Unum denies Chronic Fatigue and Fibromyalgia claims

https://lindanee.wordpress.com/2015/07/22/daily-buzz-16/

Claimants have been contacting me to report Unum’s denials of CFS and FMS claims. It’s the same old Unum story of not wanting to pay for “self-reported” impairments by denying claims outright, or limiting benefits to 24 months. I refer claimants to their policies to check out actual “self-reported” language or exclusions policies might have specifically for CFS and FMS.

Ten years ago FMS patients were treated with morphine pumps. At the same time Unum’s “Fibromyalgia White Paper” suggests that if FMS patients would only “get up on a treadmill” all would be well and healed. In the meantime, Unum’s UK physicians are engaging in research to eliminate CFS and ME from Britain’s welfare program where claims also remained unpaid.

In America, the American Psychological Association published the new DSM-5 describing both CFS and FMS as “somatic” mental illnesses that are all “in one’s head.” Clearly, the insurance industry has established a prejudicial view challenging CFS and FMS as credible causes of disability. The industry won’t pay, and that’s not likely to change.

Recently Web MD published several articles referenced on this blog giving credibility to CFS as a physical disease. Nevertheless, Unum and several other insurers are refusing to pay long-term (if at all) for CFS and FMS…

How Unum views the disabled

http://www.timesfreepress.com/news/business/aroundregion/story/2011/may/26/unum-tells-shareholders-it-considering-acquisition/50562/

Part of the reason that Unum has considered looking outside itself for new revenue streams is the meandering path the rickety U.S. recovery has taken, top executives said.

“We’ve been successful despite a weak economy and soft financial environment,” Watjen said. “It’s difficult to grow, but it’s not hindering our ability to be a successful company.”

Both Watjen and McKenney, as well as Unum Group Chairman Jon Fossel, said that it will continue to be difficult to do well in the current economic and regulatory environment.

“The economy is recovering slowly in fits and starts, and unemployment is still high,” Fossel said.

Unum, which markets mainly to employers who then offer the plan to individual employees, depends on other companies to hire and retain workers to organically grow its bottom line. The recession made that more difficult, and hiring still hasn’t increased enough to even keep up with population growth.

Additionally, the company has become concerned that lawmakers could perceive the insurer as a health care concern, and be treated accordingly by lawmakers searching for ways to pay for the national health care reforms adopted by Congress last year…

“People need to recognize we’re not a health care company,” he said. “We work with employers to get people back to work, and getting that through Congress is a challenge.”

In fact, Watjen said, companies like Unum actually help people “take responsibility for themselves and their families, and take pressure off the federal programs” in a time of shrinking wages and work forces…

How States Are Fighting to Keep Towns From Offering Their Own Broadband

https://www.propublica.org/article/how-states-are-fighting-to-keep-towns-from-offering-their-own-broadband

Earlier this year, the Federal Communications Commission voted to ease the way for cities to become Internet service providers. So-called municipal broadband is already a reality in a few towns, often providing Internet access and faster service to rural communities that cable companies don’t serve.

The cable and telecommunications industry have long lobbied against city-run broadband, arguing that taxpayer money should not fund potential competitors to private companies.

Private companies afraid of competition?  Isn’t that what privatizing is all about?

The telecom companies have what may seem like an unlikely ally: states. Roughly 20 states have restrictions against municipal broadband.

And the attorneys general in North Carolina and Tennessee have recently filed lawsuits in an attempt to overrule the FCC and block towns in these states from expanding publicly funded Internet service…

As the New York Times detailed last year, state attorneys general have become a major target of corporate lobbyists and contributors including AT&T, Comcast and T-Mobile…

And in the insurance industry, Unum, a corporation that is currently sleeping with the attorney general in Maine.

My worst fears coming true

This is a post by Zoe about how Social Security Disability believes that if you’re not taking medications (and seeing a doctor regularly) that you’re no longer disabled.  (Just like Unum.) Since I wrote to both Social Security and Medicare explaining my current situation, I expect they will cut off my benefits any day now.  Social Security Disability is the only income I have, so when these benefits are gone, I will be homeless.

Sure, I can fight a ruling that terminates my benefits, but I imagine that’s going to be rather difficult when fighting from my car. And how many months or years would that take? I won’t even have enough money to put my stuff in storage. I suppose I’ll have to load my car with as much of my belongings as possible and then throw away the rest.  Anyone want to buy a sofa?

https://trashdiaries.wordpress.com/2015/04/29/you-are-full-of-shit/

“In fact, I wouldn’t doubt they hoped I’d finally kill myself (successfully.)”

