Responses to the OIC on complaints averaged 18 days from the time of receipt at UNUM until the response was mailed by UNUM. This exceeds the 15 days required to comply with WAC 284-30-650.
Response to 4 complaint files exceeded 15 working days. (Appendix I) We also noted that if the OIC required additional information, the company response did not meet the 15 working day requirement.
Eight (8) of the complaints concerned delay of benefit payments due to lengthy investigations prior to payment. Eighteen (18) complaints concerned denial of benefits. There were no complaints for other issues during the examination period.
Standard #1 Insurers are required to respond to inquiries from the insurance commissioner within 15 working days from receipt of the inquiry. WAC 284-30-650
Complaint Responses > 15 working days
% Violating WAC 284-30-650
Results: The Company does not meet this standard.
4 15% (outside 5% tolerance)
During the examination period, UNUM processed 220 individual disability claims. This number was provided to the examiners by the Company and was obtained through a search of all company records. Of the 220 claims, 77 were chosen for file review.
During the examination period, the Claims Department was organized by geographical regions. They currently distribute claims evenly to all disability specialists based on claim load. The UNUM claims system tracks the number of claims assigned to each specialist and assigns claims appropriately.
A report entitled ASpecialist Case Plan Report@ is generated from the system showing the status of all claims assigned to each specialist. This report is monitored by management. Action is taken by management as needed based on the information contained in the report. A copy of this report was reviewed as part of the examination process.
Claim notification is received in the Customer Service Unit. A letter with claim forms and instructions about how to file a claim is sent to the claimant immediately. The