Market Conduct Practices of UnumProvident

UnumProvident dominates the disability insurance market in the United States. Since 2000, UnumProvident has been under fire for its controversial market conduct. In March 2003, the insurance commissioner of Georgia issued an order stemming from a market conduct examination of the UnumProvident companies’ claims practices. In September 2003, insurance regulators in Maine, Massachusetts, and Tennessee began a multi-state examination of the claims practices at Unum Life of America, Paul Revere Life, and Provident Life and Accident—subsidiaries of UnumProvident Corporation. The findings are detailed below.

UnumProvident claims, among other things, to be committed to “putting people first” and “focusing resources to make a difference, one person at a time.” Based on the Georgia and the September 2003 Market Conduct Examination (the Report was issued November 2004), and consumer feedback, UnumProvident’s claim could not be further from the truth.

The Georgia Report

The Georgia report identified various areas where UnumProvident failed to meet consumer expectations. One area in particular was UnumProvident’s interpretation of policy provisions. Apparently UnumProvident denied many consumer claims because the claims did not fall under a narrow-reading of the policy provisions. Additionally, UnumProvident’s claims personnel overruled medical opinions made by highly trained and/or qualified professionals relating to the disability status of a consumer’s claim. UnumProvident also denied many consumer claims while giving little or no notice to consumers regarding the appeals process available for denied claims. While identifying these problems areas, however, the Georgia Report failed to allege any violations of state laws.

The November 2004 Report

The findings of the report conducted by Maine, Massachusetts and Tennessee, published over a year after the Georgia Report, showed little change in UnumProvident’s practices. The report described several general areas of concern, including—“excessive reliance upon in-house medical professionals,” “unfair construction of attending physician or IME [independent medical examination] reports,” “failure to evaluate the totality of the claimant’s medical condition,” and "inappropriate burden placed on claimants to justify eligibility for benefits."

Essentially, UnumProvident did not change its market conduct after the Georgia Report. UnumProvident continued to rely on its own medical evaluations instead of professional evaluations and continued to narrowly interpret policy provisions. UnumProvident continually failed to conduct thorough evaluations of its claimants’ medical conditions, and required claimants to give explanations for their eligibility for benefits. The report detailed terms which UnumProvident was required to comply; however, like the Georgia Report, the report lacked any specific allegations of state law violations.

Terms of the Agreement

An outline of the terms of the multi-state agreement published in November 2004 can be viewed at http://www.oag.state.ny.us/press/2004/nov/nov18a_04.html.

What Must be Done?

The terms of the agreement, however, are deceiving. UnumProvident has not agreed to all of the terms. For example, UnumProvident has not agreed to “reassess the claims of approximately 200,000 individuals.” In fact, UnumProvident has agreed to reassess the claims of only those claimants who meet certain requirements and accept a complex offer. Reassessment of claims is limited to those who:

• offer, in writing, to reassess claims denied or closed since January 1, 2000 for reasons other than settlement, death, or reaching benefit maximums
• allow for reassessment, upon request, of claims similarly denied or closed between January 1, 1997 and December 31, 1999

Additionally, UnumProvident at times fails to make disability payments to its policyholders. UnumProvident must be held accountable for the promises it made in the agreement published in the November 2004 report. If you or someone you know has disability insurance through UnumProvident, ensure that you are adequately covered by UnumProvident’s provisions. If you have any complaints about UnumProvident, you may let us know on our consumer complaint page, or list any complaints about UnumProvident at http://www.consumeraffairs.com/insurance/unum.html.

For additional information concerning UnumProvident’s multi-state agreement go to http://www.dol.gov/ebsa/faqs/faq_unumprovident.html. Let us know about your experience with UnumProvident by visiting our consumer complaint page and filling out our easy complaint form.