While I was working, my employer provided group disability insurance as part of my employee benefit package. We were told at employee information workshops: "If you can't do your job for any reason, you will be paid 60% of your salary, no matter what" Those words continue to haunt me. When I became 100% disabled the insurer, Unum Provident disqualified me from getting my disability by making unreasonable demands for documentation from a doctor I hadn't seen in nine months. I was told there was no appeal. I lost all my pension and retirement savings just trying to survive, and will soon end up homeless or in a room because my Social Security Disability isn't enough to pay basic living expenses. My case is far from unique. Group disability insurers, particularly Unum Provident, have made similar denials several hundred thousand times all over the country, wreaking havoc with people's lives.
As a result of their lawless conduct, Unum Provident was sued by 48 states in a multi-state suit and a toothless settlement agreement was made, agreeing to notify denied claimants of possible reconsideration. The letters carried "do not forward, return to sender" messages. If the letter was returned twice, the claimant was disqualified. If the claimant did ask for reconsideration, they had to sign away all rights to legal recourse. My letter never reached me, since I had moved several times to progressively smaller and cheaper apartments. In October of 2005, progressive California settled its suit separately with improved protections, including the right to outside judicial review of cases that are denied a second time. Unfortunately, I am not covered under the laws of California, my home state, because my run-away job exporting company wrote their master policy in the great state of Georgia, where Unum Provident will review their own denials. As far as I am concerned, that amounts to putting the fox in charge of the henhouse.
After 9 attempts to get Unum to reopen my case, (which should be open and shut because I am on SSDI), I signed on to a class action lawsuit with an excellent disability law firm, Bourhis and Wolfson of San Francisco. After I signed on to the lawsuit, my virtually useless reconsideration letter from Unum Provident magically appeared. Unfortunately, I have had to withdraw from the suit because Unum Provident's lawyers applied pressure by invoking an obscure and fuzzy preemption clause in the Employee Retirement Income Security Act (ERISA), a clause which has been favorably interpreted and upheld many times by corporate leaning judges. This preemption clause allows federal law to supercede the state fraud and bad faith laws in cases where ERISA claimants attempt to recover damages, even if they have clearly been the victims of bad faith, fraud and abuse. Most judges have ruled that ERISA claimants can never recover damages, no matter what the situation. The fact that there are NO FEDERAL LAWS that regulate insurance companies doesn't seem to matter, nor do the states' rights to protect their citizens with anti-fraud and abuse laws, so insurance companies are free to do as they please without fear of penalty. Workers have no recourse if they are denied benefits, even if they meet the strict social security standards for 100% permanent disability. They can never sue for damages.
The public may be more familiar with this issue in the matter of HMOs. HMOs invoked this ERISA preemption clause to strip workers who get their health insurance through their employers from the right to sue their HMO. This applies no matter how grievous the injury and abuse that has been perpetrated. In plain terms, this means that the HMO Group Plan you have through your employer can deny you care and kill or maim you as a result, and they cannot be sued for damages as a result of their actions. They have virtual carte blanche to hide behind the ERISA preemption clause. Insurance companies love to sell employers these group disability insurance policies because it is massively profitable to keep collecting premiums and seldom pay out anything.
Hundreds of thousands of disabled workers like me have lost everything and will continue to suffer because insurance companies can deny benefits at will without any penalties. They get the carrot and the workers get the stick. Many "insured" people are on public assistance and even homeless because they cannot collect the benefits they are entitled to. Soon I will have to give up my own apartment and most everything and live in a room, because that is all I can afford on $811 per month. My savings will be gone by Spring and there is little hope of getting my $1400+ disability payments from Unum anytime soon, if ever, unless new legislation is passed. Many others are in even worse circumstances.
This is a real test of We the People. Are you brave enough to take on the insurance corporations that use and abuse us? I'm just one old lady looking for some justice and I'm not scared. I still believe in We the People" How about you?