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A Play on Words: Unum's Scam

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Seattle, WAUnum, also known as UnumProvident, is notorious for denying legitimate health insurance claims in a variety of deceptive ways. Valerie (not her real name) says Unum illegally denied her long-term benefits by changing one word in her policy without giving notice to her employer, HR or the union.

After she suffered an injury at work, Valerie collected short term benefits from another carrier for six months, no questions asked, until her Unum long-term disability (LTD) was supposed to kick in. But true to form, Unum denied her claim, even though doctors told Valerie that there was nothing more they could do after her sixth surgery except pain management.

"Unum had two paragraphs of inclusion in its criteria," says Valerie. "The original policy said you had to meet Paragraph A OR Paragraph B. Paragraph A dealt with a pre-existing condition, which I didn't meet. But I did meet paragraph B, which stated that in order to be eligible, you have to work 12 months, treatment-free, which I did. Then they changed one word in the policy: OR became AND.

"Unum's medical examiner said the pills I took for occasional migraine were part of my pre-existing condition, and air-sickness pills also constituted 'treatment,' which negated the 12 months treatment-free clause.

"In order for Unum to make a contract change in a union shop in the state of Iowa, where I was living and working at the time, they had to notify the union in advance of the changes and educate the membership on the changes. Unum never gave notice. How could they change their policy without notifying the union? In order for the union to be notified, they had to post notices; I was there and this never happened.

"I appealed and Unum offered that I take the mental health route. When, like me, you have a large medical claim that can keep them on the hook for the rest of your life (I was 50 and could live another 20 years or so), they try to get you to accept a claim under mental health benefits. This is one of their common scams because mental health benefits have a three-year limit. But I did everything they advised and was even denied the mental health benefits: Unum said it was pre-existing.

"After that I sued Unum and my employer in federal court. My attorney got a judicial revue and the judge ruled in my favor. Prior to this ruling, Unum wanted arbitration to see if we could reach a settlement. At that meeting, Unum offered me $20,000 but I said that was unacceptable in light of the $1 million plus benefits that I was entitled to. Unum's lawyer said I could keep on appealing but I will never win because they will continue until I run out of money.

"Now I'm on social security disability: I get $1600 per month. I was even on welfare for a while. My son had to move here and give up his life and career to care for me after my husband died. I should be getting $3200 per month from Unum. I've lost all my benefits. I ended up in bankruptcy but luckily kept my home, thanks to my son. If I was ever diagnosed with a terminal illness, there's no telling what I would do to these Unum executives for destroying my life."


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