Unum’s Proverbial Runaround

Jacksonville, FL“I found out firsthand that Unum, or Unum Provident, is the second worst insurance company in the world,” says Herman, who was recently denied Unum long-term disability benefits. “I am still in shock from their bad faith practice, and so are my doctors.”

Herman is correct: The American Association for Justice lists Allstate as the world’s worst, with First Unum running a close second. His Unum group for disability benefits came into effect in 1997 - Herman taught school for a Native American tribe for 15 years prior to 1997. He was diagnosed with renal disease that same year - coincidentally of course: it isn’t a disease you can put on hold until you have insurance. He had to go on dialysis and waited for a kidney transplant. (Interestingly, Unum refers to both dialysis and transplant as treatment by “artificial means.”)

“I got the denial letter from Unum this September, right out of the blue,” says Herman. “The reason they gave for denial was that my transplant center had not sent them my medical records. But that is puzzling because every two years I signed a medical release from the center. And I have never seen one of Unum’s independent medical examiners so how could they determine that I can return to work?”

Herman called the transplant center and asked why Unum had not received his medical records. “Initially, they thought Unum’s form was not conforming to the HIPPA regulations and it was an invasion of my privacy, so there was a holdup but nothing of any consequence. Then the center reversed their decision and said that Unum received my records.”

Where does the screwup originate - with the transplant center or with Unum? According to Herman, the transplant center says the standard rule is that any insurance company should have contacted them if there was a problem. The center confirmed that they contacted Unum this past February. In other words, Herman has experienced another of Unum’s bad faith tactics - the proverbial “runaround.”

And Unum had another tactic up its sleeve: Herman says that Unum has misclassified him.

“Unum has me classified as (2) but I should be (1), which is a classification for all federally certified teachers,” Herman explains. The (2) classification requires that I return to work at some level and (1) states that I don’t need to return to work because I don’t have the capacity to do the material duties. So misinterpreting my policy is yet another bad faith tactic. These Unum contracts are written by attorneys; they are meant to be precise but the Unum reps can’t or won’t translate the contract.

“I have held onto a copy of my policy like it is water in the desert so I can prove that I have been misclassified.”

Herman adds that Unum’s contract stipulates he must also apply for Social Security benefits so that Unum can deduct the amount of benefits he receives from Social Security. He was immediately approved by Social Security and gets reviewed regularly. But Unum even sidesteps Social Security with the excuse that they presumed Herman was disabled and unable to work!

“After reading about so many denied Unum disability claims at LawyersandSettlements, I expected this from Unum,” says Herman. “Unum knows that someone with a meager income cannot fight them. I have seven more years until I reach 65 years of age so I guess Unum prefers to challenge me, knowing I am defenseless.

“Here is the crème de la crème: my nephrologist never told Unum that I could return back to work. Unum’s independent medical examiner called him and said that I was indeed capable of working - Unum diagnosed me without seeing me. My nephrologist thinks that Unum was trying to provoke him into reporting that I can return to work. Anyway, that isn’t going to happen - I am getting a letter from my doctor tomorrow that clarifies he did not say that I can work.

“I got a kidney transplant in 2002 at the Mayo Clinic and I was given another chance in life. But I am really paying for it thanks to Unum - it isn’t easy living on $588 per month.”