Enhancing

our claims management services

unum.co.uk
 Welcome to the third in a series of
publications that explore Unum’s
continually evolving claims
management capabilities.
We have always said that
we do not just assess
claims but that we
manage them, seeking
solutions that are best
for all concerned.
In a recent Watson
Wyatt survey, 22%
of employers stated
claims management
capabilities as being
very important in
selecting their current
insurer. With this in
mind, within this paper
we bring you news of a
number of enhancements
to our claims management
services; including the
introduction of telephonic
claims form completion
options and proactive
identification of potential
claimants from employer records.

 Watson Wyatt Healthcare and risk consulting; 2007 risk benefit

survey report.
 Group Income Enhancing
Protection

Evolving: At the same time, we have been working to enhance

our claims management service. The wealth of changes,
In 2005, we introduced the concept of the biospsychosocial
which are available from October 2007, are designed
(BPS) model in our Evolving publication. We explained
to improve the speed and flexibility of our claims
that through our day-to-day observations of claims and
management services; you can read about the changes
our links with the Unum Centre for Psychosocial and
on pages 5, 6 and 7.
Disability Research at Cardiff University, we had grown to
wholeheartedly embrace the BPS model. The essence of
the BPS model is that as well as the bio factors, which are
Our People – the reason we don’t need
universally accepted, we must also consider the powerful to outsource
role that the psychological and social factors can play in both Unum’s people really believe in making a difference. Within
a person’s initial and then potentially prolonged incapacity. our Customer Care Division, which is made up of our Claims,
Bio – Neurophysiology, physiological dysfunction Medical Services, Rehabilitation Services and Technical
Medical Underwriting departments, we have a large number
Psycho – Illness behaviour, beliefs, coping strategies,
of specialist staff helping to ensure that each claim is dealt
emotions, distress
with in a timely, fair, appropriate and professional manner.
Social – Culture, social interaction, sick role. Unlike many other insurers, all of our core services are
in-house as this ensures good communication between
Within Evolving, we also introduced the re-alignment
all parties, and ready availability of appropriate advice
of our claims teams around brokers and employers to
and opinions. Quality and continuity of service provision
give customers a single point of contact within our
is guaranteed, which can be difficult to achieve with
claims organisation.
outsourced service providers. As well as this, all our people
have security of employment and know that this protects
Enabling: the independence of their views.
In 2006, our Enabling publication announced the
introduction of a new Medical Underwriting application
form which would make it possible for very high amounts
of income protection cover to be granted without the need
for a GP’s report. This change was underpinned by our
knowledge and belief in the BPS model.

Enhancing:
It is now two years since we published Evolving, and one
year since we published Enabling; what has changed?
We are continuing to build on what has proven to be a very
successful model. In terms of medical underwriting, 86% of
our income protection cases are currently being processed
without the need for any medical evidence, and we are fast
approaching our target of 90%.

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Our Core Services:
Medical Underwriting
Alongside our team of specialist Medical Underwriters, who
are all specifically trained in Income Protection Insurance,
we have a specialist Technical Underwriting team led by our
Chief Medical Underwriter. The team research our claims
experience, changes in medical thinking and draw on the
lessons from the Unum Centre at Cardiff to ensure that our
approach to underwriting is scientific, up to date and in line
with our experience.
Claims team
Our team of over 80 Claims Management Specialists and
Managers undergo rigorous training and assessment, with
authority levels strictly linked to proven competencies
and experience. They work in teams closely aligned
with employers and intermediaries to ensure that strong
relationships and understanding of clients’ needs, specific
requirements and difficulties are formed.
Each Claims team has a dedicated Insurance Nurse Specialist
who advises on the medical aspects of claims and assists
in arriving at the correct decision as quickly as possible.
Each team also has dedicated Vocational Rehabilitation
Consultants (VRCs) who provide guidance on the
potential for rehabilitation in individual cases, and also an
understanding of a particular customer’s needs in relation to
absence management.
Claims decisions are not made by individuals alone, but
are made in round table discussions, where a Manager or
Senior Claims Management Specialist and a member of the
Medical Services team will provide input. Our Customer Care
Director is also medically qualified with extensive expertise
in Disability Assessment Medicine.
4
Medical Services
Our Medical Services team consists of eight nurses and two
doctors. Our nurses are aligned with the Claims teams to
ensure that the team have ready access to advice both on
an ad-hoc and more formal basis, and so that our nurses can
attend round table discussions on claims. This helps us to
streamline our approach to assessing claims, enabling timely
decisions as far as is possible.
Our two doctors, who have expertise in the field of Disability
Assessment Medicine and Occupational Medicine, have
input both into Claims and Medical Underwriting, as well as
providing a source of medical advice for our Rehabilitation
Services team. The annual Unum Chief Medical Officer’s
Report is recognised as thought-provoking and informative
on issues relevant to sickness, disability and employment.
Rehabilitation Services
We have a team of 30 Vocational Rehabilitation Consultants
(VRCs) who come from a variety of backgrounds including
psychology, nursing, physiotherapy, and occupational
therapy. They are dedicated to finding solutions for
employees and employers when disability strikes. They
can provide guidance on adjustments to enable employees
to return to work and, in consultation with the employer,
employee and their GP, can develop graduated return to
work plans. The VRCs act as a bridge between employers,
employees and doctors to ensure that communication does
not break down and that barriers to work are dismantled
wherever possible. This ensures that absences need not be
any more prolonged than necessary and that return to work
is sustained once achieved.