Unum, Republicans, and SSDI

https://lindanee.wordpress.com/2015/06/04/internal-unum-propaganda/

Internal Propaganda to Unum Employees

“Unum’s senior executives had a rare face-to-face visit with U.S. House Majority Leader Kevin McCarthy last month, when he was in Chattanooga campaigning for Tennessee Rep. Chuck Fleischmann.  As the House majority leader, McCarthy holds the second most powerful position in the House of Representatives, behind House Speaker John Boehner.

Unum President and CEO Rick McKenney, along with Vice President of Government Affairs Marty McGuinness and members of our senior executive team, spoke to Reps. McCarthy and Fleischmann about our business and the role we play in protecting individuals and families.

“Majority Leader McCarthy’s visit represents a great opportunity for the company to have a conversation with one of the most prominent leaders in Washington about our company and our products,” Marty said. “It’s also a chance to raise our profile with House leadership and to solidify our relationship with our local congressman.”

Rick gave an overview of Unum’s business and how it grew to be a Fortune 500 company and top business in Chattanooga. He also spoke about the company’s continuing commitment to our communities in the U.S., U.K. and Ireland…

Rep. Fleischmann recognized Unum for its commitment to community giving. “This is the most philanthropic company I know in Chattanooga,” he said. “It has a deep sense of longtime civil commitment.”

Senior management also spoke with Rep. McCarthy about some of the issues facing our industry, such as high corporate tax rates and the insolvency of the Social Security Disability Insurance Program (SSDI)…

As for the SSDI program, Majority Leader McCarthy acknowledges the looming problems with funding disability benefits and offered some optimistic insight.

“House Ways and Means Committee Chairman Paul Ryan has made this issue part of his two-year goal plan,” he said. “I believe that by year’s end this will become a partisan issue and we will see some positive movement in the right direction.” …

https://lindanee.wordpress.com/2015/06/08/dcs-carrot-stick-awards-4/

My connections in the UK indicate both countries have taken to the streets in civil disobedience to rid Unum’s influence in their welfare programs. No one wants Unum insurance or its representatives in Great Britain or Ireland…

Unum Complaints From Consumer Affairs Website

https://lindanee.wordpress.com/2015/06/04/unum-complaints-update-from-consumer-affairs-website-patterns-of-practice/

Diane of Granville, OH on May 1, 2015

Denied benefits after became disabled by Epilepsy, which was diagnosed 2 years after I began to pay into Unum. Unum said it was because I failed to disclose every symptom for any condition, for which I DID NOT seek medical treatment. This is so broad that it includes the hangnail I had 9 years ago, for which I DID NOT seek medical treatment!

(This sounds like a pre-existing condition denial. Unum once denied a claim for pre-x because the insured was found to have taken Advil for tension headaches.)

Unum’s final denial letter

There was never any doubt in my mind that the appeal for Unum to reinstate my LTD benefits would prove successful.  I mean, there was never any reason to delude myself into thinking that all of my arguments would make a difference to Unum, a multi-billion-dollar insurance company only interested in profits.

I received its final denial letter last week, but the letter is dated April 29, 2015, and the postage on the envelope is dated April 30, 2015.  I haven’t read the letter — why get even angrier and more upset?

But I think it’s interesting that I didn’t sign the updated Authorization and Release for the appeal until April 30, 2015, mailing it the same day.  As I mentioned in my last letter to Unum, the appeal had already been decided long before this administrative process was put into motion. Because Unum demanded an updated Functional Capacity Examination and wouldn’t pay for it, and knew that I couldn’t afford to pay for this expensive report, I am in violation of the contract and Unum wins again.  Poverty is the reason I no longer have long term disability benefits. Ironic, isn’t it?

Should I try to find an attorney to file an ERISA claim against Unum in court?  Well, there’s no such thing as an ERISA attorney who works pro bono.  Meaning, what would be the point? Unum knows I can’t afford to pay a retainer for an attorney to represent me, so it has no financial reasons — possible financial exposure or consequences — for denying my appeal.  And potential ERISA lawsuits aren’t even a valid reason for Unum, as they also provide no financial exposure or negative consequences for this corporation — our politicians and Attorneys General have seen to that.

