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    Robbed of Your Peace of Mind? Your Guide to Long Term Disability Benefits

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Tag Archives: UNUM

The Dirty Secret about UNUM’s Disability Questionnaires

UNUM disability applicants will be asked to complete a number of questionnaires including an activity of daily living form.Unum Disability

Do you think that UNUM is interested in your well being and that of your family by asking these questions.

Absolutely not, long term disability carriers, including UNUM will deny disability benefits if you are capable of “sedentary” work. The US department of Labor defines sedentary work as the “ability to exert up to 10 pounds of force occasionally, spending most of the time on walking and standing on an occasional basis.”

Long term disability carriers like UNUM will use activity of daily living forms and your medical records to show that you are physically capable of engaging in sedentary employment.

So, for example, if you can exert up to 10 pounds of force occasionally, spending most of the time on walking and standing on an occasional basis, UNUM will measure these activities of daily living against the definition of sedentary employment.

So, in reality, the questions in regard to your daily activity have little to do with whether you meet the terms of disability found in your policy, those questions are solely about showing that you are physically capable of engaging in sedentary employment so your disability benefits can be denied or terminated.

UNUM long term disability denied Nancy Cavey has written the go to book Robbed for Your Peace of Mind .

UNUM’s Use of “Independent Medical Examiners” | UNUM Disability Claim Lawyer Florida

What: UNUM Article by Jane Lundy

In an interesting article by Jane Lundy on October 28, 2009, Jane outlines the gains that Long Term Disability carriers, such a UNUM play, by using “independent examiners.” Independent doesn’t means independent, it means a doctor who, for whatever a reason, needs to make money to supplement their income and becomes a hired gun for Long Term Disability insurance companies like UNUM.

If you are being scheduled for an Independent Medical Evaluation in your Long Term Disability claim, you need to immediately call and experienced Long Term Disability and ERISA attorney who can assist you in understanding the “independent medical” process and help you protect yourself from bogus independent medical evaluations.

UNUM Paul Revere Long Term Disability Policy Denials – Shifting the Burden Of Claims Investigation

The Ninth Circuit in Hangarter v. Provident Life An Accident Insurance Company, 373f.3d998, 1014 (9th Circuit 2004) entered a skating decision summarizing the extensive evidence that had been developed in a jury trial that resulted in the punitive verdict of over $10 million against UNUM Provident and Paul Revere based on a claims handling.

It was confirmed during this case that UNUM Provident and Paul Revere had a practice of shifting the burden of “claim’s investigation to the insured.”

A Long Term Disability carrier should be conducting a reasonable investigation of all the relevant information in a Long Term Disability claim, evaluate that evidence in a non-adversarial fashion, use unbiased experts in evaluating a claim and assist every Long Term Disability applicant with the claim.

Despite the existence of these “undisputed obligations that exist in the handling” of Long Term Disability claims, the court in Hangarter found that UNUM Provident and Paul Revere had instructed “their employees that it was the Long Term Disability policies obligation to prove the claim.” The Court went on to find that UNUM Provident and Paul Revere had used “in house medical personnel engaged in cherry picking records to find grounds for denying claims regardless of their actual merit.”

In a telling commentary the Ninth circuit found that the in house medical personnel “focused upon any apparent inconsistency in the medical records, whether information supplied by the claimants, rather than an attempt to derive a thorough understanding of the claimant’s medical condition.”

Further, the court noted that UNUM Provident had a “practice of piece-mealing claimant’s medical conditions and did not consider the totality of the medical circumstances.”

Unfortunately, despite the fact that that decision was entered in 2004, it remains Provident Life and UNUM and Paul Revere’s practice to use in house personnel to cherry pick your medical records, look for inconsistencies in the medical records and the information that you’ve supplied and piece-meal your medical condition without considering the totality of all of your disabling conditions.

If you are a UNUM Provident Paul Revere Long Term Disability policyholder whose benefits have been denied as a result of cherry picking or ignoring the totality of your medical condition, immediately call your UNUM Provident Paul Revere Long Term Disability benefits attorney Nancy Cavey.

Tampa Bay based Long Term Disability attorney Nancy Cavey can help you perfect your Paul Revere UNUM Provident Long Term Disability claim.