Enhancements to our services
We are always looking for ways in which to improve the
Unum customer experience. The following initiatives,
which will be available from October 2007, illustrate our
commitment to ensuring that we meet our customers'
needs, now and in the future. The initiatives below are all
optional additions to the existing services that we offer.
Improved communications:
Proactive Identification of Potential Claimants from
Employer Records
Where employers have the appropriate records, they can
send us a monthly list of absent employees, setting out
details of their date of first absence and its cause, along
with details of their line manager. We keep track of this
information and filter the list to identify those employees
who may benefit from early intervention, rehabilitation
support or those where the claims process needs to start.
Most insurers state that if there are significant delays in
claim notification then they have the right to decline a claim.
This makes early receipt of claim forms an important issue,
especially when you consider that, according to a recent
Watson Wyatt survey, 42% of employers notify their insurer
of an employee's absence after their employee has already
been off work for 13 or more weeks.
Late notification is clearly a problem for both employers and
insurers; our pro-active identification of potential claimants
from employer records will help to avoid this situation.
Telephonic Claim Form Completion
We are now able to offer telephonic completion of claim
forms to any customers who would like this service. We are
able to complete both employer and employee claim forms
over the telephone, ensuring that all relevant questions
are answered fully, and therefore removing the delays
associated with having to obtain further information.
Postal delays are also significantly reduced.
Enhancing
Electronic Claim Forms
All claim forms are available to customers in a secure
manner via e-mail and PDF as well as on paper. Customers
can then either complete them electronically and return by
e-mail, or print them off to be completed and returned by
post, according to their choice.
Dual and Combined Consent Forms
Consent to seek and share information is critical during
all stages of absence. We require permission to seek
information from doctors in order to be able to provide
guidance on rehabilitation as well as in order to assess
claims. This information needs to be shared as appropriate,
but consent from the individual concerned is of paramount
importance for both ethical and legal reasons.
Dual Consent Form
This form enables us to obtain and share information
with the employer. It is dual branded with both
the employer’s and Unum’s logo. The form is
advantageous as it allows us to fully explain our
liability decisions to the employer, thereby increasing
their understanding of the reasons behind our
decisions. This should not only help to prevent any
misunderstandings, but will also allow a more open
dialogue in the rehabilitation scenario, ensuring
all parties understand the rehabilitation plans and
have knowledge of the medical factors affecting
the claimant.
Combined Consent Form
This is a single form combining two, formerly
separate, forms. It allows Unum to obtain medical
information both for rehabilitation and claim
purposes. This is advantageous when we undertake
rehabilitation prior to the claim as we then have
consent to obtain medical information when it is
the appropriate time to start the claim process. This
prevents delays and speeds up the claims process.
5
Both forms are designed to enable a seamless transition
between early intervention from rehabilitation, into claims
assessment and management. The forms also encourage
good communication between employers, Occupational
Health Providers and Unum, ensuring that all relevant
information is shared as appropriate.
Choice of Preferred Communication Method
All customers will be able to choose their preferred method
of communication with us (PDF/e-mail/telephone/letter) to
suit their system requirements.
Use of Plain English in Claims Communications
Plain English is used in all claims communications,
avoiding the use of jargon wherever possible, and
explaining technical terms where their use is unavoidable.
This enables easier understanding of claims decisions
and aids ongoing communication.
Claims Guide
The Group Income Protection (GIP) claims process is often
poorly understood, both by claimants and their doctors.
To help all parties have a better understanding of what
employers and claimants can expect from us when they
submit a claim, we have developed a brochure entitled
Your Guide to Claiming Group Income Protection. This
brochure guides our standard GIP, Capital Option and Pay
Direct customers through various subjects such as; when
and how to submit a claim, how Unum makes claims
decisions, and how benefits will be paid. The brochure is
sent out to all new policyholders.
As an additional reminder, a brief one page document
is sent out with the forms which go to the employer,
employee and GP once the claims process has started. This
helps to set expectations when the customer or GP may
not remember or may not have seen the information in the
brochure. For a copy of Your Guide to Claiming GIP, please
visit our website www.unum.co.uk
6
Enhanced services:
Customer Site Visits
Unum’s Rehabilitation staff routinely make site visits to
customers' premises when working on rehabilitation for
their employees. However, where customers who have
claims with us request it, Claims Managers and Claims
Management Specialists are also now able to visit them
on at least an annual basis. This enables all parties to
understand the position with regard to employment,
possibilities for return to work and future claims
management options.
Monthly Claims Progress Reports
We are able to provide monthly claims progress reports
for all customers who request them. The reports give
details of the current position of live and pending claims.
This helps to ensure that our customers are kept informed
of the progress of their claims without them needing to
request this information.
“Up-front” Benefit Calculations
We shall advise customers of the value of the claim as soon
as we have received all of the information necessary for
us to calculate the benefit. This will enable us to manage
queries and potential disputes in a much more proactive
way, avoiding unnecessary delays in payment.
Electronic Payment of Claims
All claims payments are made by BACS on the third to
last working day of each month, removing the need for
cheques. This considerably reduces the requirement for
paperwork and increases security of the transfer. Notice
of remittance is sent to all customers each month.
 Enhancing