Unum and ERISA

http://www.lawyersandsettlements.com/articles/first_unum/interview-unum-lawsuit-insurance-21-19924.html#.VWpc2M9Viko

Seattle, WA: For most Unum, or Unum Provident, policyholders, trying to comprehend the role ERISA plays in Unum denied disability claims is like groping in the dark. Disability attorney Chris Roy sheds some light…

Another major component of ERISA is it “only allows an insured to sue for back-benefits, interest, and, if successful, reasonable attorney fees and costs. ERISA does not allow recovery of incidental, consequential, or extra-contractual damages.”

“For instance, if you are denied LTD benefits, and, because of that denial you cannot pay for medical expenses, or if you can’t even pay for rent or food, those are incidental and consequential damages related to the denial,” says Roy, “and they are simply not recoverable under ERISA.” …

If you or a loved one have suffered losses in this case, please click the link below and your complaint will be sent to an insurance lawyer who may evaluate your Unum claim at no cost or obligation.

Unum Taking Advantage of a Federal Law

http://www.kantorlaw.net/News/Unum-Taking-Advantage-of-A-Federal-Law.aspx

At issue are cases such as that of Laurie Hindiyeh, who was forced to quite her job as controller of a real estate company because of an inner-ear ailment. For two years, the long-term disability coverage she had from Unum helped to offset her lost income. But then the checks stopped. Unum declared her fit for work, based in part on surveillance videotapes. It cut off her benefits about a year ago, she said…

Because she obtained coverage through her employer, her ability to contest Unum’s decision is sharply limited by the Employee Retirement Income Security Act. The 1974 federal law, according to subsequent Supreme Court rulings, exempts employee benefits, such as disability insurance, from state regulation. As a result, Hindiyeh and thousands of similarly insured Americans are not covered by state consumer protection laws and are not entitled to take most claim disputes before a jury…

In fact, the insurance companies often are the only arbitrators of such disputes. Only after the insurer has denied an appeal are policyholders permitted to go to court, where they may receive a hearing before a judge. At that point, policyholders who fall under ERISA are still not entitled to compensatory or punitive damages, even if they prove the insurer knowingly cheated them out of benefits. All they may recover is the amount of the benefits in dispute, and the burden of proof is high. For a policyholder to win, a judge must conclude not only that the insurance company made the wrong decision but that is also acted in an arbitrary and capricious way.

“As a practical matter, you have lost all of your rights, ” said Ray Bourhis, a San Francisco lawyer who represents Hindlyeh. “You can’t even call the California Insurance department and ask them to investigate because they have no jurisdiction. You have nothing, and, as a result, you have no leverage.”

Bourhis and other insurance lawyers say they believe Unum has exploited the ERISA shield in its handling of employer-provided long-term disability coverage. Bourhis cited the insurer’s own internal memos, which he obtained in previous lawsuits, describing the company’s plans to use the federal rules to reduce its payouts to policyholders…

Few lawyers accept ERISA-related disability matters because even if they win, the awards usually are so small that they do not cover the cost of preparing the case…

Corruption By Design

https://lindanee.wordpress.com/2015/05/21/unum-corruption-by-design-part-i-electronic-book-by-linda-nee/

It is interesting to me that Unum’s attorneys never once questioned me at deposition about my role as a Compensation Specialist working in Jim’s Orr’s office acting as a go between Unum ‘s executive staff and Smith Barney transacting the trading and sale of stock options.

It may also be that Unum’s legal resources hoped to avoid any public disclosures of insider trading in and around the time of the merger with Paul Revere and the Provident Companies. Nothing has ever been asked or answered about the sudden disappearance of “The 1998 People Goals”, and the deliberate granting of employee stock options valued at nearly $60 per share that became worthless at $5 per share after the 1999 merger took place, [possibly] with the full knowledge of management…

While Unum’s executives lived the luxury of wealth, claims handlers felt the stress of managers who demanded more and more claim terminations. If you can, picture a work area with a large red thermometer on the wall keeping track of denials, and a service bell alongside a large fishbowl into which lottery tickets were placed by those lucky enough to deny multiple claims. Each “ding” of the bell signified another denial with applause.

