Unum Loves To Play The Denied Claim Game

A Play on Words: Unum’s Scam

Seattle, WA: Unum, 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.”

Unum, Central United, Allstate….. There seems to be a common theme. Time and time again we see insurance companies choosing profit over people. Let us help you get your benefits if you have ever been involved in a similar situation! Contact us today at www.mydeniedclaim.com

 

Complaint Against Central United Life Insurance Company by the State of Missouri Department of Insurance

John M. Huff as director of the Missouri Department of Insurance is spearheading the movement against Central United Life Insurance Company.

Some of the issue the Huff has brought up are as follows:

• Missouri law requires that insurers be truthful and provide adequate disclosure when marketing their insurance policies
• Missouri law prohibits making or permitting any unfair discrimination between individuals of the same class
• Missouri law prohibits any company compelling insureds to accept less than the amount due under the terms of the policy
• Policies at issue contain “actual charge” benefits paid based upon “actual charges” for a variety of cancer treatments
• Prior to Feb. 2003 CUL administered claims based on amount health care providers billed insureds or insureds’ primary health insurance for service
• Beginning Feb. 1, 2003 CUL changed how it administered “actual charge” claims
• Now administered “actual charge” claims such that the “actual charge” was determined to be “the amounts actually paid by or on behalf of the Covered Person and accepted by the provider as full payment for the covered services provided
• They also began requiring Explanation of Benefit forms, Medicare Benefit Summaries, or other proof of loss documentation to determine the amounts actually paid by or on behalf of the Covered Person
• This reduced benefit payments
• “Actual Charge” was not defined or explained in any of Central United’s Missouri marketing materials until October 2003.
• Some Actual Charge benefit policies issued by Central United never defined actual charges
• Missouri Dept. Ins seeks to name a few: A permanent Injunction from continuing practices, Reprocess and Repay affected claims,  a civil penalty fine to be paid to the public schools, an order requiring CUL to pay prejudgment and post judgment interest, order to pay reasonable costs of investigation and prosecution, order to pay insurance dedicated fund, and finally other such relief as the court considers necessary and appropriate.

As you can Imagine Central United has something to say and more to every point mentioned above, but we won’t get to that.

 

“Central United Life Insurance Company has made an attempt to abandon its solemn responsibility to protect its policholders facing a deadly illness” – John M. Huff, Director of the Missouri Department of Insurance

Central United Life Challenging Suit by Mo. Regulators Over Cancer Policy Payments

Source: insurance news net

Central United Life Insurance Co. plans to challenge a lawsuit filed by Missouri insurance regulators accusing the company of illegally changing the terms of its cancer insurance policies.

The suit, filed in Cole County Circuit Court, alleges the Arkansas-based life insurer changed its claims-handling practices in late 2003 to sharply reduce payments to policyholders who get cancer treatment, the state Department of Insurance said.

The insurance contracts at issue are specified-disease policies that Central United has sold since 1997, the department said. The policies promise to pay Missouri policyholders diagnosed with cancer the amount charged for their medical care, even if their health insurance pays for the treatment.

Central United is attempting to avoid paying thousands of dollars due to each of these policyholders by paying them based on paid treatment costs, instead of actual charges, the department contends.

In a statement, John McGettigan, senior vice president at Central United, said the company will soon appeal the department’s suit For more than six years now, Central United has been in discussions with the MissouriDepartment of Insurance on the issue, he said.

“Contrary to its current position, the Missouri Department of Insurance in 2003 and 2005 issued written statements that supported Central United’s method of payment of actual charge benefits to policyholders based upon the real amounts paid and accepted as payment in full instead of the list prices providers are ethically, legally and/or contractually forbidden to charge most patients,” McGettigan said.

The suit wants the court to order Central United to review its claims for cancer policies written before 2003 and pay restitution to affected policyholders. It also seeks monetary penalties to be paid to the state public school fund, as required by Missouri law.

“There are few events more life-changing than cancer, and this arbitrary decision by Central United is an attempt to abandon its solemn responsibility to protect its policyholders facing a serious and sometimes deadly illness,” said John M. Huff, director of the MissouriDepartment of Insurance, Financial Institutions and Professional Registration, in a statement.

According to McGettigan, a law recently passed in Missouri, and several other state laws, supports Central United’s position on the issue. “Central United’s payment of actual charges benefits is consistent with policy language andsupports making supplemental insurance more affordable for all policyholders,” he said.

