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Can Unum Make You Apply for Social Security Benefits? Long term Disability Lawyer Answers.

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Dallas, TX: When Reverend Bob Hutchinson filed for Unum long term disability benefits he was approved—after all, he had fractured his spinal column and medical reports stated he was completely disabled. But nine months later, his Unum rep phoned. “She said, ‘We need to get you on your social security disability now,’ and I am still unclear about this,” says Bob. LawyersandSettlements asked Peter Burke, long term disability lawyer with Burke, Harvey and Frankowski, LLC, to make this clear for Bob.

Can Unum Make You Apply for Social Security Benefits? Long term Disability Lawyer Answers.“It’s a standard practice for Unum and other insurance carriers that they require policy holders to apply for social security disability benefits,” says Peter Burke. “They take it as an offset; it reduces the amount of benefits they owe the policy holder.”

Over the years, many people who have been cut off from Unum’s disability benefits have asked this reporter if this practice is legal. It is legal. However, it borders on bad faith practices.

“Most often the policy holder is a company like the policy holder’s employer, and more often than not, it is governed by ERISA,” Burke explains. “And some contracts require that the carrier steer the policy holder to services that help them apply for social security benefits.”

Such is Bob’s case. His Unum representative directed Bob to Unum’s in-house ‘Genex’— which provides disability case management, vocational rehabilitation and related services to corporations, third-party administrators, and insurance companies. “This practice with Genex has always confused me,” says Bob. “I did everything they told me to do. They never requested that I see one of their independent medical examiners. They said an Unum rep would come to my home because I couldn’t go to them--I have a walker and I don’t have a car. Nobody came.

"Genex was helpful and I can understand why they helped me apply for social security. Unum paid me $2700 per month but I only get $1600 per month from social security. Unum was going to make up the difference until I reached 72 -- I just turned 59.” Bob says they never made up the difference.

What is the federal government’s position on this practice—can Unum actually deny Bob by insisting he must collect social security benefits? Burke says the government’s position is that they are only going to pay if Bob is disabled, so it is an entitlement he has a right to, regardless.

This is what ends up happening. “Even though Unum requires Bob to apply for social security benefits, Unum’s criteria for being disabled is different from the government,” Burke explains, “so Unum will say, ‘The government’s definition is different than our policy and therefore, it may be relevant but it is not controlling’.

“Some egregious things can happen where the insurance carrier also requires the person to apply for social security. They go through the process and the carrier—such as Unum—stops paying benefits. Then a year later, the person is awarded social security benefits and Unum demands your overpayment, or back pay. Here is the kicker: Unum will no longer recognize that you are disabled. They will claim the record of the time of that decision is past. So that is where you get caught: the carrier is trying to get the government to accept your disability and pay your benefits, but then the carrier says 'oh by the way, we want you to repay money based on that finding of disability’.”

Burke adds that Unum, and other carriers, will typically give a credit to the policy holder against whatever fee they pay to a lawyer who helps get you that favorable decision from social security. Say you are entitled to $18,000 in back pay and your lawyer receives a fee out of that for $14,000. Unum will ask for $14,000 rather than $18,000. So Unum will acknowledge that the policy holder pays the lawyer. They just aren’t that generous with their policy holders.

If, like Bob, Unum tells you to apply for social security, Burke advises that you check your policy first--there will be a provision in your contract that talks about the duties you owe to them.

“One provision is that you must provide medical information and another is that you apply for benefits that you might otherwise be entitled to, including social security,” says Burke. “It is in your best interest to do so regardless. If you do qualify, the chance that the government cuts you off is a lot less likely than Unum, which is always mindful of the bottom line.

“You don’t necessarily need a lawyer to apply, but I think having one involved in the process, regardless at what stage, is beneficial: Your interests will be looked after in a way that they otherwise wouldn’t be. As well, the attorney’s office can act as a go-between with the medical providers and Unum to ensure that all relevant information regarding your disability is presented.”

