Self Occupation Disability Insurance Policy
A definition of “Self-Occupational” in total disability means the inability to work at your regular occupation – that is, to perform the material and substantial duties of your occupation. According to this definition, total disability means the inability to work at your job. The definition of “Own Occupation” is favorable to you, the insured. The definition of Self-Occupation recognizes that a loss of regular occupation usually results in a significant decline in income even if other work can be found.
In the 1980s many disability insurance companies wrote “Own Occupation” policies because they aggressively invested their premiums in the stock market. Which, of course, turned out to be a poor business decision. Many of these “Self-Occupation” disability policies are sold to professionals: doctors, lawyers, and the like. This saga is evidence presented and substantiated in recent Federal Court Decisions involving Unumprovident, Unum, and Paul Revere.
Unumprovident, Unum, and Paul Revere – A Change in the Claims Process
In the early 1990s the defendant UnumProvident realized that claims made on its own occupation insurance policies that it sold were putting the company at risk. As a consequence the company underwent a major restructuring of its claims handling practices and philosophy. Provident changed from a company that had a claims payment philosophy to one that had a claims “management” philosophy. The results were astounding. Unfortunately, the doctors and lawyers who bought these disability policies for “peace of mind” received nothing but “peace of mind” when they suffered their own occupational disability.
Provident was not the lone wolf insurance company facing financial struggles due to poor product design, over marketing, and poor underwriting in its own disability insurance business. There were other disability insurance companies that faced similar problems. Many of these insurance companies have left the disability insurance business. Paul Revere was one of the other major disability insurance companies that also heavily hyped, marketed and sold “own occupation” individual disability products. Paul Revere also encountered major financial problems with their own occupation policies and, in response, changed its claims process.
Mergers and Acquisitions – The plot thickens
So, in April 1996 Provident and Paul Revere announced their intention to merge. Provident and Paul Revere completed their merger in March 1997. Then, in 1999, Provident Companies, Inc. merged with Unum to form UnumProvident.
In 1998, Provident Companies, Inc. and Revere entered into a General Services Agreement. Under the General Services Agreement, Provident, and then UnumProvident, assumed full responsibility for handling Revere’s claims.
Prior to the merger and the General Services Agreement becoming effective, Provident controlled the Paul Revere claims processing process. Transition teams have been formed. They wrote “Best Practices” that the combined entities had to follow and adhere to. In 1996 Provident trained Revere investigators in these “Best Practices.”
Including a claim objectification process initiated by Provident. Then the “round table” process to deny the claims began at Paul Revere even before the merger was completed.
Unum’s Bad Faith Saga continues
This is just one chapter in the continuing saga of Unumprovident, Unum, and Paul Revere. The evidence strongly establishes a corporate scheme to increase profits without considering the rights of the insured disabled – the doctors, lawyers and others who purchased their own Occupational disability insurance. In addition, the evidence establishes Unumprovident, Unum, and Paul Revere. profited greatly from their misconduct. The results of these companies’ bad faith Disability Insurance practices have devastated many, many insureds. Instead of buying “peace of mind” – – countless numbers of doctors, lawyers, and professionals faced economic ruin.
If these companies have denied your Occupational Therapist disability claim, you are advised to seek legal representation. A good Disability Claims Attorney can make all the difference in giving you and your family “peace of mind.”