Central United Life Insurance, which is a member of Manhattan Insurance Group based in Texas, currently has a Best’s Financial Strength Rating of B+ (Good).

 

Central United Life Insurance Company and their cancer policies are like cancer.

Central United Life Insurance Company and their cancer policies are like cancer. They keep changing things, are hard to deal with, and wear you down.

From The Missouri Department of Insurance, Financial Institutions and Professional Registration (DIFP) released August 28, 2009

Jefferson City, Mo. – Missouri insurance regulators have gone to court to stop an Arkansas-based life insurance company from illegally changing the terms of its cancer insurance policies. The state Department of Insurance says Central United Life Insurance Company is trying to avoid paying thousands of dollars due each of its Missouri policyholders who get treatment for cancer.

Central United has sold contracts, known technically as “specified disease” policies, to Missourians since 1997. These insurance policies promise to pay policyholders the amount charged for their medical care if they are diagnosed with cancer, even if their treatment is actually paid for by health insurance.

The civil lawsuit, filed in Cole County Circuit Court, alleges that Central United changed its claims-handling practices in late 2003 to drastically reduce payments to policyholders with cancer.

“The very essence of insurance is providing protection when life-changing events occur,” said John M. Huff, Missouri Department of Insurance, Financial Institutions and Professional Registration (DIFP). “There are few events more life-changing than cancer, and this arbitrary decision by Central United is an attempt to abandon its solemn responsibility to protect its policyholders facing a serious and sometimes deadly illness.”

At issue is Central United’s decision to pay policyholders based on paid treatment costs, rather than what’s known as “actual charges.” When consumers with health insurance receive medical treatment, insurance pays a negotiated rate, rather than actual charges. For example, a hospital’s actual charges might be $10,000, but the health insurance company might have negotiated that payment down to $6,500.

The lawsuit asks that Central United be ordered to review its claims for cancer policies written before 2003 and pay restitution to any policyholders who were short-changed on their claims. The lawsuit also seeks monetary penalties to be paid to the state public school fund, as required by Missouri law.

 

Common Reasons for Denied Claims

Common Reasons for Denied Claims

• Treatment sought without prior authorization
• Improper claim filing (missing information, illegibility)
• Claims not filed within time limits
• Treatment not covered by policy
• Procedure deemed medically unnecessary

Visit us at www.mydeniedclaim.com today and let us help you with your claim if it has been denied for any reason!

 

Hobby Lobby has to pay $35,000 for Disability Discrimination and Wrongful Termination

Julie Tufts is feeling a bit more vindicated than she did before. Her employer, Hob Lob, LLC, operating under the name of Hobby Lobby, has been ordered by a judge to pay the fine as part of a settlement in a lawsuit filed by the Equal Employment Opportunity Commission. Hobby Lobby refused to allow Tufts to perform her work from a wheelchair.

Employed since 2005 with the company, Tufts injured herself on the job. She has a medical condition that causes diminished sensation in the legs and feet and she did not realize she’d torn tendons in her right foot. Her doctor instructed her to keep to a wheelchair and avoid any weight on that foot. Hobby Lobby’s response was to come back when she was healthy and any employee had to be able to climb ladders carrying 40 pounds. Her assurances that she was healthy and could perform work from her wheelchair fell on deaf ears After weekly, then monthly requests to be allowed to return to work she was officially fired a year later.

Along with the $35,000 fine, Hobby Lobby was ordered to conduct training on the Americans With Disabilities Act and post a resolution in the branch where Tufts had previously worked. They also had pay substantial equitable relief and have injunctions against retaliation and discrimination. Their employee handbook will have to be revised to include policies for treating those with temporary disabilities. Hobby Lobby is being monitored by the EEOC for 30 months to ensure their compliance.

Discrimination is illegal in Tennessee as well as all 50 states. An employer can’t fire someone for an injury suffered on the job or a disability. The Americans with Disabilities Act protects disabled workers from termination or discrimination.

 

Blair Robes are still catching fire and killing folks wrapped inside them

 

We ran this story a couple of months ago, but we are still being contacted and asked many questions about it. We have spoken to a number of individuals adversely affected by Blair Robes, and they all seem to have a common complaint: Blair Robes keep catching fire! If you or anyone you know has had a run-in with a Blair Robe or any similar experience, contact us at www.mydeniedclaim.com today!