Unum wants you to make a mistake. “For instance, Unum likes to put in their notes that you were supposed to call your doctor, you didn’t call, and your doctor didn’t respond,” adds Burke. “Your lawyer will have a paper trail, which is important if you have to appeal the decision. Most times it is done on the administration record, and you want to make sure all your ducks are in a row. In other words, make sure you have all the paperwork.”

Back to Bob…

“I got my first social security check in March of 2010 and Unum hasn’t paid me a dime since. Instead they billed me $10,000. But my social security administrator said my benefits go back to the day you are first disabled so I received back pay.”

Bob says that his social security rep told him not to pay Unum. “She said, ‘Do not pay Unum that $10,000 because they are notorious for taking that money and then canceling your policy,’ and that is exactly what happened. Unum sent me a letter soon after I got my first social security check and said that I was no longer disabled and I was perfectly capable of going back to work.

"That totally contradicts why they wanted me to collect social security. It is my understanding that to get social security benefits is very difficult, but I got mine within three months of applying. I am put together with metal—my spine is fractured. Unum just wanted to get rid of me.

I"’m not trying to screw Unum out of money—I just want what is mine. I will always be disabled; it isn’t like I can grow a new spinal column. It is like I have no rights anymore. Now I make $19,000 a year and that is considered beneath the poverty level. I am so grateful to have a roof over my head but that’s it. I have gone bankrupt. I rely on a food bank to get food and I am physically unable to do much.

"I want other people to know that Unum lies. They take money out of peoples’ pockets to further their own business and they definitely do not help their policy holders. I have talked to many people in similar situations. How companies like Unum stay in business is beyond me.”

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READER COMMENTS

Posted by
Cheryl
on
I have MS and had a Unum disability policy through work. I went out on STD 5/22/2013 and applied for SSDI the same time. My STD went right into LTD 9/2013. I received an award for SSDI 2/14/2014 with a lump sum payment for 12/2013-2/13/2014. UNUM now tells me I must pay back an overpayment beginning 11/2013-2/2014 which equals more than the back pay I received from SSDI. They also stated they will repeat process when I claim my minor child. They have reduced my LTD payment and gave me a month to pay all this back. Is this legal? I did all my own leg work and was approved in under 6 months why must I pay this all back?. Any insight will be greatly appreciated. Thanks

Posted by
Susan dunlop
on
Has anybody heard of when you have been awarded unum through your company and you only get 50% paid and then also the government also take the same amount so I end up with a nil claim can anybody please advise?
Many thanks
Sue

Posted by
Laura
on
I was on STD with UNUM and it rolled into Long Term since
April 2013. It's only been 10 months and UNUM is telling me I must apply for Social Security. No one told me this in the beginning and I have read every word of my policy and nowhere does it state I must apply for SSDI because I have no return to work plan on file. I was never asked for one. I have M.S. and have always gone back to work and I expect to be ready to do so within six months at most. I want them to show me in writing, where it states that I am required to apply for these benefits. I also have one of the first approval letters that states they were waiving the requirement for me to apply for SSDI. This was when I first learned that I may be forced to apply. I still don't have it in writing anywhere that this is a requirement.

Posted by
Jacqueline Hutchinson
on
I received Long Term disability from Unum in 2007. I had used all I could of my short term disability that I had while I worked for Discover card. 5 or6 months on LTD with Unum they insisted that I apply for SSI. They sent me the forms from SS and I filled them out...it wasn't a month or two later I was approved through SSI. I received a back pay I believe it was $9,000 that I had to send to Unum for the money that had sent to me before I got the SSI. This I didn't understand as I had paid the premiums for 8 years at Discover card and that should have been paid by Unum whether I got back pay or not...it should have been mine to keep....
I have since 2005 had 13 major ankle surgeries due to a breaking my ankle....I was terminated from Discover Card due to to many days missed in a 2 year period for medical reasons. I had many complications with my surgeries, I got MRSA, compartment syndrome, RSD, nhemonia, and months in casts, boots, non weightbearing, and agonizing pain for 4 years. I had fusions foot to ankle, they never took, so after 4 years my ankle surgeon said, you have a choice to make....1. stay on morphine for pain at home and have no life. 2. Have an amputation. After a very hard decision I decided to have the amputation, below the knee.
that was in 2009, with a long recovery. Every year since with Unum they call me to update my status...my status has not changed, my leg did not grow back. I am on many meds for phantom pain, depression, anxiety due to all I went through...I still have a fear of a full flight of stairs....My problem is SSI says that I am disabled but Unum does not anymore. Received my yearly call 2-3 months ago and finally got a call from them stating that I was no longer eligible for benefits as there 2 physicians came to the conclusion that I could go to work in the same sort of work I did at Discover. Unbelievable....I am 63 years old for Gods sake and the amount that they pay me is $105 a month. They said this month Feb 2014 would be my last payment from them...I am so upset and don't need all this hassle...

