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Is Unum Group in the Mining Business or Insurance Business?

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New Orleans, LAThe insurance industry in general and Unum in particular appear to be more inclined toward the mining business, rather than the insurance business. Mining, as in mining the depths for reasons to deny or discontinue benefits to policyholders. Many a Unum lawsuit makes such an allegation, and there appears to be plenty of examples.

Linda Nee knows all about Unum. Now working as a licensed life and health consultant in Maine, Nee is a former employee of Unum life insurance and knows well what can go on—on the inside.

One such example, as explained to Nee by an Unum employee, is a so-called "Customer Relations" project that allegedly requires claims handlers to contact insured's and claimants to gather personal information, family and personal activities. The suggestion, and accusation, is that Unum extends monetary awards to those claims handlers obtaining information that results in a denial of claims.

Nee notes in a recent blog post that insured's and claimants are required only to provide an insurance company (in this case, Unum disability insurance) with information pertaining to a policyholder's medical condition, occupation and financial status if the policyholder is working. Anything beyond that, according to Nee, is off-limits and is not a requirement.

The former Unum Provident employee goes on further to state that such mining for information on seemingly innocent activities as doing laundry, can turn into a problem for a claimant. Nee explains that insurance companies like First Unum can translate personal activity into a formula that assesses capacity for work.

A finding of "sedentary work capacity" can serve as a trigger to deny claims, Nee writes, by identifying "gainful alternative occupations."

"All you have to do is tell a Unum claims rep you carry laundry and your claim is gone at the 24-month change in definition," Nee writes.

One particular Unum lawsuit last year suggested that Unum Insurance often benefits from the participation of others. The October 2011 issue of the American Bar Association Journal revisited Scheuermann v. Unum Life Insurance Co., a case that was heard in 2010 by the 5th US Circuit Court of Appeals at New Orleans. According to the publication, a doctor contributing medical opinion to Unum had initially determined there was insufficient evidence to conclude that an injured worker was capable of returning to work.

The doctor had asked for additional X-rays and to view MRIs, which, according to court records, were already in Unum's possession. However, the request for additional X-rays was denied. Unum reported that the records were unavailable and instead urged the doctor to arrive at a finding regarding the functionality of the plaintiff, who ended up suing Unum.

The doctor flip-flopped on his earlier finding and deemed that the plaintiff could, indeed, work. The 5th Circuit found that the doctor's subsequent finding was not based on additional medical evidence and was "in plain conflict with the medical records." The 5th Circuit strongly condemned the doctor in question for re-crafting an opinion at the request of an insurer—in this case, Unum Group.

Many claimants will file a Unum lawsuit in an attempt to reverse a denial of benefits based on a real and honest need for those benefits, from a policy into which premiums were paid for years, if not decades. To that end, an insurer such as Unum Group will happily accept those premiums, only to view Unum disability claims with disdain.

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