Unum whistleblowers seem to be increasing in numbers and contacting DCS, Inc. with inside information concerning Unum’s claims practices. I actually heard from several ex-Unum employees in the past two weeks who report identical unfair claims practices encouraged by Directors, Assistant VPs, and Quality Complaince. The overall goal – to deny more and more claims.
Allow me to first say, it isn’t easy to work as a claims handler for any disability insurance company. According to the companies themselves it takes at least 24 months for a new Unum employee, for example, to really understand its internal protocols and be able to consistently deny claims at a predictable rate. It takes time and mentoring to learn how to deny legitimate claims and “get away with it” on appeal.
Unum hires predominately A-type personalities between the ages of 25-39 and then carefully micromanages job tasks to make newbies don’t “give away the farm.” Promotions at Unum are earned by being able to manage a sizable ”block of claims” as close to 0 (zero) growth level as possible.
Other performance evaluation includes keeping track of how many claims are denied, how few claims are reopened, whether ERDs (denials) are met on time, and how many appeals are upheld and not overturned. It is difficult to be a claims handler, and it is a stressful job.
“Zero growth level” means that although claims handlers are assigned 5-6 new claims each week, they are expected to deny (or get rid of) an equal number of claims so that they do not “grow” (or increase) their block of claims over time. Managing a block of 175-200 disability claims at zero growth level is not easy to do and few accomplish it. “Equal-in, and equal-out is a near impossibility within most disability companies.
All of the former Unum employees who contacted DCS, Inc. recently report basically the same unfair claims practices. Here is the short list of what has been reported to us:
Unum’s unit Directors and AVPs have access to financial reserve information and frequently review blocks of claims looking for “the biggest bang for the buck.” The higher the claim reserve, the more probable it is for claims to be targeted as “non-compensable.” (Unum does not admit to having claim financial reserve figures, but every claims handler reports they exist and have at some time seen the figures in paperwork.”
Claims handlers are harassed on a daily basis by unit Directors with IMT sheets containing the names of claims that “need to be worked on” to produce claim denials by an expected recovery date. (ERD) What we’re told is that Unum’s Directors and AVPs actually review claims and place names on the IMT list. Quality Compliance can also place names on the IMT sheets.
Unum terminates employees when they themselves become disabled to reduce the cost of health insurance premiums. This information is consistent with the anonymous letter received by a Chattanooga reporter exposing the fact Unum fired several women employees diagnosed with breast cancer. These practices at best are illegal and should be considered by a group of attorneys for a class action lawsuit.
Unum claims handlers are continually stressed on the job and report consistent “bad mouthing” by Directors to peers and other members of the unit when claims handlers do not perform as expected. (This report is consistent with information provided to DCS, Inc. by a former Unum Medical Director, as well as my own personal experience.) Unum is a company characterized by constantly looking over one’s shoulder.
Unfortunately, all recent whistle blowers report there has been no change in Unum protocols or internal practices as a result of the multi-state settlement. Some report Unum’s review practices are actually worse than pre-2004. Although names, titles and certain departments have been renamed, processes have remained the same as pre-multistate days. (This is consistent with those who now in retrospect realize the $15 and $8 million pay offs to the states by Unum were actually payment to be left alone in the future. This may be why Unum appears to have a free-pass with state regulators.)
MDRT roundtables remain mandatory and claims handlers are forced “to present” claims to the business part of the company (directors, medical and vocational resources etc.) in an effort to come up with “a plan of attack” to deny claims. Unum explains roundtables away by alleging the experience is for educational purposes, but the majority of claims presented at roundtable are denied not paid. There are now several levels of roundtables at Unum designed to identify claims which can easily be denied.
All recently terminated Unum employees report being offered a severance package but only if they agree to sign a “confidentiality statement.”
I worry about insureds and claimants who may think all is well with their disability claim and that ”they have Unum exactly where they want them.” It’s much more likely Unum has THEM instead since with over 100 years of experience Unum has been playing the “risk game” for a long time.
In 1849 Unum sold life insurance policies to those who crossed the Rocky mountains in covered wagons as part of the California gold rush. How smart was that? How many claims do you actually think insureds filed with Unum in 1849 if they happened to not make it to California mining towns?
Unum (and other insurers) are smart – very smart. And, given what the whistle blowers are telling us, it’s more likely than ever Unum has YOU and your claim exactly where they want you, not the other way around.
Gee, I was hoping Unum might have made some positive changes over the years, but unfortunately that’s not what I’m hearing from those who know.