Posted by
Sara
on
I am searching everywhere for an answer. I have UNUM as the LTD, and they are asking for my SSDI backpay. I want to spend the backpay on a consolidated loan I have that has a big interest rate on it. I can then set up payments with the UNUM if I really am required to pay UNUM back, which I am not clear if I really have to or not. My question is, do you know if UNUM or any LTD can charge interest on me paying them back monthly payments on the back pay owed to them from back pay from ssdi? Thank you.

Posted by
Toni Jones
on
If I get back pay for SSD...who pays Unum back? I was told when I go to court and get back pay..Unum will get their money back from my back pay.

Posted by
Debbie
on
I have been on Unum since 2006, yes I went through Genex and received my SSDI. I also received the difference from Unum's total amount and SSDI from Unum since 2007. The problem I see is the social security retirement age has changed and and when I am 65 Unum will cut me off. My retirement age is 66, so I understand what others are saying about this. So, does the government even know what is really going on?

Posted by
lisad
on
I have been dealing with Justin from Unum for almost a month. Within the first five minutes of speaking with him I realized something was amiss. When he matter of factly stated that it looked like my doctor was agreeing with my decision to stay off work I knew I was in deep trouble. I have a degenerative joint disease and could not work again if my life depended on it. I"ve served in the military, raised two children on my own, worked full-time while going to college at nite for twelve long years. I've fought for everything I have. I will not go down quietly! Shame on you Unum! Shame on you!

Posted by
tom
on
unum asked me last week if I would be interested in signing up for genex .I told the lady I would look at it ..does this mean I have to talk to the people at genex ..or can tell them I not interested..the people at genex has called me 2 times...after reading all the stories I am really confused..

Posted by
tom
on
unum asked me last week if I would be interested in signing up for genex .I told the lady I would look at it ..does this mean I have to talk to the people at genex ..or can tell them I not interested..the people at genex has called me 2 times...after reading all the stories I am really confused..

Posted by
Debbie McCann
on
Same story but no policy provided until both claims for disability is finalized and SSDI is applied for (under threat to drop if did't apply)...

Then oh, "just heard that your employer" did not provide you with a policy (almost two years later) so here is a copy.

Then file again or drop your claim....This time approved for SSDI but Unum started taking 2000.00 a month from my claim to "repay back spouse and childrens SSDI" .

2008-2013 no benefits and they convinced my state that my attorney and I refused to provide requested information and we were too mean.

I do not have an attorney.

I did not file for any family benefits.

Top it all off...after Unum approved claim (after they received updated medical information and on same day sent letter out informaing that my doctors missed the "10 day" deadline for additional information....they informed me that I had to get the information.

Unum never sent any proof that they sent out any request to my doctors, they faked the date which was caught but they did not care. Under a reservation of rigjhts I was approved....and then more horrors

File for SSDI through Genex, Unum will pay the costs. Genex sends letter to me stating that my insurance carrier abd Genex have no contact with one another and I had to supply information.

Unum and Genex are the same company but Senator Grassley investigation revealed truth and they were sold.

Left without any income, large bogus bill (I even have a form that was called Protection Income Claim (used by employer to ensure claim would never be dropped.)

My employer informed me that Unum requires everyone to file for SSDI.
Unum told me that my employer required that I file for SSDI.