HARTFORD, Conn., Oct. 29 (UPI) — The daughter of a Connecticut woman who died when her bathrobe caught fire says she is suing the online seller, alleging the robe was dangerously defective.

Sharon Davis said her mother, Atwilda Brown, died Feb. 12, 2005, in her South Windsor, Conn., home, when her chenille bathrobe brushed against her electric stove’s burner while she was making a hot drink for herself, WFSB-TV in Hartford and The Hartford Courant reported Wednesday.

Brown called 911, but suffered burns to 35 percent of her arms and back and died several weeks later in a burn center, Davis said. Police and fire officials said they had never seen material burn so rapidly, she said.

Blair Corp., the Warren, Pa., company that sold the bathrobes, sent a recall letter this past April to customers who had purchased one of the garments designated a fire hazard by the Federal Consumer Protection and Safety Commission.

“When my mother died, all of her mail was forwarded to my address. My husband and I were just beside ourselves and it proved that it didn’t have to happen,” Davis said of receiving the company’s notice addressed to her mother four years after the fatal incident.

The family’s wrongful death suit, filed last week in U.S. District Court, seeks $30 million.

Nine people have died allegedly because of the flammable robe. The company, which said it doesn’t comment on pending litigation, issued another recall last week, bringing to 300,000 the number of items recalled, the news sources reported.

AND ALSO THIS

After 6 deaths, recall of Blair women’s chenille robes reissued

 

The clothing retailer and federal safety officials initially recalled 162,000 robes in April, saying they don’t meet flammability requirements.

recall  of 162,000 full-length chenille robes because the garments don’t meet federal flammability requirements and can catch fire if they are exposed to an open flame.

 

Blair of Warren, Pa., and the Consumer Product Safety Commission recalled the women’s chenille robes in April because of the fire hazard.

Since then, the company heard from families of six people who died after their Blair robes caught fire, commission spokesman Scott Wolfson said.

News of the deaths caused Blair and the commission to again alert consumers about the recall of the company’s chenille robes, Wolfson said.

Consumers are urged to immediately stop wearing the robes and return them to Blair for a $50 gift card, he said.

Of the six deaths reported to Blair as related to the burning robes, five of the victims were women who were cooking at the time and the sixth was a man wearing his spouse’s robe, Wolfson said. Three of the victims were in their 80s, and the deaths all took place before April, he said.

The original April recall was issued voluntarily by the commission and Blair after the company received three reports of the robes catching fire, including one incident that left a victim with second-degree burns, Wolfson said.

Blair sent letters to customers warning of the recall, the commission said.

A label in the robes reads “100% Cotton, RN 81700, Made in Pakistan,” the commission’s recall statement said. The robes also have labels with item numbers 3093111, 3093112, 3093113, 3093114, 3093115 or 3093116.

The one-piece robe has seven buttons, a shaped stand-up collar and two side-seam pockets, the statement said.

Blair’s catalogs, website and stores in Warren, Pa.; Grove City, Pa.; and Wilmington, Del., sold the robes from January 2003 to March 2009, the commission said.

 

Lawsuit Alleges Windstorm Association was not prepared to handle the number of claims generated by a disaster like Ike

TWIA struggled in the aftermath of Hurricane Ike. From getting slammed with claims all at once, they had to quickly figure out how to efficiently and effectively manage all their clients and claims at once. Is your Insurer capable of handling a situation like this? Regardless, call us today if you or your family has ever had trouble with their insurance company. Let us help you. Visit us at www.mydeniedclaim.com and fill out a contact form.

“Myrna Cedars had a feeling something was amiss when she couldn’t get through to her nonprofit’s property insurer months after Hurricane Ike.

Cedars, an accountant for the Hughen Center in Port Arthur, had questions about its claim, such as why the home for disabled children received a much lower payment to repair its leaking roof than an adjuster submitted.

“It was very frustrating,” she said. “It wasn’t uncommon for me to be on the line for hours at a time, just on hold, waiting.”

Internal e-mails from the Texas Windstorm Insurance Association recently filed in court indicate she’s probably not the only one. The e-mails illustrate how the state-created insurer scrambled to deal with more than 90,000 claims in the wake of Ike.