On the half hour Unum’s managers drew a ticket from the fishbowl and awarded picnic gear, movie tickets, lawn chairs and other prizes to claims handlers who denied claims…

Claims handlers were also told to call claimants from the south with 8th grade educations and offer them settlements, and or offer larger numbers of settlements around the holidays when claimants were in need of money…

Unum’s legal department is now arguing that insureds and claimants should not be able to retain qualified assistance to help them manage their claims. Without outside assistance Unum will be able to deny more claims than ever and has gained the support of the Maine Attorney General who is bed with Unum’s agenda. One has to wonder if the Maine Attorney General isn’t in Unum’s pocket…

Unum Investigates Volunteer Activities

https://lindanee.wordpress.com/2015/05/12/unum-investigates-volunteer-activities/

Last week I wrote a post about insureds and claimants volunteering for worthwhile causes in their communities only to wind up with denied disability claims because insurers, like Unum, equate volunteer activity with measures of work capacity.

Unum’s insane giant leap from a few hours of volunteer work to the physical or mental ability to sustain full-time jobs in a competitive work place is an indication of the company’s desperate attempts to deny more and more claims.

Although in concept “volunteering” is good mentally and physically for disabled persons, there are ground rules insurers look for in making comparisons to “own occupation” definitions and the ability to perform work. First and foremost, insureds (and their physicians) often make the mistake of providing Unum with medical restrictions and limitations that actually preclude volunteer activity…

Funny Search Terms from my stats page

“maine ag office sucks”

Yes, yes it does. 🙂

Importance of Medical Restrictions and Limitations

https://lindanee.wordpress.com/2015/05/20/the-importance-of-medical-restrictions-and-limitations/

From my perspective it is often true that insureds and claimants, and in fact their physicians, are completely unaware of the importance of medical restrictions and limitations in the evaluation of disability claims.

Although most insurers continually request patient notes, physicians rarely (if ever) include R&Ls in the notes. Lacking the specific information they need, insurers then keep asking for the same information over and over again, only to deny claims by citing, “there are no restrictions and limitations to preclude you from working.”

My reviews of most claims show that despite voluminous patient notes and recommendations there generally is not one R&L among them. Without specific R&Ls to support disability the door is left open for insurers to deny claims legitimately even when it’s clear from the combination of patient records there is no work capacity…

“Restrictions” are defined as work or life activities insureds should NEVER do. “Limitations” are defined as “work or life activities insureds can do, but only to a limited extent. And, all good intentions aside, many physicians themselves are not aware of these definitions and rarely write them in patient records or on disability forms…

Unum’s Field Investigations Getting Lengthy And Invasive

https://lindanee.wordpress.com/2015/05/15/unums-field-investigations-getting-lengthy-and-invasive/

Requests for field visits should never be considered “routine” or “normal and customary” as insurers like to suggest. Although field investigators have absolutely no authority or control to make claims decisions, information obtained and fed back to claims handlers can be used to justify claims denials.

In today’s environment where “everything you say to insurers” is used against you, it’s important to understand and be prepared to remain in control of the field interview and not allow insurers to “fool you” into showing work capacity where none exists.

For example, recently I heard from two separate insureds that Unum now has a 15 page template of questions field PIs are asked to use when conducting interviews. Insureds and claimants are told the interviews will take 4 hours! The “4-hour rule”, so-called, wasn’t chosen by chance since the capacity to sit, or alternate sitting and standing for 4 hours is identifiable as part-time work capacity.

Insureds need to think for just a moment. Is there realistically any occupational, financial or medical information that should take 4 hours to relate? Interviews that go on and on for 4 hours are those asking personal, and/or family related questions for the purpose of keeping the individual engaged long enough to prove part-time work capacity…

“Do you mow lawns? Laundry? Cook?” “Does your family help you clean house?” These are questions the insurance company wants to know in order to “equate” your daily activities with work capacity to deny claims…

Unum Unfairly Denies Claim For Lupus (SLE)

https://lindanee.wordpress.com/2015/04/26/unum-unfairly-denies-claim-for-lupus-sle/

Disability insurers have historically had a problem paying Lupus claims because the disease “flares” meaning symptoms worsen and then symptoms improve and insureds feel much better. Although Lupus is regarded as mid to life threatening, in the past Unum discredits disability claims when it can be documented insureds “feel better.” In fact, the saying, “I have good days and bad days” has become a new stereotype for those who are presumed by insurers to be malingerers…