Created By: Beaudette, Donald
Created Date: 09/09/2014
Response: Doyle, James 09/11/2014
We do not dispute that she remains impaired at this time due to her mental illness.
And what proof does Unum have of my mental illness? Or that I remain impaired by it?
In the absence of this information, reasonable conclusions cannot be made at this time as to the insured’s continuing entitlement to benefits under the contract, and termination of further benefits on this basis is appropriate.
As noted above, we have previously paid the maximum 24 months of benefits for disabilities due to mental illness. We cannot approve further benefits for the insured’s Major Depressive Disorder and secondary diagnosis of Anxiety Related Disorders as they are considered mental illnesses. The SSA does not limit benefits based on this criterion.
If the claim is being denied for proof of continuing mental illness, then why isn’t Unum requiring that I see a psychiatrist? And why am I required to have an expensive functional (physical) capacity test to prove a mental disability?
I see what Unum has decided to do here… During the appeal process, if I provide their forms signed by a doctor that isn’t qualified to give a mental illness diagnosis, then I haven’t provided the “appropriate” information to reinstate my benefits. If I were to obtain an updated disability status for mental illness, then I can look forward to my benefits being terminated sometime in the future because of the 2-year limitation.
You know, I’m having a hard time following all of this insurance industry talk, besides the fact that every argument by Unum appears to be circular. I’m sure other insureds have a hard time also. I don’t feel equipped to represent myself when I don’t even understand the language.
And it’s not fair that Unum has a huge corporation behind it to work on my claim, including medical, legal, and insurance experts, while I only have the internet and me.
I’m going to demand a free and impartial advocate, provided by Unum, to assist me in this appeal. (Don’t laugh.)