Unum Provident --Benefits Payment or Loan?

San Jose, CAJanice was never denied Unum Provident's long term health care benefits so imagine her surprise when Unum Provident demanded the payments back, to the tune of $20,000! Even more mind-boggling is that Unum assisted Janice in obtaining security benefits: it would seem that Unum was helping Janice so the giant insurer could get money back from her.

Janice had a back injury in 2006 and could no longer work. At first, she drew state disability insurance. After about six months she found out that she had an Unum Provident policy through her work and was covered for long term disability. "Unum OK'd my claim and when I received my first check, I stopped state disability," says Janice. "I collected state disability for one year and then Unum Provident kicked in for almost two years—they issued my first check on July 19, 2007 and that covered a period from November 2006 to July, 2007—it included back pay."

Janice didn't think she had any financial worries, even though her disability check was less than $1,500 per month from Unum. However, when her state disability ran out, Janice applied for social security benefits but she was denied.

And here is the interesting twist to Janice's plight: she was denied social security three times and appealed each time, to no avail. Janice told Unum Provident that she was applying for social security, everything she did was by the book, upfront and honest. "My case rep at Unum said they had advocates that helped obtain social security," says Janice. " They basically took over my claim and wrote up medical forms, got a hearing date with social security's appeals court and I didn't even have to show up. Not long afterward I received a letter in the mail from social security stating that my claim was favorable and I would be getting a check in the mail!

"It is really bizarre. People are denied social security then right out of the blue, you get accepted. I have no idea why they changed their minds, I never had to see an independent medical examiner; social security just took information from my medical records. Nothing changed from what I submitted and what Unum sent—social security had the same records.

Then she received a letter from Unum. "They said I had to pay them back all of my long term disability payments (LTD) that totaled over $20,000 because I had also been collecting social security benefits," Janice says, exasperated.

"I asked Unum to send a copy of my insurance policy but they sent me an outline instead," Janice explains. " It said I would have to pay them back if there was any fraud committed. Of course I didn't lie to them and had no reason to think they would deny my benefits. They are not claiming any fraud; they just say that I have to pay them back. I can't believe they are doing this, given that Unum helped me obtain my social security benefits.

I asked a rep at Unum why I have to pay back my LTD. 'That is what we are in business for,' she said, 'If we just keep giving out money, we would be out of business.' I was shocked. They weren't paying money out of their pockets; I had an insurance policy through Costco, where I worked. My employer was paying Unum so why would the health insurance company be out of pocket?

Unum Provident sent me a paper to sign saying that I would pay them back but I never signed it. It is titled 'Disability Payment option/reimbursement Agreement'. It basically says my policy coverage may be reduced by other benefits I receive.

Signed or not, Unum reduced my benefits in September of this year. My payment was initially $1,410.93 per month then they started taking off taxes (?) which reduced my check to about $900. Then in October I received nothing—they are now issuing checks to me for $100 per month but reimbursing themselves! Apparently this is a payment toward the $20,000 they say I owe them.

For the last 2 months I have sent them $150 and next month I am supposed to send them $300 per month. This is all because I collected social security--$1,497.00 per month. I talked to some people at social security and they said there is nothing they can do about it. They did say it was strange—nobody understands why I have to pay back an insurance company. They even questioned Unum's policy…"