Winning Isn't Easy Season 3 Episode 35: More On UNUM Disability Insurance Carrier Claims

Welcome to Season 3, Episode 35 of "Winning Isn't Easy"! 🎙️

In this episode, your host, Nancy L. Cavey, takes a deep dive into the world of UNUM Disability Insurance Carrier Claims. UNUM is a prominent name in the realm of disability insurance, and understanding the intricacies of their claims process is essential for anyone navigating disability benefits.

In this insightful episode, you'll explore:

🔍 A closer look at UNUM's disability insurance offerings and policies.
📋 Common challenges individuals face when dealing with UNUM claims.
🌟 Strategies and tips for successfully pursuing your disability claim with UNUM.

Nancy will draw from her extensive experience in disability law to provide you with valuable insights and practical advice for handling UNUM disability insurance claims effectively.

Whether you're considering a UNUM policy, currently navigating a claim, or simply interested in understanding the landscape of disability insurance, this episode offers valuable information to empower you.

Tune in to Season 3, Episode 35 of "Winning Isn't Easy" to gain a deeper understanding of UNUM Disability Insurance Carrier Claims. 📻📋

Resources Mentioned In This Episode:

LINK TO ROBBED: https://caveylaw.com/get-free-reports/get-disability-book/

LINK TO PROFESSIONAL BOOK: https://caveylaw.com/get-free-reports/disability-insurance-claim-survival-guide-professionals/

FREE CONSULT LINK: https://caveylaw.com/contact-us/

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Need help with your Long Term Disability or ERISA claim? Have questions? Please feel free to reach out to use for a FREE consultation. Just mention you listened to our Podcast!

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Please remember that the content shared is for informational purposes and should not replace personalized legal advice or guidance from qualified professionals.

Transcript

ERISA Disability Attorney Nancy Cavey: 0:11

Hey, welcome to this episode of Winning Isn't Easy. We're gonna talk about Unum. Unum is up to no good as always, but what Unum does other disability carriers do? So there are lots of lessons for everyone to learn. I'm Nancy Cavey. I'm a national ERISA and individual disability attorney. And before we get started, I've gotta give you that legal disclaimer. The Florida Bar says that I have to say that this podcast is not legal advice. So now I've said that, but as you know, nothing will prevent me from giving you an easy to understand overview of the disability insurance world, the games that disability carriers play, and what you need to know to get the disability benefits you deserve. So, off we go. As I said, we're gonna talk more about Unum and we're gonna explore how they're doing everything in their power to deny or terminate benefits. As I've always said, carriers are in the business of making money not paying you when you're disabled. It's important to remember that they're not looking out for you, they're looking out for their bottom dollar. And specifically, I'm going to be talking about Minnesota Federal Court rules that unum's significant history of biased claims administration is not relevant to the determination of benefits. Next, Unum's handling of an employer misleading their employee who has brain cancer about how to convert a life insurance policy is reviewed by a court. And lastly, Unum's objection to a ERISA disability claimant's a level of medical care during covid overturned by a federal judge. Before we get started, we're gonna take a quick break. We need , so you can think about these topics and how they may relate to your ERISA disability claim.

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ERISA Disability Attorney Nancy Cavey: 2:29

