Unum – Heartless AND Wrong

28 11 2009

A little background

I suffer from fibromyalgia – a very real if little understood syndrome characterized by nearly constant pain, exhaustion, and a myriad of associated symptoms.  I have learned to live as best I can with this, and those of you who know me personally understand that I do what I can, when I can.

What I can't do anymore is reliably report to a 9-5 job, even an office job.  My body has set it's own rules for when and how much rest it demands, and how long I can sit, drive, or type.  While my own business efforts try to accommodate this fact, most companies require a more dependable schedule and productivity rate for their employees, and I completely understand that.  I had been employed full time with a very accommodating company that had done the best it could to work around my condition, but eventually, it got to be too much for both of us.  So when I could finally not meet requirements anymore, I saw my rheumatologist, explained the issue, and I decided after speaking with him to take advantage of my company-supplied Short Term Disability benefit.

After dealing with the provider, Unum Insurance, I can only assume this is characterized as a benefit to my employer because it makes them appear to be generous – though it could also be characterized as a benefit to Unum because they make truckloads of money on it.  It certainly is no benefit to me, since Unum has done everything possible not to pay my claim.

The heart of the matter
I recently received a call from Unum stating that my claim was being denied.  Why?  Because the doctor didn't take me out of work, I took myself out of work because I simply couldn't do it anymore.  My rheumatologist is not in the business of telling people with fibromyalgia what they can or can't do.  Fibro sufferers have varying amounts of pain and exhaustion, and only they really know what they are capable of.  My doctor supports me in whatever decision I make, but he can't tell me "You should work" or "You shouldn't work."

Unum told me, "We can't approve a claim if your doctor doesn't support you being out on disability." 

To which I replied, "Did you ask him if he supported me being on disability?"  The rest of the conversation went something like this:

Unum:  "Well, we asked him if he took you out of work and he said no."

Me: "That's true, I took myself out of work, he didn't."

Unum: "Well, we can't approve your claim if your doctor doesn't support your being out of work."

Me: "But you didn't ask him that, did you?  You asked him if he took me out.  What if I had been in a car accident and been hospitalized?  My doctor wouldn't have taken me out of work, but surely you wouldn't deny the claim."

Unum: "Well in that case medical records would support the claim."

Me: "And did you ask for my medical record?"

Unum: "Um, no, because your doctor said he didn't take you out of work."

Me (seeing the futility of arguing with logic): "Why don't you call him back and ask him if he supports me being out of work?"

Unum: "Well, I can do that, and if he says yes I can reopen the case, but for now I have to deny it."

Me: "You can't wait ONE business day to make a phone call?!  You're the one not asking the right questions! I've jumped through every hoop you've given me."

Unum:  "I'm sorry. I will try to call him, but for now your claim is denied."

Now, the best part of the story: this all took place on the day before Thanksgiving.

This guy could have looked at the calendar and the clock and said, well, it's almost 4pm on the east coast on the day before Thanksgiving… I could just wait and call this guy Monday morning and let him enjoy his holiday.

He could have, but he didn't. 

Either his management or his corporate culture – or very likely both –  wouldn't allow him to or had dulled him to the point of not even considering it.  Score another victory for the insurance industry.

Whether or not Unum eventually pays my claim (which I doubt), how they have handled it so far speaks volumes as to their customer service.  Compassion and generosity of spirit don't contribute to the bottom line.  Apparently, neither does logic or asking the right questions.

It's all about profits – which go up if you don't pay claims.  Never mind that paying claims is the customer service part of the business model. The last thing Unum got into the insurance business to do was to give away money, right?

The whole transaction is a microcosm of everything that is wrong with the insurance industry in this country.  More to the point it's a microcosm of everything that's wrong with Unum.

Unum, you should be ashamed of yourself.  But somehow I think being shameless is a prerequisite for success in your industry.

Posted via email from NetWeave Threads

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