Wednesday, April 17, 2013

Illusory Unum Approval

It seems that even when Unum approves disability benefits it doesn’t really approve the claim. I represent a 48 year old part-owner of a flower business in connection with his claim for disability benefits under a policy issued by the Paul Revere Life Insurance Company. My client used to manage and operate the retail and wholesale flower business. Today, Unum reluctantly approved his disability application. 

I had provided incontrovertible medical and vocational evidence that my client was incapable of performing the duties of his regular occupation. That evidence included an extremely detailed occupational analysis by a vocational expert who worked for Unum for a decade. Nonetheless, Unum refused to accept what the report explained were the claimant’s work duties, even though Unum had no reason to dispute them, and insisted that its representative be allowed to interview one of the co-owners of the flower business to verify the work duties. 

It should be pointed out that my client’s policy did not provide Unum with the right to interview the claimant or his co-owners. Significantly, many Unum policies specify that Unum has the right to conduct interviews. However, since the co-owners advised me that my client’s work duties actually exceeded those set forth in the occupational analysis, I allowed a telephone interview to proceed, subject to my being present. 

Unum also insisted that it needed my client’s confidential tax returns. Since my client was not seeking residual disability benefits, there was no reason for Unum to review his tax records to reconcile any earnings. Notably, despite my specifically asking Unum to identify the section of the policy that would require the disclosure of tax records, it never did so -- because there was none. Unum knew it had the right to include such a clause in the policy as it included the right to review tax records in the policy rider that relates to residual disability. I did not submit tax records. 

As the blog title indicates, the Unum’s approval letter seems illusory. Unum stated that it wants monthly updates. Just as my client’s policy did not provide Unum with the right to tax records, or interviews, the policy also does not provide for monthly medical updates. Nor is there a reason for monthly updates because there is no possibility that circumstances will change. 

My client’s doctors made it perfectly clear that it was his occupation’s work duties that rendered him disabled. Since those work duties do not change, his inability to perform them will never change. Even if my client felt perfectly fine, that would only be because he was no longer performing his occupational duties. His disability from his regular occupation is permanent. The only way for my client to remain well is to avoid his prior occupation. Even if the policy explicitly stated that Unum could request monthly updates, which it does not, it still would be unreasonable for Unum to do so under the circumstances. 

The reason for concern about the approval letter is that it seems to be setting the stage for harassment of my client’s doctors. One need only google “Unum harass doctors” to see that harassing treating physicians for forms and information is a common tactic that Unum uses. As a result, I had to respond to an approval letter with a warning that any attempt to harass my client or doctors with an unreasonable demand for monthly updates in the hopes of imploding their patient-doctor relationship would not be condoned, and specifying the administrative actions I would take. Unum has no reason to maintain that monthly medical updates are necessary because I have similar ongoing claims with Unum where monthly updates are not required. 

To compound its approval even further, Unum mischaracterized my client’s occupation, even though his work duties were made crystal clear in the vocational report I submitted, which duties were confirmed by the co-owner. Bizarrely, Unum’s approval letter stated that my client had more than one occupation, which was patently wrong. My client did not have several jobs; he did not work for more than one person; nor did he own more than one business. He had a single occupation that encompassed tasks performed by people who happen to work in some other occupations too. I advised Unum that its approval letter was wrong when it said that my client would not be totally disabled if he could perform “any of his occupations,” because he had only one occupation, and it made no difference that people who work in different occupations also perform some of the work duties. It was necessary to reject Unum’s claim that my client would not be disabled even though he remained unable to perform all of his prior work duties.

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