forms contain the threatening language of denying or discontinuing benefits if the claimant does not follow Unum’s “requests” and instructions, without deviation. And I’m beginning to believe that Unum requests and requires more information than federal and state laws (along with its contract language) allows, using these threats to force compliance.
For instance, I believe the Affordable Care Act requires insurance companies to fully comply with HIPAA, but as your form language indicates, Unum Group does not. At this time, I am requesting that you send me a revised authorization form that does not necessitate me signing away my HIPAA rights.
15. Additional Requests
I am requesting an extension of Unum’s requirement to “establish care” by July 30, 2014, until the above issues have been discussed and resolved.
I am also requesting that you notify my previous employer, Beirne, Maynard & Parsons, of the firm’s possible liability as a co-fiduciary under ERISA for Unum’s actions and the issues delineated herein.
VIA REGULAR MAIL and EMAIL
Mr. Gary K. King
Office of New Mexico Attorney General
P.O. Drawer 1508
Santa Fe, NM 87504-1508
Department of Professional & Financial Regulation
Bureau of Insurance
#34 State House Station
Augusta, ME 04333-0034
TN Department of Commerce and Insurance
500 James Robertson Parkway
Nashville, TN 37243
Commonwealth of Massachusetts
Division of Insurance
1000 Washington St, Suite 810
Boston, MA 02118-6200
Mr. John Gaherty
Compliance Director/Investigations Bureau
Office of Superintendent of Insurance
P.O. Box 1689
Santa Fe, New Mexico 87504-1689
Ms. Patricia Torres
Consumer Assistance Bureau
Office of Superintendent of Insurance
P.O. Box 1689
Santa Fe, NM 87504-1689
VIA REGULAR MAIL
Mr. Thomas E. Perez, Secretary, Department of Labor
U.S. Department of Labor
200 Constitution Ave., NW
Washington, DC 20210