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"Back-to-Work" Policy: Another Way Unum Doesn't Pay

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Los Angeles, CA: Steve, a Deputy Sheriff, was injured on the job and he spent 90 days recovering from surgery before returning to work. At that time he filed for long term disability benefits as instructed by his health care insurance provider—Unum, also know as First Unum or Unum Provident.

Police Officer"Unum has a 90-day evaluation period before paying benefits," says Steve, who found that he couldn't perform his regular duties when he returned to work due to his injury. Steve was relegated to a desk job and therein lies the problem…

"I submitted the claim at 90 days because that is Unum's cut-off period," Steve explains. "My wife had already filed a few claims while she was pregnant so we knew the procedure. I am familiar with cut-off and qualifying periods."

Knowing Unum's policies didn't help Steve; Unum denied his claim based on the fact that he went back to work at the 90-day period. But because he wasn't able to perform his regular duties, "I appealed Unum's decision in a letter," says Steve. "I pointed out Unum's clause that says if you cannot perform 2 or more functions of your job description, then you are considered disabled and qualify under their policy.

I had an impingement in my left shoulder so the doctor did a grinding of the rotator shoulder cuff and I couldn't move my arm; I couldn't carry my gun, which was my primary function, and I couldn't drive a car. But Unum denied my appeal, saying they don't pay when the employee goes back to work, period.

I didn't get short term disability because it wasn't covered in my policy, but I should have received 3 months of benefits because I was off 3 months with the shoulder surgery and I was still unable to perform my job functions. Even though I went back to work I had to do a clerical work, a lesser job classification. And I didn't get any overtime, so I had a decrease in salary.

Unum doesn't adhere to its own policies. They advertise "on or off the job duties"; that is how the insurance brokers sold their policy to the county—who I work for. 'We will pay you until you go back to your regular job,' Unum says, but I didn't go back to my regular job for a total of six months.

A lot of insurance policies don't care what you are getting paid; they have to pay you as a result of your injury or disability. When I told Unum that I wasn't performing my regular duties, they still insisted that, because I was back to work after 90 days I didn't qualify for benefits. The county I work for has a back-to-work program; they are self-insured so they don't want to be paying Workers Compensation benefits. That is why I had to go back to work. Otherwise, I would have returned to work 6 months after surgery and Unum would have had to pay long term disability benefits.

And Unum should have been paying me for 3 months anyway. The way the county perceives employees is that if they are unable to perform their job, they are still considered to be covered under the American Disabilities Act, which is a federal law that mandates employers to accommodate needs for disabled persons in their employment. You would think Unum would abide by this act.

However, I did some research on this insurance company and they deny, deny, no matter what. I read reports where they automatically deny about 80 percent of claims just to frustrate the claimant. And I also read that there were 'secret' memos from Unum department officials instructing their employees to deny claims. Thank God for Internet research…

It isn't a lot of money they owe me, but it is a policy I had and I should be covered by Unum—I paid out of my paychecks because it is voluntary. You jump through hoops to do what this supposed health insurance company says and they just deny you for some other reason."

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