7/18/2008, Microsoft Case Studies – Unum

http://www.microsoft.com/casestudies/Microsoft-Biztalk-Server-2006/Unum/Insurance-Leader-to-Deliver-700-Million-in-Revenue-with-Service-Oriented-Architecture/4000002418

“To effectively serve small business customers,” says Mike Mason, Director of Enterprise Architecture at Unum, “we need to deliver a simple way to assess, purchase, and administer key benefits like life and disability coverage.”

Unum and Lexmark

Click to access Unum_ROI_Ins_Case_Study.pdf

In a major initiative to reduce paper, return hours and minutes to employees, control costs, and improve customer service, insurance leader Unum partnered with Lexmark to build one of the most efficient document-management platforms in the industry…

The first such automation project involved scanning thousands of paper-based customer files that were stored in the company’s 35 field offices. Each file was scanned on a MFP at the field office, converted to an electronic image and then routed automatically to a server at Unum headquarters. Unum designed and built the new system, called Enterprise Data Search (EDS), in close partnership with Lexmark, and began rolling out the EDS system at its San Francisco office in 2009….

Among other system innovations, Unum now routes all faxes through the company’s network to a central point that keeps internal company faxes within the network while using a single queue for external faxes….

The e-system for document archiving and storage also helps the company comply with new, more stringent regulations on data retention. “We now have zero lost documents or documents being kept past their retention date,” Friend said.

Ummm… Ms. Friend, I think Unum has “lost” some documents, which ended up in my mail box… (See post “Long Live HIPAA.”)

Tufts University School of Medicine

Click to access Web_2005-2006_Handbook.pdf

2005/2006

Tufts University School of Medicine requires its students to participate in a disability insurance program. The group coverage through the American Medical Association’s (AMA) Sponsored Med Plus Advantage Program is underwritten by UNUM Provident Corporation. Students are automatically enrolled in the group plan and are billed for the annual cost of the policy. Students may waive this coverage only if evidence of disability insurance coverage is presented to the Student Advisory & Health Administration Office.

Work Capability Assessment

https://en.wikipedia.org/wiki/Work_Capability_Assessment

The Work Capability Assessment (WCA) is the test designed and used by the Department of Work and Pensions (DWP) in the United Kingdom to determine the entitlement of disabled welfare claimants to Employment and Support Allowance. Atos Healthcare, part of the multinational company Atos, will continue to conduct this highly controversial disability assessment until March 2015. The test has been criticised for the high proportion of those tested being found ‘fit for work’…

Over the summer, it emerged that there was a growing backlog of hundreds of thousands of ESA claims.  At the end of October, the DWP announced that the US firm Maximus would take over the WCA contract from Atos – but not until March 2015, only five months short of the planned termination date of the five year Atos contract…

A government study published in 2012 found that one-half of the people identified as “fit for work” by the Work Capability Assessment in the UK, remained unemployed and without income…

Government statistics reveal that between January 2010 and January 2011, 10,600 sick and disabled people died within six weeks of being assessed. Government statistics also revealed that of those who had been put into the ‘Work Related Activity Group’ (which prepares claimants for future work), 1300 died within 6 weeks. Critics of ATOS allege that the number of deaths is far greater. In mid-January 2012, there was a significant scandal as media were alerted to the fact that the WCA had found a man in a coma to be ‘fit for work’.

Work Capability Assessments have found patients with brain damage, terminal cancer, severe multiple sclerosis, and Parkinson’s Disease to be fit for work. On 24 April 2013, a woman who was a double heart and lung transplant patient died in her hospital bed only days after she was told, after a Work Capability Assessment, that her allowance was being stopped and that she was fit for work…

12/31/2014, Epidemic of Violence against Health Care Workers Plagues Hospitals

http://www.scientificamerican.com/article/epidemic-of-violence-against-health-care-workers-plagues-hospitals/?WT.mc_id=SA_WR_20150107

