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Thread: Transcript Of Dateline Story On UnumProvident (about insurance industry)

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    Senior Member Max's Avatar
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    Transcript Of Dateline Story On UnumProvident (about insurance industry)

    Transcript Of Dateline Story On UnumProvident
    posted October 15, 2002

    Here is the transcript of the story about Chattanooga-based UnumProvident that was aired Sunday night on Dateline NBC:

    BENEFIT OF THE DOUBT - From: Dateline NBC, Oct 13, 2002

    Announcer - From our studios in New York, here is Stone Phillips.

    STONE PHILLIPS: Good evening. Insurance. We buy it for peace of mind, to cover our homes, our health, our lives. And millions of Americans have disability insurance to help replace lost income in case of a serious illness or injury. If you can't work, those benefits may be crucial for you and your family.

    But what if suddenly, unexpectedly, your benefits were cut off? That's
    what happened to the people in our first story. Tonight, some startling
    charges against the biggest disability insurance provider in the
    country. Here's John Larson with a DATELINE Investigation.

    JOHN LARSON reporting: Voiceover - It began on this stretch of
    Interstate 40 in Albuquerque, New Mexico, in February of 1998. A car
    salesman swerves to avoid some rocks, and the world suddenly turns
    upside down.

    (Video of car on highway getting into an accident)

    Mr. JOHN MONTANO: The nurses and all the physicians they were saying,
    `Do you have any feeling? Can you move your legs?' And--and I kept
    telling them, `I can't feel anything from the chest down.'

    LARSON: Voiceover - The accident had severed John Montano's spinal
    cord. Although he was spared some limited use of his arms, he's
    considered a quadriplegic, paralyzed for life. And what lay ahead could
    hardly have looked worse. Unable to work or support his family, Montano
    faced losing everything. But like millions of Americans, he had prepared
    for just such a disaster. He had paid $59 a month for disability
    insurance, which promised if he was ever too sick or too injured to keep
    working, it would help replace his lost income. The checks began
    arriving as promised, but after two years, he got a shocking letter.
    His disability benefits were being cut off.

    (Video of Montano struggling with disability, and picture of letter from
    UNUM.)

    Mr. MONTANO: I was scared and I was frightened. I go, `Well, there's
    got to be a mistake.'

    LARSON: But there was no mistake. Montano's insurance company had
    decided that despite his paralysis he no longer deserved benefits. So
    what was going on?

    Sources tell DATELINE that what happened to John Montano may have been
    part of something much larger. Tonight, a DATELINE Investigation into
    whether the largest disability carrier in the United States,
    UnumProvident, launched a company-wide effort to cut costs aggressively,
    and in the process, unfairly denied benefits, selling out people it
    promised to protect.

    Mr. MONTANO: They just basically cut me off and that was it.

    LARSON: Voiceover - In Montano's case, Provident claimed to have good
    reason. It said it had surveillance tape that Montano had improved
    immensely and he should go back to work selling cars.

    (Video of letter excerpts.)

    LARSON: Was there any way that John was faking his quadriplegia?

    Dr. JONATHAN BURG: Absolutely not. There's no way.

    LARSON: Voiceover - Dr. Jonathan Burg is Montano's doctor.

    (Video of Dr Burg talking to reporter - Burg examining x-rays)

    Dr. BURG: This is the area of his--basically the area of his paralysis.

    LARSON: Voiceover - He says the records are clear, Montano is a
    quadriplegic.

    (Burg describes x-rays)

    LARSON: Did you tell the company, `Look, I'll take any test you want me
    to take?'

    Mr. MONTANO: Yes.

    LARSON: And so did they do that? Did they evaluate you?

    Mr. MONTANO: No, they--I didn't hear back from them.

    LARSON: Voiceover - The disability and life insurance industry says it
    faces one and a half billion dollarsin fraudulent claims every year. So
    you can understand why it might investigate Montano's claim. But when
    UnumProvident finally shared its surveillance tape, Dr. Burg says it
    showed nothing new. Just John Montano driving his specially-equipped
    van, demonstrating what everyone already knew. Montano had a limited use of his upper arms. In a letter to UnumProvident, Dr. Burg stated, "by
    all standards this man is completely and totally disabled."