Management knew policyholders had trouble getting through to the insurer by phones, received checks without explanations and had claims handled inconsistently, according to the e-mails, which were filed earlier this month in Galveston County with a home-owner lawsuit.

Policyholder attorneys say the e-mails show that the insurer, which sells windstorm coverage to homeowners who can’t find it elsewhere, was unprepared. And the large number of consumer complaints after Ike punctuate the number of delays and unfair settlements, they say.

Jim Oliver, general manager of TWIA, acknowledged some delays and other claims issues as the insurer expanded its space, staff and phone systems after Ike. Despite the difficulties, however, Oliver said the insurer acted appropriately given the large number of claims filed after Ike.

“We were not un- prepared,” Oliver said. “We did very well.”

Rise in complaints

In two e-mails — one in September 2008 and another in February 2009 — TWIA managers reported an increased number of complaints from upset policyholders and agents. According to one e-mail, many complained about not being able to reach TWIA representatives by phone. Another e-mail shows that the insurer also received several complaints about inconsistencies in how claims supervisors handled claims and determined payments.

In other e-mails, TWIA instructed those handling claims not to tell policyholders how far behind it was or when claims reports were submitted.

“We need to keep TWIA business in house,” one e-mail said.

The e-mails indicate TWIA tried to hide that it was missing claims-handling deadlines provided by the policy and consumer protection laws, said Steve Mostyn, the attorney who filed the e-mails with a court case.

Oliver said he didn’t know those e-mails were sent and “would not ever tell anyone to cover up” anything.

A review by the Texas Department of Insurance confirmed some of the frustrations laid out in the e-mails.

The department, which received nearly 1,700 complaints as of June 1 about the insurer, reviewed 350 claims and 50 complaints this summer and recently sent its findings to members of the Windstorm Insurance Legislative Oversight Board.

Of all the companies it received complaints about, the insurance department found that TWIA had the highest percentage of justified complaints. TWIA, however, has disputed many of them.

Some of the reviewed files showed no evidence of communication with policyholders. Others showed claims checks were often sent without an explanation of how the amount was determined. There were also no reports to track the status of pending claims, and some claims weren’t processed within the time limits promised by the policy, the review showed.

The state also found that the insurer often handled claims inconsistently and lacked adequate training for its adjusters.

Before the storm, TWIA contracted with 12 firms that each promised up to 25 adjusters to help handle claims. But, the report said, the sheer volume of claims forced TWIA to use adjusters who had little training from the insurer.

The regulator is considering enforcement actions related to TWIA’s failure to process claims in a timely manner and is investigating some of its other claims practices. The department already has a pending lawsuit against TWIA that alleges it unfairly denied some roof claims.

Half of Ike claims

TWIA handled about 50 percent of the Ike claims filed in coastal counties.

Oliver maintains that the insurer’s claims practices are fair and that it processed claims as quickly as possible. The 92,000 claims Ike brought in were more than it has ever had to handle, he said.

He acknowledged the need for improvements and said TWIA plans to allow policyholders to check claims online, improve training and hire more staff.

The insurer’s board will have to weigh the benefit of having more staff and a bigger workspace with the costs of not using them in the years that no hurricanes occur, he said.

“Do you want to do that? Or do you want a system like ours that is scalable?” he said.

In a letter to lawmakers, he said hundreds of complaints came from homeowners who didn’t have adequate flood insurance and wanted the windstorm insurer to pay for flooding damage.

He also expressed surprise at the department’s criticism since he was in constant contact with Insurance Commissioner Mike Geeslin about TWIA’s response to Ike.

An insurance department representative also sat in on TWIA staff meetings for six weeks, and the department had reviewed the insurer’s plans.

‘Not fully prepared’

The department’s report speaks for itself, the commissioner said in a written statement.

“While TWIA came through on a majority of claims, it was not fully prepared for certain types of claims that follow a storm like Ike,” Geeslin said. “For these shortcomings, I take responsibility.”

But Alex Winslow, head of Texas Watch, called on lawmakers to conduct an independent investigation.

“TDI is playing catch-up because their oversight wasn’t vigorous enough immediately following the storm and TWIA is bellyaching that TDI is picking on them,” Winslow said. “Give me a break. TDI and TWIA both fell down on the job, and TWIA’s customers are the ones having to live with the consequences of their failures.”

Meanwhile, the board of the Hughen Center decided to hire an attorney.