UNUM and Paul Revere Use Targets and Goals For Claim’s Denial/ UNUM Provident Paul Revere Long Term Disability Denied Attorney

UNUM Provident and Paul Revere have been found guilty of setting targets and goals for claim’s terminations to include the profitability of UNUM and Paul Revere without respect to whether or not that Long Term Disability policy holder is rightfully due their benefits.

In the case of Hangarter v. Provident Life An Accident Insurance Company, 373f.3d998, 1014 (9th Circuit 2004) and more recently in the case Merick v. Paul Revere Life and UNUM Provident, 2008 US District Lexis 106976 (November 17, 2008), both companies have been found guilty of:

1. Establishing targets and goals to terminate Long Term Disability claims.

2. Have net termination ratio targets on a corporate wide basis.

3. Have financial targets for closing claims on a corporate basis.

4. Creating claim’s handling units for purposes for obtaining certain amounts in claims closures or recoveries from claimants who are receiving Social Security Disability benefits.

5. Requiring every unit who did not make their weekly goals to develop a written action plan to make sure that they met the closure goals.

6. Regularly communicating these targeting goals to claims handling employees by e-mails and weekly meetings.

7. Giving incentives to claims personnel to find reasons to terminate

claims.

8. Kept charts in each claims unit which were updated throughout that the day so the claims personnel could see how their termination activity contributed to UNUM Provident’s bottom line.

Isn’t that disgusting!

Unfortunately, UNUM Provident Paul Revere Long Term Disability denied attorney Nancy Cavey sees this behavior continue despite punitive damage awards in excess of $10 million against UNUM Provident and Paul Revere for this behavior.

UNUM Provident and Paul Revere put their financial well being first. If you are a UNUM or Paul Revere disability policy holder whose Long Term Disability claim has been denied or suspended for any reason contact Long Term Disability denied attorney Nancy Cavey who represents UNUM and Paul Revere policy holders whose claims have been wrongfully denied throughout the United States.

Your Doctor Tells You to Avoid Stress But Long Term Disability Carrier Denied Your Claim on the Basis that You Can Work: What Should You Do?

In case of Watson v. UNUM Provident, 185.fsupp.2d579 (N.D. 2002), the Long Term Disability claimant had heart disease and had suffered from cardiac arrest. His treating physician said that he was “at risk for sudden death on the job.”

UNUM denied the Long Term Disability benefits and Watson appealed. According to the court “UNUM argument of a objective dispassionate review as the work for the available medical records in source of information that may support his adverse determination and to review more record evidence that might support the continuation of benefits.”

Long Term Disability carriers have to consider stress as a factor and take an objective discretion to review the medical records before wrongfully denying any claim for Long Term Disability benefits.

If you are a Long Term Disability policy holder who suffers from cardiac problems be aware that Long Term Disability carriers, such as UNUM, will shuffle through medical records and seek to deny your benefits without fully considering all of the aspects of your case, including the impact of stress.

Nancy Cavey, Florida based Long Term Disability attorney, can assist you in your cardiac Long Term Disability claim denied case.

Fibromyalgia and Your Long Term Disability Claim

Long Term Disability carriers, like UNUM Life Insurance Company of America, frustrate those with fibromyalgia. Fibromyalgia is in some way a self reported disease which relies on a circuit board of symptoms and a physical examination that shows tender parts of your body on examination; http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/fibromyalgia.asp.

It is important that you look at your Long Term Disability policy to determine whether or not there are any kinds of limitations on self reported conditions or a specific exclusion for Fibromyalgia. There also may be a limit for the payment of benefits for self-reported conditions of Fibromyalgia with a maximum of 24 months of benefits.

If you suffer from fibromyalgia you need to review your Long Term Disability plan before you apply for Long Term Disability benefits. Any Long Term Disability claim for fibromyalgia should be coordinated with a Social Security Disability claim. Why? Most of the time Long Term Disability benefits limit fibromyalgia or self reported claims to 24 months of benefits. Here in Florida, it takes 24 months to get Social Security Disability benefits, so you want to be applying for Social Security Disability benefits as quickly as possible so that when a Long Term Disability carrier stops your Long Term Disability benefits, your Social Security Disability benefits pick up. If you have any questions regarding the coordination of these claims, contact Florida based Cavey and Barrett, who specializes in Social Security Disability and Long Term Disability claims.

Doctor to Doctor Calls and Your Long Term Disability Claim

Long Term Disability companies, including UNUM, routinely make doctor to doctor calls to persuade your doctor that you are capable of working. It always looks better for UNUM when they deny your claim if your physician supports that denial.