    Meanwhile, his benefits cut off, Montano spiraled towards bankruptcy.
    His wife had divorced him after the accident. Now, faced with losing
    his home and his children, he says he became suicidal.

    (Videos of Montano driving his van, and later struggling with his
    disability.)

    LARSON: It sounds like it was pretty close.

    Mr. MONTANO: Yeah. Yeah.

    LARSON: Voiceover - So how could something like this happen? These
    people say they know.

    (Video of Montano talking to reporter - people talking to reporter from
    darkened room)

    Unidentified Man no. 1: They have to literally fight to get their
    benefits.

    LARSON: Voiceover - These three former UnumProvident employees tell a
    disturbing story of a company obsessed with finding excuses to cut off benefits.

    (Video of people in the dark talking to reporter and of UnumProvident
    building)

    LARSON: Did you feel pressure to deny claims?

    Unidentified Man no. 2: Absolutely.

    LARSON: They asked DATELINE to conceal their identities because they're afraid of reprisals.

    Man no. 2: Find ways to close the claim. Just look so very carefully to
    find anything that will disqualify them from claim.

    Man no. 1: They even gave incentives.

    LARSON: Incentives how?

    Man no. 1: Incentives for closing claims. If we projected that we're
    going to close 30, if we get to 30 we'll have a pizza party or we'll
    have an ice cream party.

    LARSON: Voiceover - Would the company pressure employees to terminate claims? Financial reports show that in 1993 the company was losing millions. Then came new management and a complete reversal. It began making millions. How did they do it? UnumProvident says by
    restructuring and making smart business decisions. But internal
    documents suggest the company had a new game plan to help it deny as
    many claims as it could.

    (Video of UNUM building, their net income, and "confidential documents")

    Offscreen Voice from video - Would you raise your right hand, please.

    LARSON: Voiceover - This man, Dr. William Feist, was one of
    Provident's two staff physicians when new management took over in 1993.
    He left the company two years later. Here in a deposition, he describes
    under oath how the company changed.

    (Video of Feist being deposed.)

    Dr. WILLIAM FEIST: (from deposition) There was no concern for the
    individual. It was just bottom line. `If we can terminate this file,
    we're going to do it.'

    LARSON: Voiceover - Dr. Feist says the company first began targeting
    the policyholders who were costing the company the most money at
    meetings called "round tables."

    (Feist videotaped deposition - UnumProvident building)

    Dr. FEIST: (From video) The object of the round table was to cut off the
    high-dollar claims.

    LARSON: Voiceover - UnumProvident urged DATELINE not to believe Dr.
    Feist, saying his knowledge of the company is "outdated," and that he
    has twice signed affidavits which included false information. Dr. Feist
    says they were simple mistakes. And remember, Dr. Feist is not the only
    one speaking out.

    (Video of UnumProvident letters - Feist videotape deposition - people
    in shadows talking to reporter)

    Unidentified Man no. 3: It became a witch hunt.

    LARSON: Voiceover - These people say they encountered similar round
    tables years later.

    (People in shadows talking to reporter)

    Man no. 3: It was all looking for loopholes to close the claim.

    LARSON: `And if you can't do it, we'll have a team of experts here to
    figure out how you can.'

    Man no. 1: It was mandatory. Even if you didn't have a claim, you'd
    better find one.

    LARSON: Voiceover - They say most vulnerable were policyholders with
    so-called "subjective illnesses," illnesses that don't show up on x-rays
    or MRI's, like mental illness, chronic pain, migraines or even
    Parkinsons.

    (MRI scans and x-rays)

    Man no. 1: `So they're fatigued. Prove it.' `So they've got achy
    joints. Prove it. Why can't they work?'

    LARSON: And if they can't prove it?

    Man no. 1: They're out of there.

    LARSON: Denied.

    Man no. 1: Denied.

    LARSON: And they are not the only ones saying this. In all, 10
    UnumProvident employees agreed to speak with DATELINE, but only if we
    promised not to reveal their names. We can tell you this about them:
    their jobs range from claim representatives all the way up to vice
    presidents. Some left the company on their own, some were fired, and
    some still work at UnumProvident. But all have described the same
    atmosphere, one of intense pressure coming from management, down to
    employees. Pressure to cut off benefits to policyholders.