Welcome back to Winning Isn't Easy. Now we're gonna talk about a Minnesota Federal Court ruling that Unum's significant history of bias claims administration is not relevant to the termination of benefits. You know, I already don't like this decision, and that's because Unum has a in significant history of bias claims administration that resulted in a multi-state agreement with Unum and a number of state attorney generals. Now, this was in 2005 and it addressed , um, a number of Unum's claim handling techniques, including the use of internal peer review providers and biased, not so independent medical evaluators. I will tell you that Unum learned from this , uh, multi-state agreement to do a better job of sort of covering their tracks, but I don't think much has changed. They, of course, have been pushing back since then on the argument that their history of bias , uh, is old news and that they've cleaned up their act. Um, I don't think that's the case, but let me tell you what the court in Minnesota did in the case of Elias versus Unum Life . Now, Elias was disabled as a result of a number of mental health conditions, severe low back pain , uh, shoulder pain , uh, and Unum paid disability benefits from 2008 until 20 21, 13 years of benefits until Unum's peer reviewed . Doctors concluded he had it miraculously improve and he was able to go back to work in any occupation. Elias argued that Unum's decision to terminate his benefits was what's called an abusive discretion. He argued that Unum selectively picked from the medical records to support its desired result and ignored evidence of Elias's disability. We call that cherry picking . Next, he argued that Unum failed to demonstrate substantial evidence of his alleged improvement. He also argued that Unum failed to take a holistic approach and consider the combined effects of all of his multiple medical conditions, both physical and psychiatric in nature. They also argued that Unum violated the 2018 Department of Labor Labor regulations by failing to give him , uh, Unum's peer review reports and give him an opportunity to respond. And of course, argued that Unum had a history of bias claims administration and the court should take that also into consideration in making its , uh, decision. The court amazingly rejected each one of these arguments and specifically stated that it wouldn't consider Unum's bias because the the bias had ended before 2003. What? Now, I will tell you , as an ERISA attorney who deals with Unum claims, denials and terminations, they've learned how to better hide its bias claims techniques , um, and it hasn't changed one bit. It's us up to US lawyers to educate Unum , uh, the court about Unum's continued bias claims administration. Now, that can be hard to do in an ERISA case because discovery is limited depending on, on where uh, you live. Um, and it's hard therefore to get the courts to help us develop that evidence. So what do I try to do in a Unum case appeal? Well, I track the tricks cited in the Uniform Settlement Agreement and outline them in my appeal , uh, and document how this has progressed. It hasn't ended. And you can see based on reported case law, how they're continuing to use these tricks or to , you know , to deny or terminate claims. I have a bank of information about the Unum Peer Review doctor, so I can include that information in my appeals because guess what, that hasn't changed. We say the same repeat offenders over and over. Now that includes information regarding redacted prior reports that the repeat offending doctor has issued prior depositions, if any, and court decisions involving that particular peer review doctor. 'cause we can get at those , uh, using a system called pacer. I don't want the courts to think or mistakenly accept Unum's allegation that it has cleaned up it a its act 'cause it hasn't. Now, there are some ways to get other information. If we've had an individual disability insurance claim with Unum, we have the ability to take depositions and I will use depositions that I've , uh, taken or other lawyers have taken that are publicly available to really load up my appeal with all of this information so that the court can see for their own eyes that Unum has learned from their mistakes to quote unquote do it better, but they're still doing the same thing that got them into trouble. Got it. Let's take a break. Welcome back to Winning Isn't Easy. So let's talk about Unum's gross handling of an employer , uh, misleading their employee who had brain