“We went several months and we couldn’t get any communication,” Cedars said. “So we decided to go ahead and file suit.””
full source here

 

Dollar General has added two new board members

Newly public Dollar General has beefed up its board with Warren Bryant and Bill Rhodes, two veterans of the retail sector. The appointments bring the Goodlettsville-based retailer’s board to six.

Bryant, 63, was president and CEO and later chairman of Longs Drug Stores, the West Coast chain acquired by CVS last year. (That buyout also provided Dollar General with Todd Vasos, its current merchandising chief.) Prior to joining Longs, Bryant was senior vice president at Kroger from 1999 to 2002.

Rhodes, 42, was elected chairman of AutoZone in June 2007, adding that title to the president, CEO and director positions he’s held since 2005. He joined AutoZone in 1994 from Ernst & Young.

Rick Dreiling, Dollar General’s chairman and CEO, said Bryant and Rhodes have “worked across multiple facets of a retail organization, developing expertise in store operations, supply chain management and finance. We are confident that both will bring valuable knowledge to our newly-expanded board and look forward to their contributions as we drive the Dollar General business forward.”

 

Deaf and Mentally challenged Love files $2M claim against Mobile for Dollar General Fiasco

 

MOBILE, Ala. – A $2 million claim was filed Thursday with the Mobile City Clerk in relation to the incident where a deaf and mentally challenged man was tasered at a Dollar General store.

Birmingham attorney Tommy James, of the firm Morris, Haynes & Hornsby, represents Antonio Love, the deaf and mentally challenged man who was pepper-sprayed and tasered by Mobile police officers in the bathroom of a Dollar General store in Mobile.

Antonio Love’s family members say Mobile police went too far. “Tony,” as he is known, said he was sick and went into a store to use the restroom. The store manager called Mobile police after Love had been in the room for a while. If police knocked on the door or called for him, he had no way of knowing. Love is deaf.

Love described how things unfolded. His brother interpreted for him.

“He saw smoke. He said, ‘What’s that smell?’ He started putting water on the floor and tissue trying to block the smoke out. He put water on his mouth and face and started to hold his breath.”

What Love described was pepper spray. Police sprayed it under the door before breaking the door down. Love said he had no idea what was going on as the smoke poured in and the bashed-in door hit him in the head.

Things quickly went from bad to worse.

“Tased him in his chest. He was shaking saying, ‘Stop! Stop!’ He couldn’t move. They dragged him from the bathroom to the front,” his brother translated.

Love was tased three times. He said police didn’t realize he was deaf until they got him outside the store. That’s when they looked in his wallet and found a card detailing his handicap. Love said an EMT was dispatched, and after he was checked out, he was then put into the back of a police car and taken to Metro jail where he sat until police finally took him home later that afternoon.

James stated in a press release Thursday that his investigation is in its early stages, and that the family would have no further comment at this time.

“The family has not made a final decision on whether they will file a lawsuit. We are just trying to get all of the facts as to what really happened to Antonio and why it happened and then we will go from there. However, we may be forced to file suit so that we will be able to issue subpoenas to obtain the Internal Affairs investigation and other relevant documents because the City of Mobile is not willing to release this information to us.”

The incident occurred on July 24, 2009, at the Dollar General on Azalea Road. A notice of claim is required to be filed with the city clerk under Alabama law within six months of an incident when a city and its employees could potentially be defendants in a lawsuit.

In the press release James said, “The City has essentially forced us to file this because they have completely ignored all of the requests that we have made for information. We have requested the 911 tapes from the Mobile Police Department and they have refused to provide them to us even though they provided them freely to local media. The City has also refused to provide us with the internal affairs investigation into this incident. Based on the nature of this case, I am extremely surprised that the City is being so uncooperative.”

 

Interesting story… Makes you wonder if the family claims Love is as challenged as they do, why would they leave him unattended and allow him to venture out on his own? Did Love tell Dollar General or the Mobile Police department that he was deaf and mentally challenged and why he was in the bathroom for an extended time? It seems if Love is incapable of diffusing a simple situation such as this on his own, he should be considered incapable of going out on his own. You can not blame Police for doing their job. Sad yes, but what if Love was a dangerous criminal that had locked himself in the bathroom? No one could know the difference, as Love apparently is incapable of explaining himself. Love’s family has the responsibility here.