    Voiceover - DATELINE also searched thousands of pages of internal
    corporate documents and court records and found evidence that appears to
    back up what they say. This is a series of internal monthly reports
    that show company savings seem to be growing--the result of cutting
    claims. "Terminated claims have reached a record level."

    And, we found evidence that suggests the company set goals for cutting
    claims, deciding ahead of time how many claims should be denied. Like
    this 1995 top-level memo. It spells out a company-wide goal to
    terminate $132 million in claims. Here, an internal e-mail from last
    year alerting a group of adjusters they have one week to close 18 more
    claims to meet our projections. These people say if they didn't meet
    their projections, they'd have what they called "fire drills," intensive
    efforts to find claims to close.

    (Stacks of papers and memos - emails - people in shadows talking to
    reporter - files)

    LARSON: The image is of a fire drill, a bell goes off, and everybody
    rallies to a cause. What was the cause?

    Man no. 3: The cause was looking for opportunities to close a file.

    LARSON: Deny claims.

    Man no. 3: Deny claims.

    LARSON: Voiceover - UnumProvident would not agree to an on-camera
    interview, but vehemently denies that it sets goals to terminate claims.
    In a letter to DATELINE, it says it does "estimate claim results to
    project a business plan into the future," which may have been
    "mischaracterized or misinterpreted by others." Also, it says that it
    will pay $3.6 billion in benefits this year. And that of all the people
    who filed claims with UnumProvident last year, only 2 percent were found
    to be not disabled. And, it says it has a consistent record in paying
    claims.

    UnumProvident is more than just claims people and managers. It's also
    doctors, over 100 of them, doctors sworn to do no harm. Wouldn't a
    UnumProvident doctor stop the company from cutting off disabled people?
    Not according to this policy holder.

    (Exerpts from letters)

    If I could have every wish in the world, I'd--I'd wish that I could
    teach again and see my kids get older. Two wishes.

    LARSON: Voiceover - Once a healthy, vibrant school teacher from
    Illinois, Rosemary Wright began suffering from a progressive, fatal form
    of emphysema. Even the smallest activity can leave her gasping for
    breath.

    Her doctors say the kind of emphysema Wright has is genetic, it's not
    from smoking. The same disease had already killed her younger brother,
    and now it's killing her. When Wright became too sick to teach,
    UnumProvident began paying her disability benefits. But two years
    later, just as in John Montano's case, the company cut her off.

    (Photos of Rosemary Wright - Wright making bed, pausing to catch breath
    - photo of man - Wright - Wright taking medicine from inhaler)

    Ms. WRIGHT: I opened that letter, and I couldn't believe it. I thought,
    `Why? I mean, this must be a mistake.'

    LARSON: Voiceover - UnumProvident based its decision on the opinion of
    a UnumProvident staff doctor who not only never examined Wright in
    person, but disregarded the opinions of Wright's two doctors, both lung
    specialists who had examined her and found her totally and completely
    disabled.

    So how could a UnumProvident doctor help cut her off? Dr. Fergal
    McSharry, who doesn't know Rosemary Wright, worked for UnumProvident for
    a year and a half. He says it is more about the system than the doctor.

    (UnumProvident building - UnumProvident letter - excerpt from letter -
    letter from Arizona Pulmonary Specialists, Ltd. - excerpt from letter -
    UnumProvident building - Fergal McSharry)

    LARSON: Doctor, were they interested in your honest, objective medical
    opinion?

    Dr. FERGAL McSHARRY: No.

    LARSON: Voiceover - McSharry says doctors at UnumProvident were
    pressured to write narrow medical reports to help the company deny
    benefits.

    (UnumProvident building)

    Dr. McSHARRY: We were a means to an end.

    LARSON: And the end was?

    Dr. McSHARRY: The end was denial.

    LARSON: Voiceover - And if too many of their opinions favored the
    claimants, McSharry says doctors would be reprimanded, in his case, by
    his boss.

    (UnumProvident building)

    Dr. McSHARRY: I was told that I'd fallen off the career path.

    LARSON: What did you feel you had to do to get back on their career
    path?

    Dr. McSHARRY: You know, I was just going to have to do more of what the
    claims people wanted me to do, which was...

    LARSON: And what was that?

    Dr. McSHARRY: That was to make it easy for them to deny the claim.

