Even Superman Had To Fight the Insurance Companies
. . . the late Christopher Reeve . . . had to push hard for
the necessary (and expensive) exercise equipment that would help prevent his
muscles from succumbing to atrophy.
Unum Group Reports Healthy Earnings,
Despite Denied Claims Reassessments
Albany, NY: It would be little
consolation to current or former clients of Unum Group (formerly
UnumProvident) who have ever had their claims denied, to know that the company
has announced healthy earnings for the second quarter, fuelled by record
revenue from their Colonial Life division.
And in spite of taking a
$53 million dollar charge against the costs of dealing with claims
reassessments, Unum expects to put that messy business behind them a full three
months early, and they have hiked their revenue and performance forecasts for
the remainder of the year. Operating income, as reported August 1st, was up 31
per cent from a year ago and the company is feeling bullish about the
Compare that position to policyholders who may have lost
wages, their homes, even their livelihoods, in the wake of a spate of denied
claims and other unfair practices. Many policyholders, in comparison, have paid
a far stiffer price than the company, even with a $53 million dollar setback,
would ever have to pay.
The former UnumProvident is under new
management, however - and re-branded the first of the year in an attempt to
distance itself from the tarnished image it once had of a greedy, unscrupulous
Their conduct came under the scrutiny of the U.S. Department
of Labour, and a subsequent investigation led to an agreement by UnumProvident
to re-evaluate previously-denied claims from January 1st, 1997 to December
31st, 1999. Policyholders hoping to have their denied claims reassessed had
until December 31st 2006 to submit an appeal.
The agreement reached
with the Department of Labour is not related to any action brought by any
individual state. The insurance industry is regulated at the state level.
Past complaints against UnumProvident included denials of claims for a
medical condition for which the insurer conducted no examination. In essence,
Unum's medical authority would disagree with the findings of a typical claim,
without benefit of conducting a personal, individualized examination. In this
way, many policy holders who depended on their long-term disability coverage to
get them through in the event of a health concern that prevented them from
working, were left at loose ends without the safety net, they thought, they
In fairness to Unum, it appears to be a systematic failing of the
industry, as insurers will gladly accept premiums (and will just as quickly
cancel a policy if the premium is unpaid), but will balk when it comes to
paying a claim. In his autobiography 'Still Me,' the late Christopher Reeve
told of the frustration he and his late wife Dana Reeve went through in the
aftermath of the actor's riding accident that left him a quadriplegic and
paralysed from the neck down. In spite of his celebrity and the obvious need,
their long-term disability insurer objected to an extension of his stay in
rehab, and the Reeves had to push hard for the necessary (and expensive)
exercise equipment that would help prevent his muscles from succumbing to
In a word, Mr. Reeve explained that in his view employees of
insurance companies interpreted their jobs as having a responsibility for
saving money and mitigating the payouts - and that the antidote to that
position is to simply fight back.
Not enough people are willing to
take on their insurer in such a way.
It's not like they don't have the
money, as Unum's August 1st financial statement revealed. Even with the costs
associated with claim reassessments, the company is making money. And that is
bound to continue, as the age wave peaks at a place where the largest chunk of
workers begin to realize it's not enough to simply earn a paycheque. More than
that, you've got to put something away for a rainy day, and to ensure that you,
your family and your assets are protected in the event you are no longer able
to earn an income.
That's why people buy insurance. And premiums,
which are paid diligently, should be met with equal diligence on the part of
the insurer, according to the provisions and the limitations of the
If an insurer (as they have a tendency to do) attempts to
misrepresent, or misinterpret a client's policy or circumstance to its own
advantage just to save a buck, there may be legal precedents based on a denial
of the policyholder's rights. The client needs to be prepared to push back and
fight, in order to ensure those rights are protected, and that safety net isn't
full of holes.