August 25, 2014
VIA FAX 800-447-2498
Mr. Donald Beaudette
The Benefits Center
Post Office Box 100158
Columbia, SC 29202-3158
RE: Unum correspondence dated July 24, 2014
Unum Life Insurance Company of America
Claim No. ***
Policy No. ***
Under threat of the discontinuance of benefits, I have been diligently searching for a doctor to complete Unum’s forms. In addition to previous efforts, this past week I have visited numerous doctor’s offices in my area, asking if they take Medicare and if the doctor is willing to fill out disability insurance forms (which I brought with me). Here are some of the responses I have received so far:
1. We are not taking new Medicare patients at this time.
2. You can bring the forms to the appointment, but there is no guarantee that the doctor will fill them out.
3. We are booked up with children getting check-ups for school, and the first available appointment for a new patient would be sometime in September.
4. There are only nurse practitioners at this clinic, and I think you need a doctor to sign disability insurance forms. Ask your insurance company.
Since Unum neglected to answer all of the questions in my previous letter, I am now forced to ask them again. What treatments, specialties, or doctors does Unum believe are included in “generally accepted medical standards” for the treatment of intractable pain? What kind of doctor will Unum accept to fill out these forms? Can I use a chiropractor? An acupuncturist? Since a nurse practitioner is less expensive (and just as qualified to ask questions and fill out forms) than a specialist, that would be my choice. If Unum will not accept the services of a Nurse Practitioner, I need to know why it believes these medical professionals are not qualified for the job.
The problem is, of course, that if I don’t choose the doctor or medical specialty that Unum considers to be “appropriate” for my “disabling condition(s),” then I continue to be at risk for the discontinuation of my benefits — in fact, my choice could give Unum the ammunition it needs to do just that. And I would have paid for a service that I don’t need, and one that Unum won’t accept.
Additionally, is Unum requiring that I choose an available doctor that doesn’t take Medicare?
When Unum can answer my questions, I will be able to narrow my search to the type of providers that Unum demands.
The other problem, as mentioned in my previous letter, is how difficult it will be to find this medical practitioner, and the fact that Unum’s deadlines do not give me enough time to find a doctor, make and keep an appointment, then wait for the doctor to produce the completed forms. As a patient, I cannot ensure that a doctor completes insurance forms by a certain date.
Therefore, I am requesting an extension of the August 30th deadline. I cannot force a doctor to take me on as a new patient to fill out Unum’s forms, and I will need more time to find one who will.
In the interim, I am enclosing a copy of a medical evaluation dated 5/1/13 generated by Dr. Anthony Reeve for inclusion in my file.
Now, to address additional issues brought up in our latest correspondence:
First, let’s look at Unum’s definition of “Regular Care”:
Regular Care means:
– you personally visit a physician as frequently as is medically required, according to generally accepted medical standards, to effectively manage and treat your disabling condition(s); and
– you are receiving the most appropriate treatment and care, which conforms with generally accepted medical standards, for your disabling condition(s) by a physician whose specialty or experience is the most appropriate for your disabling condition(s), according to generally accepted medical standards.”
For more hints on what Unum is talking about, I googled “generally accepted medical standards” for the treatment of “intractable pain,” and only received 8 hits, none of which were helpful.
It is my position that “the most appropriate treatment and care” for my disabling condition is a home treatment program, generally accepted by medical standards for the treatment of long-term intractable pain.
It is also my position that a home treatment program for intractable pain does not medically require a personal visit to a physician, especially for the specific reason of filling out insurance forms.
“Preliminarily, we would like to address your dissatisfaction with our periodic requests for updated information. We take exception to your remarks characterizing the handling of your claim and believe that you may have misunderstood the nature of our requests. Please note that we have not received medical records since September, 2011, and our current request cannot reasonably seen as excessive.”
You may have not received “medical records,” which are expensive to obtain, yet I have filled out all of your “periodic” forms, in detail, keeping you updated as demanded. And when it costs so much money to obtain the reports Unum is requesting, then yes, it is excessive. After all, I have already paid for every single medical report for the last 25 years, all of which are contained in my file.
And what about the personal interview I was forced to have with your field representative? Is that not considered an update? (One that I didn’t have to pay for, by the way.) And why am I not allowed to read the report?
“Insured’s have a continuing obligation to provide proof of loss at regular intervals as necessary to permit the evaluation of their claim.”
Proof of what loss? The loss of the ability to be employed? As I stated previously, you have been given ALL of that information. Unum has evaluated my claim, then re-evaluated it, then approved it, many years ago; and yet, Unum is continually re-evaluating it. I’m just not getting that Unum understands the definition of “intractable.”
To me, “proof of loss” means “proof of disability.” Please explain what you mean by “proof of loss,” and why Unum thinks that I am obligated to continually supply proof that I am disabled, especially considering the definition of intractable pain. This definition was created by the medical industry, and is considered “generally accepted by medical standards.”
“It appears that you are suggesting that your condition is permanent and that because you feel you will not benefit from further medical treatment, you should not be required to see a physician from time to time. We are unable to accept your characterization of your condition as permanent and untreatable, and must continue to ask you to obtain information from a treating physician to allow us to understand your current conditions and any restrictions and limitations.”
I am not just suggesting that my condition is permanent and untreatable, the very definition of my disability says just that. As for benefiting from further medical treatment — the answer to that is also found in the definition of my condition, as I’ve already tried all the “standard” treatments offered by the medical industry. And as I’ve mentioned, these “standard” treatments almost killed me (besides being incredibly expensive).
So, if you are requiring me to “see a physician from time to time,” then I need more specifics as to what kind of physician Unum will accept in my case. Because I am unaware of any medical specialty that involves overseeing a home treatment plan and filling out insurance forms.
As to Unum’s contention that my condition is treatable — what is that opinion based on? Perhaps Unum doesn’t agree with the medically-accepted definition of intractable pain? Does Unum think it knows better than doctors how to treat and manage my disabilities? Does Unum want to be my doctor?
The restrictions and limitations are that I am disabled and physically unable to work. Again, I am not getting that Unum understands the definition of “intractable.” Oh, I know why Unum wants these restrictions and limitations constantly updated and written down by doctors — to find loopholes in the language a doctor uses to complete the forms, so as to determine me fit for some kind of employment and discontinue my claim.
“Medical conditions and individual circumstances may change over time…”
Intractable and degenerative conditions do not change, except to get worse. And by “individual circumstances,” I’m guessing you mean economically. So, didn’t your field representative confirm that I haven’t won the lottery?
“Please understand that so long as your claim remains open, we will require updated information…”
“…and accordingly, we must continue to ask for updated information for the duration of your claim.”
I assume Unum is saying that my claim will remain open until I die, so why don’t you just state that? “Unum’s harassment will continue until your benefits are unfairly denied or upon the date of your death, whichever occurs first.”
“At this time, while your claim is open and being paid, we are not prepared to release copies of additional file documents.”
Oh, I know that Unum is not legally required to turn over a complete copy of my file unless it chooses to deny my claim — which, I might argue, it already did, back in 2003. My question is, why can’t I have a copy of this one report?
“We enclose a complete copy of your policy.”
When I asked for the signature page, I was looking for the one that included MY signature.
“If we do not receive the requested information by August 30, 2014, your claim will close and no further benefits will be paid.”
I am trying to obtain the information demanded by Unum, and if Unum stops my benefits on 8/30/14 because of its unreasonable deadlines, then I’m going to spend that money on a lawyer, not a doctor.
I await Unum’s response.