    LARSON: Voiceover - Dr. McSharry says, like other doctors who work at
    UnumProvident, he succumbed to the pressure.

    (McSharry talking to reporter)

    LARSON: Did you ever change a medical opinion because you were being
    pressured?

    Dr. McSHARRY: Yes. I did.

    LARSON: These were cases where, in your best medical opinion, you
    thought these people were either sick or impaired or disabled. You
    reversed your own best judgment?

    Dr. McSHARRY: Um-hm. I did that. I didn't want to lose my job. I
    didn't want to upset everybody around me, and I tried to play within the
    rules.

    LARSON: Voiceover - McSharry says he did it only a couple of times and
    vowed never to do it again. Even so, if what he's saying is true, they
    got his medical soul.

    (McSharry talking to reporter)

    Dr. McSHARRY: Yeah. I'm only human. I--I had--you know, I--I gave in
    once or twice. I just hope I didn't hurt somebody too--too badly.

    LARSON: Voiceover - UnumProvident says it doesn't pressure doctors to
    terminate claims. So what happened to Dr. McSharry? He was fired from
    UnumProvident for what the company calls "poor performance." It also
    says Dr. McSharry was forced to resign from other jobs for similar
    reasons.

    But McSharry says that losing those other jobs had nothing to do with
    his performance, and the real reason he was fired from UnumProvident was
    that he began standing up to the company, refusing to play along. In
    fact, five of DATELINE's sources back up Dr. McSharry's story.
    Specifically, that doctors were pressured to help cut off benefits. Dr.
    McSharry is now suing UnumProvident.

    (Video McSharry talking to reporter and excerpts from letters)

    Dr. McSHARRY: I don't have a problem with people setting targets as long
    as those targets are reasonable and don't hurt people.

    LARSON: Were these targets reasonable?

    Dr. McSHARRY: No, not at all.

    LARSON: Did they hurt people?

    Dr. McSHARRY: They hurt people every day.

    Ms. WRIGHT: They didn't just take the money away from me. But they took
    a sense of dignity away from me.

    LARSON: Voiceover - After UnumProvident ended her disability payments,
    Rosemary Wright says she was forced to begin spending money she had
    saved for a lung transplant just to cover living expenses. Wright sued
    the UnumProvident, which suddenly reversed itself, reimbursed her back
    benefits and began paying her again. But Wright has not dropped her
    lawsuit, and says the stress took its toll.

    (Wright)

    Ms. WRIGHT: I wasn't sleeping. You know, I was a wreck. And yes, last
    year was the sickest year I've ever had. I believe that they robbed me
    of a--of a whole--almost a year of my life.

    LARSON: Voiceover - As for John Montano, the quadriplegic, he also
    filed suit against UnumProvident and the company settled with him for an
    undisclosed amount of money.

    (Montano getting into van)

    LARSON: In the end what was this company's promise worth?

    Mr. MONTANO: To me, nothing. Their word, the way they operate, they're
    totally unethical.

    LARSON: Voiceover - UnumProvident says it regrets how it handled the
    cases of Wright and Montano, but says they're exceptions. It also says
    it handles 400,000 new claims a year and it does on occasion, make a
    mistake. Yet, in the eyes of at least one insurance commissioner, it
    may be more than an occasional mistake.

    (Video of UnumProvident letters - excerpts from letters - GA insurance
    commissioner)

    Mr. JOHN OXENDINE: There are some substantial problem areas...

    LARSON: Voiceover - Georgia Insurance Commissioner John Oxendine told DATELINE he began investigating UnumProvident's disability practices
    more than a year ago. He says his investigation should be complete by
    the end of the year.

    Mr. OXENDINE: Unless something radical changes, there probably will be some disciplinary action based on what we have already found.

    LARSON: Voiceover - UnumProvident says the problems in Georgia
    represent a small percentage of their overall claims, and it will do
    what is necessary to correct these issues. In the end, both Montano and
    Wright say no one should be treated the way they were treated--cut off,
    abandoned by a company that had promised if the worst ever happened, it would be there for them.

    (UnumProvident building - and Mr. Montano)

    Mr. MONTANO: It's like stealing. They should have - be held accountable
    for that.

    http://www.chattanoogan.com/articles/article_27804.asp

    Email this to a friend

    ==============================
    "Events in our past seem to slip further away with time. But what happens when they circle back and meet us head on....in the present? Before we allow ourselves to be consumed by our regrets, we should remember the mistakes we make in life are not so important as the lessons we draw from them.." Outer Limits(Last supper)



  2. #2
    Just out of curiousity, why was this guy unable to return to work?

