American United Life Insurance Company (“American United” or “AUL”) is the founding member of OneAmerica. American United significantly increased its disability insurance portfolio by purchasing the group life and disability business from The Union Central Life Insurance Company in 2003. American United currently offers a portfolio of disability insurance products, including the following:
- Traditional Group Long-Term Disability Insurance: Issued and underwritten by AUL, this employer-paid group disability insurance is designed to help an employee continue to receive income during periods of prolonged total disability.
- Traditional Group Short-Term Disability Insurance: Issued and underwritten by AUL, this employer-paid group disability insurance is designed to help employees continue to receive income during periods of total disability up to 104 weeks.
- Individual Disability Income Insurance: AUL offers various disability income individual policies through its national agreements with Illinois Mutual Life Insurance Company and Principal Life Insurance Company. AUL offers custom-designed income-protection solutions for each individual’s specific needs. These policies are typically sold to doctors, dentists, lawyers, other business professionals, and executives.
- Group Voluntary Disability Insurance: Issued and underwritten by AUL, this employee-paid, payroll-deducted, voluntary disability insurance coverage offers flexible coverage design options with short and long-term benefit periods, guarantee issue amounts, and the ability to have different coverage options under one policy.
- Cost-Shared CorePLUS Group Disability Insurance: Issued and underwritten by AUL, CorePLUS group disability insurance is available to employers with 50 or more eligible employees and provides a cost-shared approach to disability coverage. It offers basic and enhanced group disability coverage options, claims administration, and billing statements, allowing combined payment by the employer and employee.
Unfortunately, American United does not always pay disability claims when it should. American United has been sued numerous times for wrongfully denying or terminating long-term disability benefits.
American United and Disability RMS
American United Life Insurance does not administer its disability claims. Instead, AUL typically hires a third-party administrator to evaluate each disability insurance claim, which means that American United may not be the entity making the final decision to approve or deny disability benefits. Most of the time, American United subcontracts the administration of claims to Disability Reinsurance Management Services, Inc. (Disability RMS), a claims administrator based in Maine.
Disability RMS’s Use of “Independent” Medical Doctors
Disability RMS will have a claim reviewed by a purportedly “independent” doctor, although the insurance company pays the doctor substantial sums of money. One such “independent” doctor that Disability RMS routinely hires to evaluate a claimant’s medical records is Dr. Alan P. Neuren, a psychiatrist and neurologist in Maine. Dr. Neuren does not appear to see real patients in active medical practice. Instead, Dr. Neuren also works for many other disability insurance companies, providing detailed opinion reports based solely on a review of the claimant’s medical records. As you can imagine, Disability RMS frequently relies upon Dr. Neuren’s opinions to terminate or deny benefits.
Another service Disability RMS uses to retain doctors to evaluate records for ERISA disability claims and appeals is the University Disability Consortium (“UDC”) of Massachusetts. Like Dr. Neuren, many of the doctors used by UDC no longer have active practices and no longer see actual patients. It is worth noting that the report from a UDC doctor may not necessarily contain that doctor’s opinions.
Instead, UDC will typically conduct what it calls a “quality assurance review” and may even ask a doctor to change his or her opinion to match another doctor’s opinion. When UDC doctors were caught doing this on an American United claim administered by Disability RMS, UDC tried to reassure Disability RMS by stating: “We are changing our procedure such that on co-morbid reports, different wording will be used on each report.” Take that for what it’s worth.
In short, you may have a disability claim with American United that was terminated or denied by its administrator, Disability RMS. If so, you should look very closely at the medical reviews relied upon by Disability RMS in denying or cutting off benefits.
Disability RMS’s Technique to Limit the Payment of Benefits in Claims with Both Mental and Physical Impairments
For claimants with co-morbid conditions, one seemingly common practice that Disability RMS uses is to emphasize mental impairments. This is important because there is usually a limited benefit period under most policies for disabilities caused by mental illnesses. Disability RMS will then terminate benefits at the end of this limited period (typically 12 or 24 months) because physical conditions are not disabling.
Disability RMS’s Claim Standards
Disability RMS has written claim standards. These claim standards will detail the claims handling procedures directly relevant to your claim. You should request a written copy of the claim standards to be utilized in your claim, especially if you have a claim that is potentially subject to a limited period of benefits (such as a claim with a mental illness limitation or if you have “concurrent” mental and physical disabilities).
Understanding Your Rights After a Disability Claim Denial by American United or Disability RMS
If you hold an individual insurance policy or are employed by the government, you might not be required to go through an administrative appeal process with your insurance provider to assert your rights. Consulting an expert in disability law can aid you in understanding your unique rights and options. For those enrolled in a group disability policy with American United Life Insurance Company, your plan is typically subject to the rules and deadlines outlined by ERISA (Employee Retirement Income Security Act). Compliance with ERISA’s stringent internal appeal procedures is mandatory if your disability benefits have been denied or terminated. Be cautious of the tight deadlines for filing an appeal—commonly, you have only 180 days to do so. Some policies may offer a secondary, voluntary appeal process.
Seek Legal Representation from an American United Long-Term Disability Attorney
Attorney Nick A. Ortiz offers a comprehensive range of legal services for clients with long-term disability insurance policies through American United Life Insurance or OneAmerica.These services include contesting denials or terminations of long-term disability benefits under individual or government policies and filing ERISA appeals for denials or terminations of group long-term disability benefits. Additionally, he can initiate lawsuits against American United Life Insurance after the final denial of benefits for individual or government policies, file ERISA lawsuits following a final group benefits denial, and negotiate lump-sum buyouts or settlements for long-term disability policies. Call American United disability attorney Nick A. Ortiz at (888) 321-8131 for a free case assessment.