Final Appeal Letter by me

April 10, 2015

VIA FAX 800-447-2498

Mr. Donald Beaudette
Ms. Katherine Durrell
Unum
The Benefits Center
Post Office Box 100158
Columbia, SC 29202-3158

Unum Reference:  Claimant:  Johnna Stahl
Claim No. ***
Policy No. ***
Unum Life Insurance Company of America

Dear Unum:

I am in receipt of two letters dated March 5, 2015, one from Ms. Durrell and one from Mr. Beaudette. Mr. Beaudette’s letter mentions that a copy of my Social Security file was also sent to me, but I did not receive it.  However, I’m also having trouble receiving other mail, like monthly bills, so it’s not just mail from Unum that I haven’t received.

“We decline your request for a list of legally privileged communications and the remainder of your requests.”

So, Unum is making a claim of privileged communications. Tell me, are the photos that your field investigator took of the inside of my apartment considered privileged?  How about the reports on me mentioned in Unum’s notes in my file, but not included in the copy Unum sent me?  And if I could afford to retain an attorney, would that person be able to have access to Unum’s allegedly privileged communications?  In other words, do I have to sue Unum to get a complete copy of my file(s)?

“With respect to the remaining remarks in your letter, we believe we have fully explained our position in our prior communications and refer you to those letters.”

And I beg to differ.  As just one example, Unum still has not provided a definition of “Regular Care” specifically for a 30-year intractable pain patient.

“We refer you to www.unum.com/claimant, which will allow you to see certain communications pertaining to your claim online.”

It will also allow Unum the opportunity to put cookies on my computer and follow my every move on the internet.  Thanks, but no thanks.

“We understand from your November 29, 2014, letter that you have not yet requested an appeal.”

From that very same letter:

1. Response to Ms. Durrell’s letter dated 10/28/2014:

“You will need to submit a written letter of appeal outlining the basis of your disagreement.”

The reason my letter indicated an “intent” to appeal instead of the actual appeal letter is because it was my initial response after my benefits were terminated. Since there seems to be a question of my not having submitted a basis for the numerous disagreements I have with Unum: At this time, I am requesting that Unum consider all of my correspondence, including my Notice of Intent to Appeal, as part of my final appeal letter, and I incorporate same herein for all intents and purposes. (Forever and ever, amen.)

I’m not sure how I can be more plain, but maybe Unum is waiting for my “final” appeal letter, which I guess is this one.  So, without further ado:

THIS IS A FORMAL REQUEST FOR AN APPEAL OF THE UNFAIR, ARBITRARY, AND CAPRICIOUS TERMINATION OF MY BENEFITS BY UNUM.

“You will need to submit a written letter of appeal outlining the basis of your disagreement.  Please include any additional information you would like considered with your letter of appeal.”

As indicated above, all of my letters to Unum should be considered part of my appeal and a part of the basis for every single one of my disagreements.  Also, this will notify Unum of the additional information I would like considered with my letters regarding my claim, including its current status in your Appeals Unit:

1. Every post I made under “painkills2” at nmcannabisreview.com.

2. All posts on my blog, All Things Chronic, at wordpress.painkills2.com.  (I suggest you start with the post entitled “This Is What Desperation Looks Like.”)

3. All posts on Linda Nee’s website, lindanee.wordpress.com, including language like this:

“Failure to evaluate the totality of the claimant’s medical condition; and an inappropriate burden placed on claimants to justify eligibility for benefits.”

“As indicated in our October 28, 2014 letter, enclosed, the appeal timeframe is mandated by ERISA. However, due to the delay in fully responding to the inquiries in your November 29, 2014 letter, we are granting you an additional 30 days beyond the current appeal timeframe to submit your appeal.”

Interesting.  So, the appeal timeframe is mandated by ERISA, but only when Unum wants it to be. Only when Unum hasn’t made any mistakes, like not responding to my November 29, 2014 letter until March 5, 2015.  I wonder how many other mistakes will be found that can negatively affect Unum’s position on the denial of my benefits?  Until I receive a full copy of my file from both Unum and Social Security, along with the agency’s answers to my questions and requests outlined in my March 2, 2015 letter, that question cannot be answered and I cannot fully represent myself in this matter.

This will formally notify Unum that within the copy of my claim file, it also sent copies of some of Eileen Lisker’s hospital bills from Frick Hospital.  I tried to reach out to Ms. Lisker through a relative and was told the message would be passed along, but I have not received any further communications from the Lisker family.  I believe it is Unum’s duty to notify its claimants of any HIPAA violations and ask that you do so.

“If we do not receive your formal written appeal and supporting documentation by April 10, 2015, we will be unable to complete an appeal review and the determination on your claim will be final.”

