Caryn E Montague and Associates
For consultation:
(305) 935.1622
Caryn E. Montague and Associates
Caryn E. Montague, RHU, LUTCF, CSA became licensed and appointed to sell life and health insurance in 1978; and has been a personal producing general agent since 1980.  Ms. Montague is a mediator, certified by the Supreme Court of Florida (County Court); and Diplomate, American Board of Disability Analysts. Since the mid 1980s, Ms. Montague has regularly been engaged by plaintiff and defense counsel as a consultant and expert witness in insurance claims and litigation regarding standards of practice, application, claims, and agent’s actions. Bad faith, disability insurance, and forensic field underwriting are Ms. Montague’s areas of specialty. She has lectured and written in these areas of expertise; is often featured in industry and professional periodicals; and, has been the senior moderator and lead contributor for www.disabilityinsuranceforums.com since 2002. Ms. Montague has presided over many organizations in addition to numerous appointments in community, insurance, and legislative organizations. She has held public office as Councilwoman and Chairperson of the Zoning Appeals Board of Northeast Miami-Dade County.  Ms. Montague served in the quasi-judicial capacity of Administrative Hearing Officer for Miami-Dade County in order to conduct hearings, fact-find and adjudicate contested County Code Violations. Most recently, Ms. Montague was invited to join the Round Table Group, a symposium of experts from around the world. Ms. Montague maintains memberships in the National Association of Insurance and Financial Advisors (NAIFA) formerly known as the National Association of Life Underwriters; National Association of Health Underwriters (NAHU); National Organization of Social Security Claims Representatives (NOSSCR); National Association of Disability Representatives (NADR); Florida Association of Professional Mediators, and other local, state and professional organizations.

 
  UnumProvident  Re-Assessment of Disability Claims

In December 2004, the Insurer, along with most States’ Departments of Insurance, and the Dept. of Labor entered into an agreement that affords   several hundred thousand claimants a review of their claims.  The “Multi-State Settlement Agreement” (MSA) is the result of a  50 State, plus jurisdictions,  investigation into the claims practices of the insurer.   Links to the MSA and other info are at the bottom of this page.

If your Unum, Provident Life and Accident, Paul Revere Life Insurance Company, or First Unum disability claim was denied or terminated between 1997 and 2005, you may be entitled to a review of the claim.  If you received a letter from UnumProvident offering to reassess your claim, and you think you may be ineligible for benefits, think again before dismissing the letter.  If your claim was paid on a residual basis when it should have been total, if you did not get the COLA and indexing benefits factored in, if your claim was treated as “self-reported” or “subjective,” or a physical disability was moved to the psych department for evaluation before termination, you may have benefits due you.

Most importantly, please seek competent guidance from an advocate or attorney concerning the most appropriate way for YOU to proceed.   Whether or not you are already in suit or walked away after being terminated or denied; whether your claim is ERISA, employer sponsored, or an individual policy you purchased yourself; whether you think you received the maximum amount due you or the amount the insurer determined you were entitled to, please take the time to have a professional explain your options in your particular case.  A brief call or inquiry can help you assess what your options are, what you may expect, whether you are entitled to a re-assessment of claim, and what any state or jurisdictional issues may be.  

Claimants terminated or denied January 2000-2005 should have received letters already.  Claimants 1997- December 1999, and those who have not received letters, need to call 1-866-278-4641 to inform UnumProvident that they want their claims re-assessed.  When you call in, please have your Social Security number, policy #, Claim #, group #, current and prior address, phone numbers ready for identifying purposes.

Keep accurate logs of calls and correspondence.  Send letters certified, return receipt requested. Be careful of the overly broad authorization to release information, and discuss with your advocate the scope of the release and if modification is indicated.

If you are proceeding with the re-assessment, while awaiting your review, please begin securing the support that you will need, including but not limited to:

·    SSDI award.  This may be the most important component in expediting the claim since compliance with the MSA stipulates attention to the award must  be accorded. If the SSDI claim was paid on the basis of mental/nervous, your advocate needs to factor this into the overall plan for re-assessment.  Please pull the SSDI files, and have available the award letter for you and dependents.  This will also help determine if the correct offsets and repayments were sought.
·    Copies of the policies, certificates, amendments, and SPDs from time of notice of claim.
·    Full and complete medical records since the denial and termination. Include ALL treating physicians and practitioners, their notes, narratives, protocols, LEFT and RIGHT sides of their files.  Include hospital stays, Lab work, FCEs, physical therapy notes.
·    Progress reports, Attending Physicians Statements, referrals to IMEs.
·    Videos, photos, testimonials demonstrating the progressing of your condition since the onset of disability.  A picture says a thousand words, and a testimonial describing you before and after onset is quite powerful.
·    Correspondence with insurer, claim stubs and offset statements, letters explaining “new math” in calculating the prior monthly income, current income, and shifts in formulae concerning treatment of claim.
·    Timelines showing the key dates for disability, medical appts, protocols followed or attempted; restrictions and limitations; hospitalizations, therapies, etc.
·    Tax returns, income/expense support and distribution of monies, especially in claims treated as residual in basis.
·    Get your pharmacies to give you printouts of as many years possible of all your prescriptions.  The pharmacist may certify the list.

The list is inconclusive but serves as a starting point for you.  I know you do not want to go through the mental and physical hell you fought while fighting your claim.  Now, with the records reflecting the improper practices, the people actively engaged in the advocacy process are hopeful  that the re-assessments will be fair.   Please allow yourself to be  guided by persons who can bear the burden so that the process can be as painless for you as possible.  As more info becomes available, it will be posted.

Remember, people who received letters must respond  within 60 days.  All others need contact the insurer and initiate the process.  Please contact me or another advocate or an attorney for answers to your specific questions.  You are not alone this time.  Now you have hundreds of thousands in the same boat as you.

The UnumProvident Settlement is at http://www.unumprovident.com/settlementagreement/


Please direct inquiries to contact@montagueassociates.com

Nothing contained herein shall be construed to be legal advice.
You are advised to seek competent guidance in your specific matter.
    
Links

 For a No Obligation Consultation, or for References, CV, or Articles:
CARYN E MONTAGUE
AND ASSOCIATES
13899 BISCAYNE BOULEVARD
 SUITE  #110
NORTH MIAMI BEACH, FLORIDA 33181

305.935.1622  OR  305.944.0657
                                       Upcoming presentations:
Date:   April 14-16, 2005
Topic:  Understanding LTD and SSDI Offsets to Protect Client’s Assets
Organizational Information:  National Association of Disability Claims Representatives (NADR) and International Association of Rehabilitation Professionals (IARP) Conference; Orlando, Florida  
   ---------------------------------------------------------------------------------------------------------
Date:    June 10, 2005
Topic:   Life and Health Insurance – Remaining Informed in a Litigious Environment
             The Agent’s Role: Risks and Claims
             Underwriting- Pre and Post Claim    
Organizational Information:  Advanced Issues in Insurance Coverage Claims and Litigation in Florida.  Lorman Educational Services.  Miami, Florida
_______________________________________________________________________________________
Date:    June 17, 2005
Topic:   Distinct Differences in Life and Disability Insurance Field Underwriting and Claims
            Trends in Coverages:  Clauses, Rates, Claims, Issue and Participation, Retention, Re-insurance
           “Red Flags”:  Real or Imagined?
            Repaying Offsets- Who Does the Math?    
Organizational Information:  Current Issues in Disability Insurance, Claims, and Litigation. Lorman Educational Services.  Palm Beach, Florida