unum strikes again !!

[don james]

What is the name of your state? colorado

unum has dropped my claim after 4 years...none of my health problems have changed..they are marking a couple off as pre existing and forgetting about the bulging discs [my main problem] and the reason that i went out in the first place!!
they ordered a funtional capacity test a couple of months ago....i went thru that and i was hurting for days after ......i think they know just how far to push
apparently they determined that i was able to do some light duty work [two jobs suggested were security jobs at 7 dollars an hour and a 90 mile commute]
my company has since dropped unum and gone to another carrier......because of their reputation....but i am grandfathered- in ....lucky me!!
i am tired of putting up with their crap [i have the privilage of not needing a lot to live on] and will probably find some part time work to make up for this deficit.......i have gone all thru their little games being honest and direct .....i am the type of person that doesn't like to go down with out a fight......but i am old enough to know [53]...when i'm whipped before i start.....what direction should i go, what type of lawyer, and is their some type of class action suit that i can sign ??
i saw a little of a documentery on tv but missed most of it....sounds like a not so reputible company!!!
sorry so long
don james

 

[ALawyer]

UNUM was a well regarded mutual company for many years and then it demutualized and merged with Provident, a stock company that, shall we say, did NOT enjoy a fine reputation.
And to be fair, experience began to go to heck in a hand-basket, so many companies got tighter with thgeir definitions and standards.

You need an insureance lawyer who knows insurance bad faith law -- although as the policy you have seems to be covered by ERISA, there is little likelihood of bad faith punitive damages. Alternatively, a social security disability lawyer may also be able to help -- if they are really good on their medical knowledge.

 

[don james]

thanks a lot Alawyer.......i plan on consulting a lawyer just to show him the case and have him decide whether to engage it or just let it go......as i said they [unum] has worn me down and i am tired of the battle......but if the case looks foolproof i will go for it...just for the personal satisfaction of fighting a giant and winning!!!

i sure hope that these ins. company's get investigated and put down like enron and so many others......i think that their time is comming......many many people are going without health ins. because of corporate greed.......

i will post any info when i get it
thanks again
don james

 

[ALawyer]

Good. Get some real advice first, it is worth the cost as if the lawyer can present facts, you will eventually win, and can sometimes get lawyer's fees also.

 

[CIAA]

don james,

We are not attorneys and do not give legal advice. Based on our insurance claims experience:

Alawyer is right on about the medical aspects. Claims people are taught that since discs are suppose to "bulge"(it's their function) to look for frank "herniations", MRI, evidence of "impingement" on the nerve root, postive EMG findings, etc.

Insurers should consider work availability and if a claimant cannot sit for 2 hours, driving 90 miles may not be possible.

While being unable to engage in "any occupation" is subject to interpretation Colorado courts have historically leaned towards a strict interpretation.

If your coverage is employer sponsored the federal ERISA regs will rule, but this puts you at a disadvantage because your burden of proof is different (something not disclosed to employees). To succeed in an ERISA claim you will usually have to prove, not that you are disabled, but that the insurance company has no good reason to say you are not. That's an entirely different thing.

 

[don james]

thanks ciaa,
your comment:

If your coverage is employer sponsored the federal ERISA regs will rule, but this puts you at a disadvantage because your burden of proof is different (something not disclosed to employees). To succeed in an ERISA claim you will usually have to prove, not that you are disabled, but that the insurance company has no good reason to say you are not. That's an entirely different thing.

my coverage is employer sponsored, but as i said my employer has dropped unum and gone to some other carrier [no wonder why!!!].....do you mean by saying [ no good reason to say your not] that, the four years that they have paid me is a good defense just for the fact that it has been so long?

they said in thier letter..... "that i was paid 24 months until oct. 2000.....after this date you must be considered unable to performthe duties ofany occupation as discribed above" ie.,,,any gainfull occupation for which i'm suited.

my question for this is why have they paid me way beyond 24 months and a year after a social security hearing [social security, by the way turned me down]??

i could have slipped thru the cracks somehow, because i have been honest with all of the case workers.....one example is when their appointed lawyer called me before se flew out for my s.s. hearing and asked me if i had anyone that could drive me 40 miles to the hearing......i told her that i did, but asked why and her response was that it would look better for the case!!......my response was."i drive this distance with no problems and i'm not going to tell a judge that i can't!!!"

i have had some amusement from the quiet on the other end of the phone line when they get answers and comments [from me] that they are not trained to answer.

thanks again for your replies......i just want to say again that i am only wanting what is right.......social security turned me down and i understand why.....i just hope some day i might draw a little of all those thousands that i put in!!!
don james

 

[CIAA]

What I am saying is you will most likely have to prove that their decision is not based on satisfactory and reliable evidence or that based on the evidence their decision just doesn't make any sense.

SSD has generally the same application and you seem to understand why they say you are not disabled.

Therefore, sounds like an uphill battle.

 

[don james]

CIAA,

i agree with the s.s. process.....we have no choice.....but when i first went out on ltd with unum i was the first to do so in our plant [lucky me!] so i actually ended up bieng the "expert".....no one new any more about the rules than i did and we all came to the conclusion that our ltd paid until age 62 if you were proven to be disabled and could not perform the work that you were accustommed to doing, according to the paperwork that we had on it.
we soon learned that it was not that simple and there was a lot more fine print that some one at a corporate level should have studied before they signed on the line!!!!! it did finally come to their attention and the contract was dropped.....i actually think that them dropping the contract and no longer paying the premiums paid a big part in my regection.....i did read somewhere that the recipient has the right to keep the premiums up when a company drops a policy.......i may do a little more footwork and find out exactly when the change was made.

i guess in a nutshell.....the question i would like to find out most is; why they carried me past 24 months without trying place me in a light duty job..even after a rejection from s.s.??

i just don't know if i'm willing to pay a lawyer a couple of grand for the answer......i am inquisitive, but not quite that much.

thanks again
don james

 

[ALawyer]

What is involved is CAREFULLY studying the policy language (and 2 years in own occupation is a rather common provision when followed by a test including inability to work in any occupation you are reasonably qualified for) and then checking your medical records to see if they support the disability. THEN the issue is whether there are available jobs you can do for an 8 hour day with your condition.

The more I think about it, see a GOOD Social Securitiy Disability Lawyer, preferably one who is experienced and does NOT have a very high volume practice, which often is a plain old Claims Mill. They are used to dealing with what it takes to establish disability in SS Cases, and working with experts on other available jobs. Also, the maximum fee on an SSD case is only 25% of back benefits with a MAXIMUM of only $5,300, so they are not likely to only take a potential million dollar case. Very often the fee should be a few hundred dollars for an evaluation as to your chances, and they may work on a low fee with a contingecy if successful.

 

[don james]

well Alawyer thanks again.....i will take a little time to make up my mind.......i am submitting my papers for retirement as of nov. 1.....i hope this doesn't hurt the case.....but i takes a while for the retirement process to happen.....and i need the income

i will post any progress if i decide to go ahead with an appeal...the info might help others

don james