Meanwhile, more than 18,000 Kaiser nurses and nurse practitioners in Northern and Central California are planning to strike Jan. 21-22…
A study in 2007 sampled 15,000 veterans with chronic pain (Edlund et al.). They were all given opioids, and only 2% abused his or her medications. I have read other studies like these for chronic and cancer pain in which the addiction or abuse rate is always extremely low…
A neuropathic pain study published in 2003 by the New England Journal of Medicine found that opioid pain medication only gave 36% pain reduction at the highest dose possible before side effects of the drug were intolerable. Those with such extreme pain continue to feel pain; therefore, how can there be a medicated euphoria? Maybe this is why there is a much lower rate of addiction in chronic and terminal pain…
Just a side note, in my research I learned that a doctor’s office can be thought of as a “pill mill” if 50% or more of its patients are treated for pain management, even if they offer physical therapy, biofeedback, counseling, acupuncture, interventional pain therapies, etc. If the doctor is chief at the local hospital, she still runs a “pill mill” up the road because she primarily treats people with chronic pain or cancer pain. Nice, right? CDC Pain Clinic Regulations…
The Struggles of Audrey Conn, Founder of ‘Moderation Management’
It is important to note that the Substance Abuse and Mental Health Services Administration lists MM, in conjunction with a web-based program called moderatedrinking.com, in its national registry of evidence-based treatment programs. A.A. is not included.
(Transcribed directly from Unum-provided documents.)
Response: Kertay, Les P 02/27/2004 14:27:00:
Ms. Herbert’s analysis as presented in the 2/24/2004 review, as it pertains to psychiatric issues in the claim, adequately and succinctly captures the essence of our discussion and my review of the relevant data. I concur that the records available in the file, over a number of years and multiple providers, are suggestive of psychological factors that likely contribute to the claimant’s perception of pain and her reactions to it. However, there is no current documentation of treatment, evaluation, or clinical formulation that attributes impairment to psychiatric condition, either alone or as it might contribute to a general medical condition. I will be glad to discuss further or to respond to any questions.
Les Kertay, Ph.D., ABPP
VP, Medical Director
Licensed Health Services Provider (TN, GA)
Diplomate in Clinical Psychology, American Board of Professional Psychology
Date of first Unum denial letter: February 27, 2004
The same psychologist later responded to a UNUM questionnaire, in which he noted that the “causation or precipitating factors” leading to Plaintiff’s psychological symptoms were: “history of lupus, aggravated by stress, neck injury, low immunity.” An April, 1995, report from Plaintiff’s rheumatologist diagnosed Plaintiff with lupus, fatigue, and depression. A July, 1996 report diagnosed Plaintiff with “lupus, arthralgias, headaches, spine, depression, and fatigue;” a secondary condition of “depression” was also identified…
Internal UNUM staff notes and memoranda throughout the administrative record identify Plaintiff’s disability only as major depression, depression, or depression and post-traumatic stress disorder… At no time does UNUM categorize Plaintiff’s disability as “medical.”
Plaintiff alleges a violation of the Employee Retirement Income Security Act (ERISA), 29 U.S.C. §1132 (Count I), breach of contract (Count II), and breach of fiduciary duty (Count III)…
I’ve only reviewed parts of my Unum file, but I’ve noticed that Unum doesn’t like to list TMJ and degenerative disk disease as part of my disability — although it does, but usually close to the end of the list. “Mental” conditions are usually at the beginning of the list, like depression and anxiety.
The order of the list puts more emphasis and importance on the items at the beginning, so that it looks like most of my symptoms are psychiatric. And I’m guessing that Unum thinks including chronic pain in this list — usually before and after mental conditions — also makes pain look more like a a mental condition, like this:
Depression, chronic pain, panic attacks, fibromyalgia, TMJ…
It’s kinda like capitalizing certain terms to make them look more important — like some anti-drug advocates capitalize the words “heroin” and “god.”