  3. #3
    Senior Member mk99's Avatar
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    My experience with UnumProvident

    I had a small critical illness policy with UnumProvident. After my injury they didn't want to pay up.

    After harassing the adjustor for a long time she told me flat out:

    "We are going through your entire medical history trying to find ANY documentation of depression. Then we will try to prove that you were attempting suicide and therefore we don't have to pay you".

    No joke, that's what they said. In the end they paid up but it was a real struggle.


    LindsayS: maybe the guy can't work cause he has chronic pain, bowel & bladder incontinence, can't stay up in a chair for more than an hour, maybe he's got a big head injury, etc , etc. Many people stay off work for years because of back pain, why is it so hard to comprehend that some people can't work after becoming a quad or para? Maybe this guy bought insurance so that IN CASE this kind of thing happened that he wouldn't HAVE to work?

  4. #4
    Uh, Mkowalski, that's why I asked. I wondered if anyone knew the reason. I wasn't flaming. Geez.

  5. #5
    thanks ; i've been looking for this to fw to someone. it wasn't on dateline nbc's website.
    joy

  6. #6
    Senior Member mk99's Avatar
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    Perhaps my post came across as too strong. I have my own bitter experiences with UnumProvident (as well as other Insurance Companies) and to me it sure sounded like you were saying:

    "Another lazy person with SCI. Why can't he work? I can work, therefore everyone else should work".

    Regardless I apologize for the overly harsh respone. Today in particular my back is killing me, just went for another botox injection and it hasn't kicked in yet, 3 hour bowel program this morning... this is the shit I go through all the time. The thought of having to hold down a full time job AFTER purchasing insurance EXACTLY for this reason is very offensive and I can relate to it very personally. You buy insurance, your #'s come up and the bastards don't want to pay. Then you need a lawyer to help you collect what you paid for. And then of course the lawyer takes a nice big cut as well.

    It's still a million times better than NOT having any insurance company to fight with and living in poverty.

  7. #7
    Senior Member Max's Avatar
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    Mike

    Take is easy


    Everybody has bad days...

    ==============================
    "Events in our past seem to slip further away with time. But what happens when they circle back and meet us head on....in the present? Before we allow ourselves to be consumed by our regrets, we should remember the mistakes we make in life are not so important as the lessons we draw from them.." Outer Limits(Last supper)



  8. #8
    Lindsay, some of your responses are baffling?

    Mike, you're absolutely right. We are encouraged to buy the insurance, pay the premiums in case of a catastrophic illness. Paralysis is a catastrophic illness. Anyone who denys that and refuses to reward the benefit is an idiot and a criminal.

    98% of the general population doesn't have LTD. God bless them if they ever get a serious illness or injury. Odds are they'll be bankrupt in a year.

    Insurance is purchased to ensure that your assets are protected. A job (income) is an asset. If someone can't perform their job as they always have (income) due to health related issues then disability, both STD and LTD, are designed to pick up the financial loss.

    UNUM should be sued for every dime. How pathetic.

    Onward and Upward!

  9. #9
    Unum and Provident were feirce competitors who made a lot of money in the 80's but lost money 5 years in a row in the 90's.They merged out of desperation hoping that they would cut costs and stop losing money,but it did not work.Their unethical actions are out of desperation to stay in business.All this can be verified by reading the A.M. Best reports from1985 thru present.
    WHAT TO DO: It does not matter your insuer.You have to have a detailed letter from your doctor explaining why you cannot work.For example I have had 2 flaps because of pressure sores and am now on bedrest with another one.When my insuer asks for an update I complete the form but enclose a letter from my wound doc explaining that I have to gat out of my wheelchair every few hours or i will get sores.If they deny benefits send a copy of the letter from your doc and a copy of the denial letter to your state insurance commissoner ,you can copy your local reprsentative and even your newspaper before you pay an attorney get o a meeting with the insurance commiossioner and try to get them to help
    Brian

  10. #10

    Tee hee hee....

    This branch of Provident is about 5 miles from my office :-)

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