Unum Provident Still in Denial

Boise, IDDiane paid into an Unum Provident policy through her employer for more than a decade, so when she was injured on the job and collected Workers Compensation benefits for a few months, she assumed that Unum Provident's health insurance would kick in and pay her long term disability benefits. Wrong.

"When they denied me, it made me so depressed," says Diane (not her real name pending a lawsuit). I paid health insurance out of my pay check for more than 10 years--for all this time and nobody bothers to help—it really hurts." Diane has been under the care of two doctors for a back injury that has left her disabled. She has letters from her doctors that clearly state her injury is permanent, yet Unum Provident's independent medical examiner disagrees with them!

"My manager helped me file with Unum for long term disability," Diane explains. "I sent all the paperwork, all my medical records to the insurer but they kept asking for more and more information. I know it was a stall tactic. Unum also requested information from Workers Compensation (WC) and after they had every piece of information imaginable, an Unum rep said treatment for my upper back injuries should have reached MMI (maximum medical improvement) within 8 weeks. In other words, I should have recovered after a few months off work.

I tried to return to work—I applied for various positions. I couldn't return to my previous job because I was terminated: my employer was told by Unum Provident's independent medical examiner that I could return to work but my doctor said I couldn't; I also saw a spinal surgeon who concurred with my doctor—that I cannot return to work. I also have a small disc at L5 S1 that required surgery but it didn't heal and I now suffer from drop foot. [Drop foot is a symptom of an underlying spinal condition, such as spinal stenosis or a herniated disc.] I am in constant pain and I can barely walk. According to the surgeon I could only perform sedentary work but the job I was terminated from required physical work.

In a nutshell, my injury happened in July, 2006 and I was terminated from my job in January 2007. During this time I collected WC but they cut me off right after I lost my job. I applied for benefits from Unum in November but they denied my claim in March. I had surgery in April and I appealed my claim—I was denied a second time because I was no longer employed and didn't qualify for benefits.

Since when do you have to be employed to receive benefits? Since I had already applied before I was unemployed, this wasn't right. And I had to fight to get surgery: my medical insurance was terminated right after WC cut me off. Luckily I was able to qualify for medical insurance through my husband's policy which covered two MRIs and more. I was finally able to have surgery and it has helped a little but my muscle didn't regain strength and I was still left with this drop foot."

Diane has now applied for social security—she has no money left and no prospects of work. According to Unum, she is not disabled, despite her injury and her medical records. Diane is furious with the health insurer's independent medical examiners (IMEs): "these doctors are crooked—they are making money by denying policy holders benefits."

"A company like Unum Provident takes your money and you think you are covered but then you get nothing but the runaround and denial," says Diane. " Something really needs to be done about these so-called health insurers."