Burns v. Paul Revere Life Ins. Co. and UnumProvident Corp. – Confidential Settlement – U.S. District Court, Honolulu, Hawaii, May 2003. Disabled lawyer sued insurers for breach of contract and bad faith after his benefits were denied following disabling mental illness. Confidential settlement. FR’s Co-Counsel – John O’Neil, Wailuku Maui, Hawaii.
Merrick v. Paul Revere and UnumProvident (Unum Group) – $61,647,355 Verdict for bad faith denial of disability benefits – U.S. District Court, Las Vegas, Nevada, 12/13/2004 (compensatory award) and 6/26/08 (punitive damage award). Disabled venture capitalist sued insurer for denial of disability benefits and bad faith. Jury verdict of $1,147,355 in back benefits, $500,000 for emotional distress and $60 million in punitive damages. See our News page for further details. This award was # 7 in the Top Ten Jury Verdicts of 2008 FR’s Co-counsel – Julie Mersch, Las Vegas, NV and Mac Sasser, Charlotte, NC.
McKendry v. General American, Paul Revere – $17,300,000 Verdict for bad faith denial of disability benefits – Maricopa County Superior Court, Phoenix, Arizona. 6/1999. Man whose disability insurance benefits were terminated sued for bad faith. $350,000 compensatory damages, $17 million punitive damages. Confidential settlement pending retrial. FR’s Co-counsel – Steve Dawson, Phoenix, AZ.
Ace v. Aetna – $16,500,000 Verdict for bad faith denial of disability benefits – U.S. District Court, Juneau, Alaska. 5/1996. Woman whose disability insurance claim was denied sued for denial of benefits and bad faith. Jury verdict of $127,000 compensatory damages, $16.5 million punitive damages. Remitted post appeal. Case settled for confidential amount.
Fisher v. Aetna – $8,600,000 Verdict for bad faith denial of disability benefits – Anchorage Superior Court, Alaska, 7/9/1998. Man whose disability insurance claim was denied sued for denial of benefits and bad faith. Jury verdict of $292,000 compensatory damages, $8.4 million in punitive damages. Settled for a confidential amount.
Greenberg v. Paul Revere Life Ins., Co., et al. – $2,950,000 Verdict for bad faith denial of disability benefits – US District Court, Phoenix, Arizona, 1/2002. Disabled stockbroker sued for bad faith arising out of termination of benefits under own occupation disability insurance policy. $547,445.42 compensatory damages; $2.4 million punitive damages. Affirmed, 2004 WL 74630 (9th Cir. 2004). FR’s Co-counsel – Calvin C. Thur, Scottsdale, AZ.
Jakway v. UnumProvident and Paul Revere Life Ins. Co. – Confidential Settlement – U.S. District Court, C.D. California, January 2003. Disabled hospital administrator sued when disability insurer arbitrarily terminated benefits. Confidential Settlement. Co-counsel – Tom Curtis, Pasadena, CA.
Leak v. Unum Life Ins. Co. – Confidential Settlement – U.S. District Court, S.D. California, April 2004. Disable electrical worker injured in rock slide on Mt. Rainier sued when disability insurer arbitrarily terminated benefits. Confidential Settlement. FR’s Co-counsel – Howard Bennett Hellen, Vista, CA.
Prabucki v. UnumProvident – Confidential Settlement – Western District of Washington, 2001. Insured sued for bad faith arising out of termination of benefits under disability insurance policy. Confidential settlement.
Statute of limitations refers to a legislatively-created time limit to file a lawsuit against a defendant. Most long term disability claims made under group disability plans are not governed by an actual statute, but rather, the time limit is usually found in the wording of the long term disability plan. Consider the following:
What happens if your long term disability insurance carrier has paid you benefits for several years, and then unfairly decides to terminate your benefits? Under most long term disability plans, you have an obligation to appeal within 180 days of receiving the termination letter. Assume you appeal by the 180th day, and then the insurer takes 45 days plus another 45 days to decide that they are still terminating your benefits. So now you are in a situation in which 9 full months after you receive the termination letter, in order to get your benefits paid, you must sue the insurance company in Federal Court under the Employee Retirement Income Security Act.