cancer about how to convert that life insurance policy from a group policy to an individual life , uh, policy. So we have two offenders here. We've got the employer who misled the employee, and we've got Unum who took advantage of that. Let's take a step back. Do you have a opportunity to purchase or did you have an opportunity to purchase a life insurance policy with your employer? And if you did and you accepted that coverage, you might wanna ask, well, what happens to my coverage, both my disability coverage and my life insurance coverage if I leave my employer, does that insurance and or do I have the right to convert that group insurance benefit to an individual policy? And what are your employer's obligations to you when you do that conversion? All great questions, and they were important in this decision. Now, some of the answers can be found in this very sad case of Kert versus the Heritage Corporation. A case outta Indiana. Mr. ert was hospitalized with brain cancer in December of 2019, and his group life insurance was through the heritage, and of course it ended. He had 90 days to convert that policy to an individual whole life policy, which obviously his family needed During his hospitalization, the plan administrator Unum sent him a letter about his conversion. Right ? Guess what? He didn't get it. Why? 'cause he was in the hospital. And when he was discharged, a month later, he followed the instructions in the plan's summary plan description, and contacted the heritage. A heritage HR administrator responded to his emails, told him to contact Uummm , and also provided him with inaccurate information about how long he had to convert his life insurance. That misinformation was corrected in a follow-up email, but before he could complete that conversion, he passed away and obviously the life insurance claim was denied when it was filed. His widow sued Heritage and Unum for breaches of what's called fiduciary duties, arguing that both were responsible for her deceased husband's inability to maintain his life insurance. She argued that the HR representative provided misleading information, including telling him that the conversion deadline had passed when in fact it hadn't passed. She argued that Heritage had a duty to initiate the conversion process when he initiated an inquire , inquired about , uh, the conversion process , uh, and that because he was suffering from brain cancer, he might've found that conversion process to be confusing and hard to follow. Well, well, what of course did UN heritage do his employer heritage and, you know, moved to dismiss the lawsuit? And guess what? The judge dismissed the counts involving the email exchange. Uh , and the judge also , um, was not particularly impressed with some of the other allegations, but the judge did deny the motion to dismiss the other allegations, finding that heritage had not fulfilled its fiduciary duty by punting it back to Unum . The court found that since the widow had pled a plausible fiduciary claim based on the failure to obtain the conversion application, the confusion about the process, including the discrepancies between what the plan said and the way Heritage explained it , uh, could be the basis of of a , uh, fiduciary claim. It was obviously the inability to convert the coverage , uh, that that was caused, if you will. That alleged breach was caused by , uh, both Unum and by a heritage. And the judge felt that that satisfied the elements necessary to state was called a fiduciary claim. So , um, she won and she lost. And of course this litigation will continue. But the good news is that in certain circumstances, employers like Heritage can be held responsible for the misconduct and breach of the fiduciary duties to their employees. My best guess is based on my experience is that UN Heritage probably settled this case , um, out of court so that the litigation didn't continue. While that may have given the widow some of the benefits, probably not all of them, she had to really go through , um, litigation tell , if you will, to get where she got. It's sad when employers don't do what they're supposed to do, and carriers like Unum take advantage of not only , uh, what their employers , uh, clients have done in terms of misleading clients, but to also sort of enhance the breach of that fiduciary duty by their own conduct. Sad case, but you can see the games and lengths at which employers and disability carriers, life insurance carriers will go to deny benefits. Let's take a break.