Month before approval Unum sent a letter informing that the income would not be reduced if I kept them informed about SSDI. (They were told everything when we filed and denied, etc...

Approved for SSDI but only a phone call from SSA and that the award would come in the mail. I passed this along to Unum but they started reducing claim before I had anything to give them...why?

They claim I did not answer two letters, one each year...first date (I checked the record and guess what, yes, I did answer them and they thanked me in writing for speaking to them on that date.

Next date, they made another false claim, but oh well..and it took close to 5 months to find out why I was loosing benefits.

My medical records were falsified and the state has tried to help me (now) but not much help...

I have never been denied for LTD and the only reason Unum did not get the details of SSDI award was I did not have anything to give them...

I have so many actions such as above but I cannot get help...Not only did my ex-employer hired Unum as TPA but Unum also hired the ex employer to provide similar actions for Life and LTD benefits.

I had no reason to doubt there requests (no policy) but when I finally realized something was very wrong my company, under investigation for stock fraud and they were sold.)

If we were the ones lying to State, SSDI, etc... We would be in jail.

BEFORE you file a claim call an attorney. Start reviewing the court records (I didn't have that help until 2006)

So many lawsuits that courts have defined a Standard of Review...

Sad, but true, the reason I am disabled started when in the military 25 years ago. I have to remind myself that the Lord is in control and nothing happens without a lesson.

Do not trust what is told to you, demand the information by the TPA or Employer.

As fort SSDI...if Unum is forced to approve a claim they may but they have other ways to drop you...

Check what medications you take and document their usaged especially if the med may be used for depression or mental problems...Even if the same prescription is written for a medical reason such as elavil (FMS use this drug but so does those depressed...)

SSDI benefits are paid for both medical or mental illness, it doesn't matter.
Unum only pays for TWO years if they find a way to make it appear that mental illness is part of the disability... I caught this after they llied about my doctors missing a 10 day dead-line....but after the fact they finally did send a letter and one of the 10 questions stated, Me has a "history of mental illness" and did the doctor believe that was the root cause of the illness?

Doctors who do not know the patient could easily mistake that question but you may never know if Unum asks such a question.....

Help yourself, don't let a greedy company to take away your health by making you put them first and knowing at any time you could be dropped.

I lost my health, my carrer and all of my retirement but I am blessed to have a husband who loves me almost as much as Christ. He already carried the sin of the world and I stand on His promises.

Hang on to hope and the love of the Saviour.

Deb

Posted by
Chris
on
I was approved by unum for LTD. As the article addressed I had to also apply for SSD. Again I was approved but had to repay unum the "overpayment". It took about about 12 yrs to do so and during that time I received only a very small payment from unum. I payed it off and I am now receiving a payment from unum based on what I receive from SSD.

Posted by
George Matheson
on
I am disabled and unable to work, I am a goverment employee, and federal law dictates that they retire me at age 62. i, also have Unum for my disability insurance carrier and they also after being approved , said they were having to drop me as I was not disabled under their policy. After some discussion, they reinstateed my policy some eleven years ago.

I did notice that they had incorrect information on a payment receipt, but after telling the lady, she only increased my monthly payment, but did nothing about the nine years earlier. After approx 90 days I wrote a letter which provided information as to the correct facts. I was very lucky - they sent me 46 thousand dollars for back payment increases. Although this is wonderful, I get taxed for the increased tax bracket this lump some payment put me in. They are unwilling to mark-up the lump sume to pay for the taxes at year end. They said just send back the check, They did pay interest on the amount but not taxes. Their mistake in accounting will cost me royal in March 2013. I am not finished yet on this matter!

Posted by
marilyn
on
And what about the companies that intergrate social security benefits but fails to adhere to the new social security retirement ages because the company's plan states that cut off is at age 65 when now normal social security benefits start at age 67 and above. While these plan get to offset the social security monetary benefits, they also get to dictate your retirement age. I think the government should demand that all disability plans have to adhere to any new retirement age that the government dictates and not to just what the company policy states.

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