You have done everything correct according to the rules. You appealed as you were required to do, and you did so within the time frame. You might be surprised to find out that by the time you receive the letter from the insurance company denying your appeal, that your time to file a lawsuit has already expired!
The reason this is possible is because under controlling New York federal common law, your time limit for filing a lawsuit is governed by the specific wording in your long term disability insurance plan. Some plans actually have the time start ticking when you file your first claim forms. So if you have a long term claim, your time to file suit could theoretically expire before your benefits are actually terminated.
In the lawsuit, the plaintiff also pointed out that the LTD Contract between the plaintiff and UNUM was one of adhesion. This means UNUM presented the terms in the contract on a “take it or leave it” basis leaving no room for any negotiations or revision of the language contained in the contract. The plaintiff argued that in the situation where the contract is one of adhesion, the Courts have long been disinclined to effectuate clauses of limitation which are unconscionable… Therefore, the plaintiff argued that the provision in the policy offsetting benefits should be deemed void as unconscionable…
The plaintiff alleged that the language in the policy is ambiguous as two different reasonable interpretations can be derived from the policy’s language. The plaintiff argued that because of the ambiguity, the contract of insurance is to be construed liberally in favor of the insured and strictly against the insurer…
Beavers is suing Unum for breach of contract, breach of duty of good faith and fair dealing and violations of the Texas Insurance Code.
The Unum disability insurance lawsuit is Gary M. Beavers v. Unum Life Insurance Company of America, Case No. 3:14-cv-01826-D, in the U.S. District Court for the Northern District of Texas, Dallas Division.
She continued to fight Unum for two years, including appeals, until she received a final notice that their decision to terminate her Unum disability insurance policy was verified and upheld. Now, Christine is taking legal action against Unum Insurance Company for their alleged negligence and a breach of contract that Unum had a duty to fulfill…
As it stands now, more than 3,000 Unum lawsuits have been filed in the federal courts and are awaiting litigation.
A Texas woman filed a Unum lawsuit last month against the giant health insurer alleging she was denied benefits. The suit cites breach of good faith and fair dealing, violation of Texas law, violation of the Texas Deception Trade Practice Act, negligent handling of claims and breach of contract. Cynthia Ann Bland filed a long-term disability claim for a work-related injury that was at first accepted by Unum but later denied. The Texas woman is appealing the denial, alleging that Unum has misrepresented her medical condition. She is seeking damages in excess of $1 million (Jefferson County District Court Case No. D195-55).
Another Unum tactic, and one that is illegal, is to demand reimbursement from policyholders who have accepted social security disability benefits, as per Unum’s requirements. This nasty little tactic makes the policyholder apply for benefits, and once received, Unum claims their policy provides no double-recovery of benefits. For instance, James Kinsey, a former NBA referee, was sued by Unum in 2012 for reimbursement of disability insurance benefits to the tune of $105,337.
However, in 2009, a federal court fined Unum for making its disability recipients file false social security disability claims, even if the policyholder was not entitled or eligible for Social Security Disability. The court found that Unum violated the False Claims Act and fined the company $11,000 for each violation – the fullest amount of civil penalties allowed by the False Claims Act…
A former Unum employee testified that Unum “would say to the insured, if they believed that the disability was going to last more than six months, they would tell them that they needed to apply for Social Security Disability…It was just simply a duration analysis” and other eligibility requirements were not considered (UNITED STATES OF AMERICA, ex rel. PATRICK J. LOUGHREN, Plaintiff, v. UNUMPROVIDENT CORP., et al., Defendants).
Walgreens has a lot of personal information about a lot of people stored in its computers. If you file for any kind of disability, that information is pretty much now public. First, all your medical information travels through Social Security and other government offices. Then through any disability insurer… How many people at Unum (both former and present employees) and its subsidiaries and agents (too many to list) have read all this personal information about me?
I’m telling you, HIPAA is dead.
