Unum Rubberstamping Puppets

I read a blog by a former Unum claim representative that described how Unum claim handlers are glorified secretaries. The truth is that calling Unum claim handlers glorified administrative assistants is an insult to the latter. 

I deposed a Unum claim representative who approved, and then 20 months later terminated, my client’s long term disability {“LTD”) benefits. The claim handler testified that my client’s benefits would continue if her condition did not improve, and that he was required to consider all of the evidence that my client had submitted. While my client continued to submit the same evidence that Unum found rendered her disabled, when terminating my client’s benefits, the Unum claim handler admitted that he did not even compare the findings and opinions of Unum’s doctors with those of Plaintiff’s doctors, and the issue of improvement was never even considered. 

An administrative assistant may not perform executive or managerial tasks, but they do exercise independent judgment. On the other hand, the Unum claim handler unabashedly testified that he exercised absolutely no independent judgment in his work. The claim handler admitted that he relies exclusively on what Unum’s doctors say, that he simply accepts whatever Unum’s doctors say, and rubberstamps their conclusions. 

In other words, Unum completely disregards all the evidence that supports a claimant being disabled, as long as Unum’s doctors say a claimant can work, regardless of what that evidence shows.

Chronic Fatigue Syndrome Update

Today’s New York Times included an article entitled "Getting It Wrong on Chronic Fatigue Syndrome.” The article describes how a closer examination of the evidence reveals that psychotherapy and a steady increase in exercise are not effective treatments for chronic fatigue syndrome (“CFS”). In short, once access to the actual data, which was the genesis for those treatment options, was made available for analysis, the data revealed that psychotherapy and graded exercise do not improve symptoms, and to the contrary, frequently make them worse.

Consultative Examinations

The POMS revised its rules regarding a consultative examination (“CE”). A claimant’s own medical source, which does not have to be a physician, “is generally the preferred CE source.” 

The State agency is supposed to schedule a CE with your doctor who: is qualified; has adequate training and experience necessary to perform the types of examinations and tests needed; has access to the equipment required to perform the types of examinations and tests needed; is willing to perform the examination or test for the fee schedule payment; and is willing to provide a detailed written report of the examination in a timely manner. 

The State agency will assume your doctors are not willing to do a CE if they failed or refused to provide medical evidence when asked. The State agency frequently asks treating doctors if they are willing to do a CE – in small print – on their letters to doctors that request medical records. The State agency might also call to ask if your doctor would do a CE. 

If you are applying for Social Security Disability (“SSD”) benefits, you should tell your doctors in advance to say that they will do the CE, or to send any letter they receive from the State agency to you or your attorney to respond. You should also arrange to pay the difference between what the State agency will pay for the CE and what your doctor will accept to avoid payment from being an obstacle for your doctor to do the CE.