Did you know that UNUM will cold call doctors when they are busy hoping to catch them when they are short of time and don’t have time to really focus on your case in their discussion with the doctor?

Unfortunately, it’s also common for doctor to doctor calls to be totally twisted by the carrier physician.

At Cavey and Barrett, your Florida disability attorneys, we routinely revoke carrier authorizations to have one on one doctor calls, we modify the release so that they are required to notify you of the call, allow you to be present, and allow for the phone call to be recorded.

Quite frankly, we don’t think your treating physician should have any discussion with the Long Term Disability carrier unless you have a disability attorney like Nancy Cavey who will prepare your doctor for the tricks that will occur during this doctor to doctor call.

Protect yourself from these sneaky doctor to doctor calls that can result in a denial of your Long Term Disability claim.

Federal Court Fines UNUM for Requiring LTD Receipents to File False Social Secuirty Disability Claims | Tampa Long Term Disability Attorney

Unum was found quilty of requring LTD applicants to file for Social Security Disability even if the applicant was not entitled or eligible for Social Secuity Disability. The court found that UNUM conduct was a violation of the false claim’s Act and fined UNUM $11,000 for each violation.

If you have been required by UNUM to file a claim for Social Security Disability, contact Cavey and Barrett.

The full text of the decision is found below

“2009 U.S. Dist. LEXIS 24340, *

UNITED STATES OF AMERICA, ex rel. PATRICK J. LOUGHREN, Plaintiff, v. UNUMPROVIDENT CORP., et al., Defendants.

Here, although each claim must be evaluated one-by-one, the Court has already resolved the essential legal issues that undergird all of the claims. Evidence at trial suggested that Unum had a general policy of requiring claimants for Long-Term Disability (“LTD”) insurance to file an application for SSDI as soon as they had been disabled for six months, making no separate subjective evaluation regarding whether the claimant actually met the SSA’s requirements. (See, e.g., Trial Tr. vol. 14, 38-41, Oct. 15, 2008 testimony of Unum claim administrator regarding a letter sent to a claimant “based on the time frame she’s been out of work” stating that “[s]ince your disability has extended beyond five months, to receive an unreduced disability benefit, we encourage you to apply for Social Security Disability Insurance benefits.”); Trial Tr. vol. 3, 122-23, Sept. 24, 2008 (Unum employee testifying that claims handlers had access to a manual instructing [*7] them that “[i]f it is anticipated that the disability will be more than a short duration, the claimant will be asked to apply for SSDI.”); Trial Tr. vol. 4, 22-23, Sept. 25, 2008 (testimony regarding a document stating that, for at least one major claim site, “[g]enerally, if disabled over six months, SSDI advocacy pursued,” and describing a similar policy at another site); Trial Tr. vol. 4, 64-67, Sept. 25, 2008 (testimony of former Unum employee that Unum “would say to the insured, if they believed that the disability was going to last more than six months, they would tell them that they needed to apply for Social Security Disability. . . . It was just simply a duration analysis” and other eligibility requirements were not considered); Trial Tr. vol. 5, 39-45, Sept. 26, 2008 (testimony of former Unum employee that Unum’s policy was to tell insureds that they were required to apply for SSDI with “no assessment with respect to the Social Security requirements” so long as a claimant’s “disability was going to extend beyond five months.”); Trial Tr. vol. 9, 139-142, Oct. 3, 2008 (testimony of Unum employee that internal review indicated that claimants whose disabilities were expected [*8] to last more than six months were told to apply for SSDI .)

While not contesting that they coerced insureds to file for SSDI benefits if they expected their disability to extend beyond six months, Defendants have argued that they cannot be liable under the False Claims Act for knowingly causing claimants to file requests for SSDI benefits so long as the SSA knew of the facts that made such claims false. The Court has rejected this legal argument because claimants must state that they are eligible for SSDI, that is, that they expect to be disabled for at least twelve months. While Unum does not fill in the application itself, Unum threatens to reduce the insureds’ LTD benefits by an amount equal to the insureds’ potential SSDI benefits if the insureds refuse to apply. (See, e.g., Trial Tr. vol. 2, 87-90, Sept. 23, 2008.) There is no possibility that trial of the remaining claims will moot this core legal question. At the same time, without resolution on appeal, the claims of the remaining fifty-five claimants will be tried on the same theory of liability and with the same instructions given to the jury. Given that it took four weeks to try the claims of six claimants, trying the remaining [*9] claims will undoubtedly be extremely time consuming. See Comite Pro Rescate De La Salud v. P.R. Aqueduct and Sewer Auth., 888 F.2d 180, 184 (1st Cir. 1989) (finding Rule 54(b) judgment warranted where “the remaining claims . . . may take considerable time to try” and where “it seems unlikely that a determination of the remaining claims would moot (or lead to settlement of) the issues”).