Nurses often have to get uncomfortably close with extremely stressed-out people, so an element of aggression is perhaps inevitable. Some assaults come from people experiencing psychosis or other mental crises. Dementia and in-home-care patients are also frequent sources. Much of the violence is less explainable, however. In the 2014 survey, almost 50 percent came from patients and family members who were drunk or on drugs. Plenty of people attack nurses out of simple frustration…

Jeaux Rinehart, a registered nurse for more than 30 years, was working at Virginia Mason Medical Center in 2008 when a patient seeking methadone attacked him with a billy club, breaking his cheekbone…

The Veterans Health Administration has successfully reduced assaults in its hospitals by electronically flagging high-risk offenders, such as people who have been abusing drugs and alcohol and those with a history of attacks on caregivers, who are then treated with extra precautions…

The Hidden Agenda

Click to access THE-HIDDEN-AGENDA-a-research-summary-March-2013.pdf

The Work Capability Assessment (WCA) is exclusively conducted on behalf of the Department for Work and Pensions (DWP) by the corporate giant Atos Origin IT Ltd Medical Services, better known as Atos Healthcare…

Whilst the BPS model is an interesting theory, the selective use of the BPS model of disability assessment, as used by both Unum Insurance and Atos Healthcare, was exposed long ago as an invention of the insurance industry…

The WCA is an American imported ‘disability assessment model’ and has no medical credibility whatsoever, as confirmed by the British Medical Association(17), yet it is enthusiastically employed by the DWP and causes devastation to those least able to protest. This ‘medical assessment’ is working very well as the thousands of genuine claimants that have either died, committed suicide, been forced into poverty due to mounting debt, or who have developed a mental health problem due to anxiety are now the disregarded victims…

4/4/2012, Clarke v. Unum Life Ins. Co. of America

http://www.leagle.com/decision/In%20FDCO%2020120405B76

A few weeks later, on October 6, 2008, Unum sent Senior Field Representative Paul Weiss, ALHC, to interview Plaintiff at her home. (Weiss Field Report, FU-CL-LTD-000631-639 — SEALED). Mr. Weiss spoke with Plaintiff for about 95 minutes on various topics, including her condition and daily activities. He noted that she did not appear to him to be in any physical distress or to be suffering from any cognitive difficulties. On the contrary, he observed that she appeared “animated,” that her answers were “on point and thorough,” and that she maintained her own claim file at home, which to him evinced a “well-organized person.” Id…

On April 1, 2009, while the surveillance was underway, Unum referred Plaintiff for a functional capacity evaluation (“FCE”) to determine the extent to which her condition would affect her ability to work. The evaluation was performed by Mylah Garlington, P.T. of the Heartland Physical Therapy Provider Network. Based on Plaintiff’s performance on a number of physical tasks, Ms. Garlington determined that Plaintiff was capable of working full-time in the “light” physical demand category. She noted that although Plaintiff exhibited pain with certain tasks, some of which she was unable to complete, she believed Plaintiff was restricting her effort and not allowing her full capacity to be measured. (Garlington FCE, FU-CL-LTD-001152-1159 — SEALED)…

Further, it noted that Unum’s reviewers found the hand tests and the neurorehabilitation report to be largely unreliable because of the lack of symptom validity testing, Plaintiff’s mostly normal performance on the cognitive evaluations, the inconsistencies between the two reports, and the apparent mismatch between the abilities tested by the hand test and the requirements of Plaintiff’s occupation. The opinion also noted that Plaintiff’s counsel had requested copies of any internal medical reviews that Unum conducted prior to its appeal decision and stated that that request was denied, as Unum was not obligated to provide those reviews until after the appeal process was complete. (Appeal Decision, FU-CL-LTD-004283-4289 — SEALED)…

Since Plaintiff met her initial burden of proof, Unum was required to identify substantial contrary evidence to justify terminating her benefits. Even giving Unum’s decision all of the deference that is due to it, the Court simply cannot find any such evidence in the record…

1/28/2006, Giant UnumProvident Insider Trading…

http://www.insider-magazine.com/unumprovidentstoryfinal.html

Insider Magazines in-depth investigation reveals a monster corporation with a “religious front” to hide away Billions siphoned from investors and policyholders. The Maclellan Foundation definitely has hooks into the Bush White House, IRS, federal courts and the U.S. Department of Labor and it may have received millions from U.S. government sponsored faith based initiatives explained in their “how to get taxpayer money Web site” “http://www.maclellan dot net.

