Was Your Disability Insurance Claim Denied or Terminated?

UnumProvident; Re-Assessment of Disability Claims


In December 2004, the Insurer, along with most States’Departments of Insurance, and the Dept. of Labor entered into an agreement that affords several hundred thousand claimants a review of their claims. The “Multi-State Settlement Agreement” (MSA) is the result of a 50 State, plus jurisdictions, investigation into the claims practices of the insurer. California and Montana have not agreed to this ratification, and appear supportive of more stringent re-assessment guidelines for the Insurer. Links to the MSA and other info are at the bottom of this page.
If your Unum, Provident Life and Accident, Paul Revere Life Insurance Company, or First Unum disability claim was denied or terminated between 1997 and 2005, you may be entitled to a review of the claim. If you received a letter from UnumProvident offering to reassess your claim, and you think you may be ineligible for benefits, think again before dismissing the letter. If your claim was paid on a residual basis when it should have been total, if you did not get the COLA and indexing benefits factored in, if your claim was treated as “self-reported” or “subjective,” or a physical disability was moved to the psych department for evaluation before termination, you may have benefits due you.

Most importantly, please seek competent guidance from an advocate or attorney concerning the most appropriate way for YOU to proceed. Whether or not you are already in suit or walked away after being terminated or denied; whether your claim is ERISA, employer sponsored, or an individual policy you purchased yourself; whether you think you received the maximum amount due you or the amount the insurer determined you were entitled to, please take the time to have a professional explain your options in your particular case. A brief call or inquiry can help you assess what your options are, what you may expect, whether you are entitled to a re-assessment of claim, and what any state or jurisdictional issues may be.

Claimants terminated or denied January 2000-2005 should have received letters already. Claimants 1997- December 1999, and those who have not received letters, need to call 1-866-278-4641 to inform UnumProvident that they want their claims re-assessed. When you call in, please have your Social Security number, policy #, Claim #, group #, current and prior address, phone numbers ready for identifying purposes.

Keep accurate logs of any and all calls and correspondence. Send letters certified, return receipt requested. Be careful of the overly broad authorization to release information, and discuss with your advocate the scope of the release and if modification is indicated.

If you are proceeding with the re-assessment, while awaiting your review, please begin securing the support that you will need, including but not limited to:

SSDI award. This may be the most important component in expediting the claim since compliance with the MSA stipulates attention to the award must be accorded. If the SSDI claim was paid on the basis of mental/nervous, your advocate needs to factor this into the overall plan for re-assessment. Please pull the SSDI files, and have available the award letter for you and your dependents. This will also help determine if the correct offsets and repayments were sought.

Copies of the policies, certificates, amendments, and SPDs from time of notice of claim.

Full and complete medical records since the denial and termination. Include ALL treating physicians and practitioners, their notes, narratives, protocols, LEFT and RIGHT sides of their files. Include hospital stays, Lab work, FCEs, physical therapy notes.

Progress reports, Attending Physicians Statements, referrals to IMEs.

Videos, photos, testimonials demonstrating the progressing of your condition since the onset of disability. A picture says a thousand words, and a testimonial describing you before and after onset is quite powerful.

Correspondence with insurer, claim stubs and offset statements, letters explaining “new math” in calculating the prior monthly income, current income, and shifts in formulae concerning treatment of claim.

Timelines showing the key dates for disability, medical, protocols followed or attempted; restrictions and limitations; hospitalizations, therapies, etc.

Tax returns, income/expense support and distribution of monies, especially in claims treated as residual in basis.

Get your pharmacies to give you printouts of as many years possible of all your prescriptions. The pharmacist may certify the list.

The list may be inconclusive but serves as a starting point for you. I know you do not want to go through the mental and physical hell you fought while fighting your claim. Now, with the records reflecting the improper practices, the people actively engaged in the advocacy process are hopeful that the re-assessments will be fair. Please allow yourself to be guided by persons who can bear the burden so that the process can be as painless for you as possible. As more info becomes available, it will be posted.

Remember, people who received letters must respond within 60 days. All others need contact the insurer and initiate the process. Please contact me, another advocate, or an attorney for answers to your specific questions. Remember that you are not alone. Hundreds of thousands of loyal policy owners may be in the same boat as you.


The UnumProvident Settlement is at http://www.unumprovident.com/settlementagreement/

UnumProvident answers questions at: http://www.unumprovident.com/aboutus/ourcompanies/FAQ.aspx

 



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Nothing contained herein shall be construed to be legal advice.

You are advised to seek competent guidance in your specific matter.

    

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