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ERISA Disability Attorney Nancy Cavey: 13:42

Welcome back to Winning Isn't Easy. Let's talk about Unum's objections to an ERISA disability claimant's level of medical care during the covid crisis and what one judge did. Now, even though this dealt with the question of the level of medical care during the Covid crisis, this is a continuing issue in most disability insurance claims. Uh , it's what is the level of care that's appropriate and why is that important? Because many ERISA disability plans or policies require that the plan beneficiary or the policy holder get reasonable and appropriate medical care. Uh, and if you doubt one of the tools in the carrier's denial or termination toolbox is for them to take the position that you didn't get appropriate medical care or that the level of care didn't rise to the level of your claimed disability. In other words, your lack of treatment is, or the nature of the conservative treatment is disproportionate to your alleged severity of the pain. Hmm , okay. Now what they argue is, if you were in the degree of pain that you say you were or the had the degree of disability that you say prevents you from doing your own or any occupation, you would've gotten a greater level of medical treatment and you would've been compliant, very compliant. Now, disability carriers like Unum are making that argument , uh, particularly in cases where a , a person didn't get a lot of care during the pandemic. And let me tell you about the case of Graziano versus first Unum. Ms . Graziano was a senior property underwriter. First Swiss Re . Swiss Re is a reinsurance , uh, company. Many disability insurance companies, life insurance companies will have multiple layers of coverage. Uh, and , uh, companies like Swiss Re provide this additional layer of coverage. Think of it like Lloyd's of London's, if you will. They're also , uh, a , um, a , uh, a person or a group that will carry this excess coverage. So , um, there was an issue where this policy holder got, had low back pain, got cortisone injections and physical therapy and medication, unam merrily paid him his benefits, did a life insurance , uh, uh, premium waiver until they decided to deny his claim in part on the basis that his attempts to get treatment for his condition were too conservative. They were inconsistent with complaints of pain and ignored the realities , um, of getting treatment during Covid. Now , um, using a de novo standard of review, the judge I think quickly dispatched Unum's argument that the carrier received was conservative , um, because that is the kind of care that one will normally see in the context of a back claim. Then the judge took on Unum's argument , uh, that Anos condition was not severe and wasn't disabling since he only got minimal care during the height of the pandemic pandemic . Obviously he hadn't gotten physical therapy recommended by his pain management provider. He was concerned about contracting , uh, covid and that was particularly true since he suffered from comorbidities. He was obese, he had type two diabetes, and of course, that, as we all know, put him at an increased , uh, risk for developing , uh, covid and with increased , um, adverse consequences if he were to have contracted covid. So Unum said, huh , you know, your concerns about contracting covid aren't credible because the relevant timeframe related to the dispute that we're talking about was prior to the pandemic. Now, the court didn't necessarily buy that argument because they noted that prior to the onset of stay-at-Home Orders in March of 2020, Graziano was having ongoing conversations with his, his physician about the efficacy of in-person physical therapy. He was doing exercises at home and he was exploring getting additional physical therapy prescriptions. Now, obviously when the , um, stay-at-home orders were lifted in October of 2020, he resumed physical therapy. Um, the court noted that Unum's peer review , Dr . Faulted graziano for not attending physical therapy in August of September. You know, during the course of the pandemic. And during the period of time when stay-at-home orders were still in effect. Of course, Unum was then also arguing alternatively that he could have gotten a vaccine, but of course that that wasn't necessarily , uh, available at that point. Um, so in this case, the court accepted graziano and is treating physician's explanations that his failure to attend physical therapy stemmed from his desire to avoid desire , serious jeopardy from contracting covid and not any improvement in his medical condition. Now, the court cautioned him and cautioned claimants noting in its ruling that that shouldn't be construed as an endorsement, that the absence of medical treatment like physical therapy, medication or surgery would entitle a policy holder to benefits. Rather, the decision was limited to the combination of his active conversations with his physicians about the efficacy of physical therapy, the nature of the treatment plan , uh, the fact that he was doing home exercises. And the court also looked at functional capacity evaluations that had been done relevant to this timeframe that showed that he was , um, working or performing at less than a sedentary condition. So the judge looked at the totality of his medical condition, the nature of the treatment that was being recommended, what he was doing at home, his concerns about , uh, contracting covid particularly , uh, because of the potential side effects that , uh, he would, or likelihood that he would develop covid and the particular side effects that he would be susceptible to including death. So it was a great decision, but again, I want you everyone to understand, you know, you might have a medical condition like post-cancer treatment that could result in you being , um, developing complications or infections that might be a reason for justifying you not attending things like physical therapy or other , uh, modalities of treatment. But that is only gonna go so far regardless of the fact that you might be susceptible to infections, your uh , immune system is compromised. That in and of itself is not going to excuse you from getting reasonable and appropriate medical care based on the level of severity , uh, of your medical condition. So keep that in mind as you're just trying to decide whether or not you're gonna attend a treatment that is being recommended , uh, and how that can result in a claim denial and termination that could possibly be upheld by the court. We've covered a lot of Unum games , um, but as I've said, these are games that other disability carriers play. So I hope you've learned a lot and enjoyed this week's episode of Winning Isn't Easy. If you've enjoyed this episode, please like our page, leave a review, share it with your family and friends. Please subscribe to this podcast. That way you'll be notified every time a new episode comes out. I hope they join you next week. And another episode of INS of Winning Isn't Easy. Thanks.