Terri Truitt v. UNUM (9/6/2013)

Click to access 12-50142-CV0.wpd.pdf

Years later, a former companion of Truitt provided Unum with emails indicating that, while claiming to be disabled, Truitt engaged in activities, such as traveling abroad, that were inconsistent with her asserted disability. Based, in part, on these emails, Unum denied Truitt’s claims, and sought more than $1 million in reimbursements for benefits paid.

5/27/2004, Law is called stacked deck for insurers

http://www.sfgate.com/health/article/Law-is-called-stacked-deck-for-insurers-2772822.php

Susan Ackerman was vice president of a financial services company in San Rafael. She ran 30 to 40 miles a week on the Mount Tamalpais trails. Once her daughter was grown, Ackerman’s work became her life. But in the mid-1990s, her body began to deteriorate. The diagnosis was post-polio syndrome. The polio she had as a child had damaged nerves that were now giving out, cutting off energy to her muscles.

She could no longer run. The fatigue was so oppressive at times she had to pull over on the highway for 10-minute naps just to make it home at night. She cut back to four days a week at work. Then three. Her speech slowed. Her left arm eventually became useless. Finally, in 2000, she couldn’t work any longer.

But her insurance company rejected her claim for long-term disability benefits, and she made a dismaying discovery — one that ought to be stenciled in bold letters across the policies of all 130 million of us who have health and disability coverage through our employers. It is a clause in a well-known 30-year-old law — the Employee Retirement Income Security Act, or ERISA…

If an insurance company is found to have improperly denied a claim, it is required to pay only what the claim would have been in the first place, plus attorneys fees, in some cases. The insurers are not liable for damages caused by their decisions. In other words, ERISA allows insurers that provide insurance through employers to reject claims with virtual immunity…

Ackerman said the insurance company sent her to physical therapists hired and paid for by the insurance company. After four hours of testing, the therapists confirmed that she was too disabled to work. Unum dismissed the report as irrelevant. It rejected Ackerman’s appeal.

“At the time she left her employment, she was not under a doctor’s care for her claim of disability,” Unum spokesman Jim Sabourin said from the company’s Tennessee headquarters. “We didn’t feel the evidence supported her claim.”

“If there are no consequences for denying a claim, what incentive do insurance companies have for treating you fairly?” Levinson said. “The deck is completely stacked in favor of the insurance companies.”

A U.S. district judge in Massachusetts, William G. Young, summed up his frustration in having to dismiss a wife’s suit against Travelers Insurance a few years ago because ERISA prohibited any kind of legal or financial redress. Travelers twice denied 30-day alcohol rehab stays for the woman’s husband, whose employee-benefits policy expressly provided for it. The man’s addictions soon led to his death.

“It is … deeply troubling,” Young wrote in his decision, “that, in the health insurance context, ERISA has evolved into a shield of immunity which thwarts legitimate claims of the very people it was designed to protect.

“What went wrong?”

8/21/2005, The Safety Net She Believed In Was Pulled Away When She Fell

http://articles.latimes.com/2005/aug/21/nation/na-disability21

Debra Potter made a good living selling disability coverage. But like many working Americans, she learned the hard way that federal law now favors insurers…

Disability insurers had sold a generation of doctors extremely generous, individual, “own occupation” policies, confident that their new clients would continue working almost no matter what, and therefore file few claims. But as the managed care revolution began to clamp down on what physicians could charge, many doctors started to exit their profession and, according to insurance industry executives, a considerable number filed for disability…

“I’m a big fan of ERISA,” UnumProvident Chief Executive Thomas R. Watjen said in a recent interview. “It gives consumers a voice they didn’t have before.”

