UnumProvident's Stall Tactic

Indianapolis, INFor the past 9 years, Kevin has been working with a back injury. And all those years both Kevin and his employer paid into an UnumProvident (also known as First Unum) insurance policy. A few months ago, Kevin's doctor told him—and UnumProvident--that he could no longer work, yet Kevin received just one check before he was denied further benefits.

Kevin explains that both short term disability (STD) and long term disability (LTD) policies are with Unumprovident through his employer. "I collected one check for STD from Unum and I was cut off," says Kevin. "They said any future payments would be determined by medical evidence."

Kevin has a cervical and lumbar back injury and doesn't know when he can return to work. His last day on the job was June 30th and time is running out. Up until June 30th he was on intermittent family medical leave; Kevin had 12 weeks a year that he could be off work without affecting his job. But 12 weeks has expired and now he is taking a personal leave, meaning you're off work and still have a job up until 90 days. Even if he returns to work within those 90 days, he is not guaranteed the same job.

Right now, Kevin doesn't think he will be able to work again and Unumprovident isn't giving him an answer—whether or not he will be able to collect LTD—so he's really in limbo. Kevin works at a hospital in the accounting department but now he can't sit or stand for any length of time. "I get pains shooting down my arms and legs and pins and needles in my fingertips," he says.

"UnumProvident requested medical records from 1985 to the present and my doctor sent all the information to them," says Kevin. "And Unum has my doctor's statement—that I can no longer work." But to Unum, one doctor's statement doesn't necessarily count.

"While I was waiting to get STD, Unum kept requesting more and more information but they already have everything," says Kevin. "It seems like they are just stalling. Right now I have an appointment to see a pain specialist but that isn't until September 30th. I saw a neurosurgeon on September 8th for a consultation: He just told me that surgery isn't necessary right now and referred me to the pain specialist. He also said that I needed to get any information about returning to work from my primary care doctor—the doctor who took me off work.

But Unum said they need statements from specialists before they will consider my claim.

Unum has all the doctor's names and all this information. They sent a letter for information to this neurosurgeon, but he just talked to me. I was checking my claim and Unum said information has still not arrived from the neurosurgeon so I called his office; they said I just had a consultation and there was nothing to report. I then phoned Unum: again, my claim is 'on hold pending further medical information'.

Obviously my primary care doctor isn't qualified in Unum's judgment. But who is? Unum has my MRI scan. They know I have a disability yet they say I need more medical evidence to prove I can't work. Unum has not specified what more evidence they need. I asked them what specifically they require but I can't get an answer.

The pain specialist is going to look at my MRI and I am hoping his record will be the determining factor. As well, prior to seeing the specialists, Unum made me apply for workers compensation. I told Unum that my injury was not work-related and my employer also agreed.

Right now, the way my back feels, I don't think that I can return to work. I'm only 52 and wasn't planning to retire, especially without any income. Meanwhile, I have applied for social security benefits. At this point I don't know what is going to happen. I already lost my house and all my savings went as well, so there's not much for me to fall back on. I'm getting pressure from my employer because I have 90 days to return to my job and it has already been 45 days.

Even if the pain specialist reports to Unum that I can't return to work, that still does not guarantee that I will receive LTD. My only recourse now is to find an attorney to help."