"Last time we talked, Unum was deciding whether or not I would get paid short term disability (STD)", says Kevin. "They eventually OK'd benefits but not before I sent them even more paperwork—the process took about 3 months. An Unum Provident insurance representative told me that I would collect STD for 4 months then it would flip into long term disability (LTD) but my case would have to be reviewed first."Kevin has a work-related injury from 1985 that has left him disabled. He says his condition has become so bad that even shaving is difficult.
"I went to a couple of doctors on my own—part of my treatment was still trying to find out what exactly was wrong—and they determined my lumbar injury was so severe that I was disabled," Kevin explains. "Unum never sent me anywhere, not one visit to one of their independent medical examiners. But they did want my complete medical records from 1985 until now."
Kevin supplied them with every medical record he had, from every doctor he saw. But still the insurance company insisted on more information. Was this a stall tactic? At the same time, Kevin applied for social security. "The way Unum was talking, I didn't think they were going to pay my LTD benefits," says Kevin.
"Social security sent me to a psychiatrist (I also suffer from depression) and a neurologist to determine whether I was disabled. Meanwhile, Unum continued to ask for more information and then I got a decision from social security—they determined that I was indeed disabled. I didn't even need an appeal.
I sent a copy of the letter from social security stating their decision to Unum. ''This will weigh heavily on our decision but it doesn't mean that we will approve it,' Unum replied. More statements were required from my primary care physician and the neurosurgeon…
A month or so later, Unum Provident decided they would approve LTD under 'reservation of rights' which means the payment cannot be construed of past, present or future liability. And they 'reserve the right to enforce any and all provisions of the policy'. In other words, since social security said I was disabled, they had to do something. But they wanted to do their own review to determine if in fact I was disabled.
Unum paid me four months LTD and then they cut me off. I received a denial letter--8 pages long-- dated February 10th, stating in a nutshell that, even though social security has found me disabled, according to their policy, I am not. Basically it says social security based their decision on what I told them. But social security doesn't work like that—what about the doctors' reports that determined their decision?
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I am furious with this insurance company that continually practices in bad faith. And my depression is out of control. My depression was a direct result of this injury in 1985—I was diagnosed with clinical depression shortly afterward. I couldn't work and we lost our house, which just added to my problems.
I saw my doctor just yesterday and he is writing Unum a letter, explaining to them that I cannot work. Now I am going to find an attorney to appeal their decision."