But industry experts say that the profitability of disability insurers hinges not so much on the mass of routine claims, which typically are for short periods and involve small sums, but rather on a small number of long-term claims by people who were making good — and therefore expensive-to-replace — incomes…

“In the last 12 months alone, we’ve seen the largest insurance brokers in America, the largest property and casualty companies in America, the largest title insurance companies, the largest financial service firms and the largest disability insurers all engaged in flagrant violations of their most basic obligations to their customers,” said Garamendi, the California insurance commissioner. “This is not just a UnumProvident problem; it’s an insurance industry one.”

Although ERISA prohibits state regulators from intervening to help individuals in most disputes over employer-provided disability insurance, states can investigate insurers’ overall conduct, penalize firms for bad behavior and, in some cases, ban companies from doing business within their boundaries…

In Berkeley, Joan Hangarter had had to give up her chiropractic practice because of shoulder, neck and arm pain several years earlier. But after paying Hangarter under her individual disability policy for 20 months, a UnumProvident subsidiary terminated her benefits, attached her bank account and canceled her policy. Before it was over, the single mother of two had lost her home and gone on welfare…

In Michigan, another insurer, Liberty Life Assurance Co. of Boston, came in for a blistering verbal assault from a federal judge for its treatment of former Steelcase Inc. employee Nancy Loucks. The company, as administrator of Steelcase’s disability plan, first concluded that Loucks had been disabled by a rheumatic condition and began paying her. Then, after requiring her to undergo repeated evaluations by company-paid doctors, it concluded that she was not disabled and stopped paying…

When Deskins fell ill in 2002 — like Potter, with multiple sclerosis — administrators for her employer’s disability insurance plan apparently were so convinced that she would never work again that they assigned a specialist to help convince Social Security that she met the government’s stringent standard for federal disability payments, which requires that applicants be unable to function in any occupation.

Disability insurers have a huge financial interest in getting people who are seeking benefits from them onto the Social Security rolls. In effect, these insurers have come up with ways to shift much of the risk of having to cover ill and injured workers from themselves to Washington even as they continue collecting premiums…

For example, the multi-state review concluded that there was a bias in the way UnumProvident’s in-house medical staff interpreted the records that claimants submitted to prove their disability. “The bias,” the regulators wrote, “was reflected in attempts to focus upon any apparent inconsistencies in the medical records or other information supplied by claimants, rather than attempt to derive a thorough understanding of the claimants’ medical condition.”

Disability insurers have a considerable financial interest in concluding that a disability has psychological rather than physical roots. Most policies — including the one that covered Potter — limit the benefits that a company must pay for “mental and nervous disorders” to two years. By contrast, many of those with physical causes must be paid until the claimant turns 65…

After reviewing company records, state regulators said they found many instances where UnumProvident denied benefits “on the grounds that the claimant had failed to provide ‘objective evidence’ of a disabling condition” even where the company’s claim forms did not require such evidence.

Company documents show that within three weeks of receiving her disability claim, UnumProvident officials were on the phone to Potter complaining that her condition was “self-reported” and saying they needed objective evidence that something was wrong with her…

Among other things, the regulators said they found evidence that UnumProvident was engaged in a companywide effort “to shift the burden of responsibility to the claimant to provide … records in support of a claim,” rather than investigate a claim’s legitimacy on its own…

“There is no basis to support that her complaints are anything other than legitimate. Clearly, not having total knowledge of the pathophysiology of a disorder is no basis of the denial of its existence.”

When Potter tried to get the insurer to reconsider, she was sent her 4-inch-thick claim file and told the case was closed…

However, the files that the insurer sent to Potter after it closed her case suggest that UnumProvident’s decision to reverse itself occurred only after Potter retained Jon Holder, a Bar Harbor, Maine, lawyer. It was Holder who provided the company with new information about Potter’s condition and notified the insurer that Social Security had concluded that she was totally disabled…

As for Ricky D. Hart, the North Carolina chicken plant mechanic, UnumProvident acknowledges in documents that he has coronary heart disease. But in a letter last month, it said that it was cutting off his disability checks after an independent medical exam paid for by the company concluded that Hart could still work a 40-hour-a-week desk job and “should not have any problems in operating heavy machinery.” It suggested that he exercise…

1/15/2011, UNUM Is Still Doing It To the Disabled

http://biomedicalmecfs.blogspot.com/2011/01/unum-is-still-doing-it-to-disabled.html

Particularly fascinating, since in UK Works and Pensions has decreed that the neuroimmune disease ME/CFS is mental and not biological, is the case of the eye surgeon who developed a “phobia that caused his hands to shake” and couldn’t do surgery anymore…

In the last 8 years UNUMProvident has cleaned up its image but has it cleaned up its act?