Entry of final judgment would also be in the public interest. See Quinn v. City of Boston, 325 F.3d 18, 27 (1st Cir. 2003) (stating that the “most important factor counseling in favor of allowing an immediate appeal in this case is the public interest.”). Presumably, were the Court of Appeals to affirm this Court’s decision, the Defendants would cease to require LTD insureds to file claims for SSDI benefits without an individualized assessment of eligibility. Other insurance companies apparently have similar policies. Such a change would not only lighten the SSA’s significant workload, but, for Unum’s sick and disabled insureds, it would also ease the process of attaining the LTD benefits for which they have paid. As such, there is no “just reason for delay” and entry of judgment under Rule 54(b) is [*10] appropriate.

All that remains is to assess damages and penalties against Unum. The jury found that Unum committed two violations of the False Claims Act and that the government had sustained $ 425 of damages because of each claim, for a total amount of $ 850. Violators of the False Claims Act are “liable to the United States Government for a civil penalty of not less than [$ 5,500] and not more than [$ 11,000], plus 3 times the amount of damages which the Government sustains because of the act of that person . . . .” 31 U.S.C. § 3729(a); 28 C.F.R. § 85.3(a)(9). Generally, treble damages are mandatory. See Vt. Agency of Natural Res. v. United States ex rel. Stevens, 529 U.S. 765, 786 n.16 (2000). Trebling the jury’s finding of the Government’s damages results in a total damage award of $ 2,550. As for civil penalties, the evidence at trial indicated that Unum forced insureds to file SSDI claims as soon as they had been disabled for six months, with no regard for the statutory eligibility requirements. Unum’s defense seems to be that it should not be required to sort through all of these claims, choosing instead to foist the hassle on the SSA. Unum’s method of sloughing its work off on [*11] the SSA was to force sick and injured insureds, who had paid Unum good money for their LTD benefits, to apply for SSDI or face a drastic reduction in their LTD benefits, typically their primary income stream. Although Unum had the contractual right to ask these people to apply for SSDI or face a cut in their benefits if Unum determined that they might qualify for SSDI (see, e.g., Trial Tr. vol. 4, 103-105, Sept. 25, 2008), Unum made no such individualized determination in most cases. The Court finds Unum’s conduct extremely troubling. As such, I assess the fullest amount of civil penalties allowed by the False Claims Act, $ 11,000 for each of the two false claims that Unum caused to be filed.”

Answering these broad-based questions isn’t easy. Help is a phone call away. You can contact Nancy Cavey, an experienced long-term disability attorney at 727-894-3188.

The 2009 Economy and UNUM’s Payment of Long Term Disability Benefits | Florida Insurance Disability Lawyer

At Cavey & Barrett we are seeing a “slow pace strategy” and out right denial of valid claims by long-term disability carriers such as UNUM. This delay or denial is for the benefit of long term disability carrier. This aggressive claims handling has resulted in increased profits for UNUM. According to a UNUM Group Q1 2009 Earnings Call transript on May 4, 2009 “group disability earnings were 44% higher driven by strong risk results”… a fancy way of saying claims delay and denial .

With stock prices down and a lack of investment income earnings, disability insurance companies are taking longer to determine disability claims and to pay long-term disability benefits.

If you are experiencing any of these problems with your long-term disability or ERISA carrier, immediately contact Nancy Cavey at Cavey & Barrett to assist you in your long-term disability claim. There are things that can be done to expedite the handling of your long-term disability or ERISA claim. Remember, long-term disability insurance companies think that they can outlast long-term disability claimants. Our advice and counsel help you understand what your carrier is doing and help you prepare yourself financially.

You can order a no-obligation copy of Nancy Cavey’s must read book “Robbed of Your Peace of Mind” which is all about the mistakes you can make in the long term disability claims process.

Answering these broad-based questions isn’t easy. Help is a phone call away. You can contact Nancy Cavey, an experienced long-term disability attorney at 727-894-3188.