Unum, previously known as UnumProvident, First Unum, and Paul Revere, is the largest disability insurance provider in the United States today. With profits reaching almost 900 million dollars, according to CNN Money, Unum is one of the most profitable and resourceful companies in the insurance market. And with great success comes bad publicity – Unum has been in the news numerous times in the past few years for their questionable and sometimes outrageous claims handling practices.
The American Association for Justice (also known as the AAJ) has recently published a list of the worst insurance companies who continuously put their bottom line over the needs of their customers. The Ten Worst Insurance Companies in America lists Allstate, Unum, AIG, State Farm, Conseco, WellPoint, Farmers, UnitedHealth, Torchmark and Liberty Mutual as the industry’s bullies in the order from biggest to smallest.
Unum’s ranking as the second worst insurance company in America comes as no surprise to people familiar with the games they play with claimant’s disability benefits. Disability Insurance Attorneys have seen a huge spike in the number of complaints received by policyholders of Unum disability policies. What is Unum doing to cause such an increase in claim denials?
For years Unum has been practicing what lawyers call “bad faith claims handling practices.” Since Unum is the largest disability insurance provider in the US, it is only logical that the largest number of claim denials come from Unum disability claims.
Some of the most common denial tactics utilized by Unum are:
- Use of surveillance video to discredit claims of disability. Unum will hire an outside private investigator to take surveillance of a claimant for a few days to record their daily activities. The investigator may film you getting in and out of your car, driving to the grocery store, or picking your children up from school. Unum is hoping to catch you on video performing an action you stated you were unable to do due to your disability. If they can prove you misrepresented the extent of your disability on your application, they will likely deny or terminate your disability benefits.
- Only paying for part of a claim for total disability. If Unum initially approves your claim for disability benefits, they generally will only pay benefits for a certain time period. After a certain time period, they state that you are no longer disabled and are able to return back to work.
- Denying a claim with the intent to wear the claimant down to a lower settlement price.
- Claiming a condition is “pre-existing.” Many disability policies, especially Unum disability policies, have a Pre-Existing Condition clause that leaves the insurance company off the hook for payment of benefits. Although the specifics outlined are different in every policy, most disability policies will state that if you file a claim for disability benefits within one or two years from the date you received coverage under the policy, the insurance company is allowed to investigate if your disabling condition was “pre-existing.” They will ask for medical records from as far back as 3 to 6 months prior to your date of coverage to review.
- Refusing to acknowledge certain disabilities, especially mental disorders, Fibromyalgia and Chronic Fatigue Syndrome. Although Unum does not have the worst reputation for denying these types of claims, many claim denials for these types of disability claims state that claimants are not disabled from working from these “self-reported” symptoms. Even with all the advancements in medicine and technology, there are still a lot of conditions with no available treatment plans.
- Changing policies after claims are filed (and without authorization or knowledge of its policyholders). This could include changes in policy definitions or adding provisions to include Other Income offsets and limitations on policy payment periods.
- Demanding repeated requests for IME and threatening to deny claim without a medical examination. Some disability policies provide Unum with the right to request you submit to an IME scheduled by Unum. However, it is important to check your policy – not all policies provide Unum with this right.
- Misreading medical records. Courts have reversed claim denial decisions from Unum due to inaccurate conclusions from medical records and “cherry-picking” out of context statements in order to deny claims. Unum has also been shown to provide their record reviewers with incomplete files of medical records, omitting records that show a claimant as disabled.
- Improper claims investigations by obtaining opinions from biased, sometimes unqualified “experts.” Unum utilizes a variety of staff and outside experts on their payroll to evaluate new and existing claims. Former employees have come forward over the years claiming they felt pressured by upper management to write reports and opinions in favor of the company. If they did not, they feared they would be asked to leave. Sometimes, claims representatives would even take the opinion of a nurse that favored a denial of benefits over a more qualified doctor’s opinion of disability.
Source: Unum Group – CNN Money –http://money.cnn.com/magazines/fortune/fortune500/2011/snapshots/2343.html;
The Ten Worst Insurance Companies in America – AAJ – http://www.justice.org/docs/tenworstinsurancecompanies.pdf; Unum Provident Denied Disability Claims – Lawyers and Settlements http://www.lawyersandsettlements.com/lawsuit/first_unum.html;
Unum/Provident/Paul Revere Long and Short Term Disability Claims Video: Episode 13 – http://www.youtube.com/watch?v=Qd5KcLunlQo&list=UUX1BOBVG4NvDpHEILAGPs1g&index=72&feature=plcp