4/24/2014, Federal District Court Overturns Unum’s Decision To Terminate LTD Benefits

http://www.californiainsurancelawyerblog.com/2014/04/federal_district_court_overtur.html

Plaintiff, through Kantor & Kantor, requested the Court to find that Unum wrongfully terminated her LTD benefits because she remains disabled from “any occupation.” Plaintiff also requested the Court to find that Unum failed to properly calculate her monthly benefit.

Since 2007, our client has undergone three significant back surgeries in an effort to alleviate her severe back pain. The first surgery occurred on August 7, 2007 and was not a success. Two additional spine surgeries also did not relieve her disabling back pain. Unable to work, our client made a disability claim to Unum and the Social Security Administration. Both found her to be disabled from her sedentary occupation as an Administrative Assistant (aka Secretary).

Over a year after our client’s last surgery, Unum reached the conclusion that “claimant would only be able to perform approximately 4 hours of sitting in an 8 hour day….” According to Unum, four hours of sitting falls into the “frequent” category (34-66%). Unum recognizes one must be able to sit at least six (6) hours a day to be capable to perform a sedentary job. Six hours of sitting falls into the “constant” category (67%-100%). Hence, Unum’s vocational consultant reached the conclusion that our client’s ability to sit frequently “would not allow for capacity for sedentary work” Multiple legal cases have reached the same conclusion.

As a result of this finding, Unum advised our client: “Based on the facts of your claim, as well as our clinical review, we do not anticipate a change in your medical status and therefore, have made the decision to extend our approval of your benefits through February 20, 2030”

A MRI taken on October 3, 2011 confirmed that the degenerative disease in our client’s spine had not changed. Inexplicably, however, Unum determined that our client was able to perform full-time work. Unum’s justification for its change of position was patently erroneous. As explained by Unum’s internal paper only medical reviewer Dr. Robert J. Clinton: “My reasoning is that the insured’s back pain has been stable….” According to Unum, because our client’s condition had not deteriorated further, she was no longer disabled. This is exactly the logic the Ninth Circuit has said is unreasonable under the more deferential abuse of discretion review.

Unum hoped to find support for its unreasonable conclusion by sending our client to a medical examination. The medical examiner, Dr. Kamran Hakimian, came to the conclusion that our client would be able to work a sedentary job on a part-time basis – provided she was allowed a 10 minute break every hour.

As part of her appeal of the termination of benefits, Kantor & Kantor sent our client to undergo objective testing of her functional capacity. The testing showed that she had even more severe limitations than assessed by Unum. She was limited to occasional sitting (1-33%) with a continuous duration of less than 30 minutes. This is far less than necessary for sedentary work.
The functional capacity evaluation also included validity factors verifying that our client “gave maximum effort with testing.” Perhaps most telling: “The client’s heart rate rose significantly corresponding with reports of pain during activities.”

Nothing sounds more fun than proving my pain in a functional test — which Unum is requiring that I have and pay for. Of course, the vast majority of the time, these tests are used against claimants to prove they’re no longer disabled.  Good deal for Unum — have the claimant pay for the tests, which Unum reviews and uses to make the decision to terminate benefits (regardless of what the results actually say) — it must save this corporation a lot of money.  And the potential problem of Unum’s doctors showing bias and profit motives is almost erased, because the claimant chooses the doctor to perform the test.

But does having a good doctor and an appropriately performed functional test guarantee that Unum will agree with the results?  Uh, no.  Perhaps if I could afford a well-known and respected doctor, that might give me some support.  But I know I can’t afford the prices of a doctor like that.