Before I paid two doctors to certify my medical condition for New Mexico’s Medical Cannabis Program, I prepared by creating a medical summary — obviously for the doctor’s file, but also so I wouldn’t have to verbally relay the information. (Talking for any length of time is painful for TMJ sufferers, especially during a stressful visit to the doctor.)
I thought it might be helpful for other patients to see an example, in case they want to prepare one of their own. It’s hard to sum up a 25-year history, but I tried to make it as short as possible.
Prepared April 2013
INTRACTABLE PAIN SUMMARY
Fifty-year old woman suffering from constant pain for about 25 years. Began with symptoms of headaches and clicking in the jaw; diagnosed with Temporomandibular Joint Dysfunction (TMJ) at 16-years old by family dentist. Condition likely caused by competitive gymnastics. Constant pain began about 5 years later as toothache which remained unresolved after numerous dental treatments. Following about 7 years of attempting all available TMJ treatments, during which the pain level increased, TMJ surgery was performed in 1991 by oral surgeon. Surgeon performed bilateral arthroscopy and removal of meniscus on right side due to perforation too large to repair. Surgery made pain worse. Without treatment options available, home therapy program commenced.
Throughout the next 8 years, constant pain traveled into neck, shoulders, and throughout upper body. Eventually saw various medical specialists, including pain management specialists, trying all available treatments, none of which brought pain level to manageable level. Finally began medication regimen with pain management doctor in 2002, while continuing home therapy program. Became disabled in 2003. Upon death of this doctor in 2010, jumped from pain specialist to pain specialist, unable to stabilize condition or manage side effects of medications. In 2011, the political climate against use of narcotics to manage pain became even more intense, and finally just gave up. No medication for about 1 1/2 years and unable to continue home therapy program.
Severe TMJ Syndrome
Myofascial Pain Syndrome
Four herniated cervical disks/chronic cervicalgia
Lumbar disc degeneration/facet arthritis
Shoulder bursitis/frozen shoulder
Mild spinal stenosis
Bilateral tracking dysfunction and early degeneration/knees (patella)
Fibromyalgia (muscle pain)
Chronic then Intractable Pain Syndromes
MRI of temporomandibular joints (11/1/90)
X-ray, right shoulder (9/16/98)
X-ray, neck (10/21/98)
MRI of temporomandibular joints (3/31/00)
MRI of cervical spine (3/31/00)
MRI of shoulders (4/1/00)
X-ray, cervical spine (12/13/00)
X-ray, lumbar spine (12/13/00)
MRI of knees (1/9/03)
EMG for carpel tunnel (7/3/03)
X-ray, right hand (11/3/03)
MRI of cervical spine (3/24/04)
MRI of cervical spine (5/15/09)
Medications (all types)
Trigger point injections
EXPECTATIONS FOR, AND BENEFITS OF, MEDICAL CANNIBAS USAGE
It is impossible to explain the physical and psychological effects of chronic pain on day-to-day life. It is, of course, disabling. But when hope is lost for any relief, it is so easy to just become inert, which can become an early death sentence.
I do not expect cannabis to reduce my pain levels; rather, I expect it to give me the ability to distract myself from the constant pain. The ability to focus on things outside of the pain.
I would like to be able to sleep longer than 2 hours at a time. I would like to obtain some control over my constant anxiety and related conditions (like eczema). I expect it to allow me to increase movement and flexibility. I hope it works as an anti-anxiety, anti-inflammatory, and as a sleep aid. I expect that the side effects will be minimal, especially compared to prescription medications.
STANDARD TREATMENTS HAVE BEEN TRIED AND FAILED
After 25 years of both invasive and non-invasive treatments, and extensive research into TMJ and the disease of intractable pain, my conclusion is that the medical profession cannot help me. I have learned enough over the past quarter of a century to design and implement my own home therapy program, which I have been unable to perform after discontinuation of the medication regimen.
Over 100 million Americans suffer from chronic pain, and recent attention to the problem may initiate research and development actions. At this point in time, the only new pain treatment involves Ketamine. Recent knowledge and research on the brain may eventually lead to new treatments, including treatments involving stem cells, but those advancements look too far into the future to be of help to me in my lifetime.