C’mon, who’s kidding who?  Unum has already decided that its termination of my claim is final.  It hopes that I won’t find an attorney to take my case, and since I can’t fight back, that will be that. It’s a very uneven fight:  Unum, a massive corporation, against one disabled and poor individual. Doesn’t seem quite fair, does it?

This letter is not meant to regurgitate every one of my questions to Unum that remain unanswered — it is not a full and complete account of all of my disagreements.  (For some reason, I feel like I have to add this language, as Unum appears to have difficulty understanding English, picking and choosing which words of mine it wants to use against me.)

Linda Nee says that I shouldn’t take Unum’s attack on me personally, but considering the additional pain and agony Unum has caused me, that’s very hard to do.  I have never wished a life of chronic pain on anyone, even DEA agents, as it’s something that no one should have to suffer from, even the employees of evil corporations.  And until I sat down to type this letter, I wouldn’t have considered myself a vengeful person…

But here I am, in the middle of a pain storm, trying to concentrate on what this letter should include, and I can’t help wishing that every Unum employee included in this attack against me suffer as I have suffered — and will continue to suffer at Unum’s hands.  If there is such a thing as an evil curse — kharma, if you will — then I hereby ask the powers that be to deliver some justice for me.   In the alternative, my blog and Linda Nee’s website will have to do.  Because no matter what happens, Unum will always be on my shit list.  I will not be satisfied — justice will not be served — until Unum is taken to task for every illegal thing that it does.  For every disabled person it has harmed.   A person cannot suffer as Unum has made me suffer and just leave those consequences to kharma.

Even though I haven’t slept in over 24 hours, the left side of my face is swollen, my current pain level is creeping up to a 9, and the light hurts my eyes, I’m now going to get into my car, drive to the UPS Store, and pay to have this fax sent.

Ya’ll have a nice day.

Johnna Stahl

10 thoughts on “Final Appeal Letter by me

  1. If you have the filing fees (low income sometimes waives these fees) you can subpoena your records and file a suit against them for their shoddy work, intentionally missed deadlines (by them), HIPPA violations, the emotional distress they’ve caused you….I could write a list….I have self represented in court and found that if you do your homework it can be an advantage to go in without a lawyer. You are a very well spoken person…I think you could do it.
    If I were you I would become their worst nightmare…but, that’s just me….I’m like that sometimes…especially when I feel wronged.

    Liked by 2 people

    • A lawsuit based on ERISA is a little different than civil legal cases. Suing for emotional distress and things like that are not allowed. Even if I could show that Unum was negligent, they wouldn’t have to pay any penalties or fines. It’s an area of law that I’m not very familiar with, like most people, and requires an attorney — because if you leave anything out of an ERISA lawsuit, you have no way of repairing the damage. ERISA determinations are final, with no way to appeal.

      But thanks for the encouragement 🙂

      Like

  2. ((hugs)) that sounds like an absolute nightmare. I hope you are able to get them to get their crap straightened out. In my neck of the woods, one of the news stations reports on stories like this and takes the business to task, airs out all their dirty laundry…I wonder if a news station or maybe even a newspaper in your area might do the same if you reached out and shared this post? It’s a crying shame to have to go that far to get someone to step up and do what’s right, but maybe it would help.

    Liked by 1 person

    • I have tried to get the local media interested in the plight of chronic pain patients, but so far, Florida is the only state that has media willing to cover this issue. New Mexico doesn’t have much in the way of real reporters, unfortunately. I’ve also reached out to agencies like the Department of Health and the State Medical Board, to no avail. I’m afraid I’m on my own, as are most pain patients.

      But thanks for the encouragement and your comment 🙂

      Like

  3. What is it that the benefits were terminated?
    What? Pictures of the inside of your apt? Cookies on your computer?
    Geez! It’s rather upsetting! I am shocked that it’s happening? Looks so wrong to me!
    Motherfuckers! Pardon my french. Jesus!

    Liked by 1 person

    • Huge insurance companies like Unum are very, very powerful… like a god. They’ve been able to talk politicians and Attorneys General into making the laws favorable only to them, so disabled people have no recourse. They have departments full of lawyers to fight, while disabled people have neither the funds or the energy to take on a multi-billion-dollar corporation. Some people have even committed suicide because they were forced into poverty by Unum…

      And it feels good to cuss at them 🙂

      Liked by 1 person

  4. I wish there was something I could do to help…..my sister has been fighting to get on disability for chronic pain for 3 years…she truly is unable to work and they give her such a hard time…it is disgusting. How do these people sleep at night?

    Liked by 1 person

    • There isn’t a specific listing for chronic pain as a disability with Social Security — most who are approved have multiple conditions. If you want to give your sister my email address, I can try to help her (painkills2@aol.com).

      Like

If you don't comment, I'll just assume you agree with me

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s