Additional services: And finally:

Payment for Treatment
Our medical team can work with employers, employees
and their medical advisers to identify those cases where
additional treatment could help facilitate recovery. In
cases where, in our judgement, there is a good prospect
of achieving a significantly accelerated return to work or
significantly enhancing the likelihood of return to work by
use of such treatment, we may agree to share or cover
the costs. This applies to treatments which are evidence-
based, licensed for use in the UK and which are not readily
available on the NHS or through Private Medical Insurance.
Telephonic Rehabilitation Case Management
A core value of our rehabilitation service is our ability to
meet face-to-face with both employer and employee to
facilitate a return to work. However, when there is an urgent
need for return to work services, which makes it difficult
to arrange meetings on a timely basis, we are also able
to offer an immediate telephonic service. The telephonic
service that we offer prevents any possible delays and
ensures the employer has access to information on best
practice right away, to effect a successful return to work.
This can also be of use where the employee is still in work,
but not on full duties or hours due to an illness or injury, and
the employer is simply looking for information to assist their
management of the situation.
Nine out of ten people who go off sick from work and who
are subsequently in receipt of Incapacity Benefit do not
foresee that their incapacity may be prolonged and usually
intend to get back to work . Unfortunately, this does not
always happen. It is this that drives us to continue our work
into understanding disability and come up with solutions
that can help employers and their employees to find
suitable solutions at difficult times in their lives.
Unum has been specialising in Income Protection
Insurance in the UK since 1970. In the 37 years that
have passed, we have grown to be the leading
provider of Group Income Protection Insurance
in the UK. As our knowledge, experience
and understanding of this complex area has
grown, so too has our hunger to drive and
enhance the market in terms of delivering
leading edge theories, concepts, products
and services.
 Waddell G Aylward M 2005, The Scientific
and Conceptual Basis of Incapacity Benefits.
The Stationery Office, London.

Good Relationships with Clients’ Occupational

Health (OH) Providers
Our Medical Services team includes experienced OH
Specialists. Where possible, we have regular meetings and
conversations with our clients’ OH Providers to ensure that
all parties are aware of and have a good understanding
of any relevant medical issues and are therefore
interpreting evidence in a similar way. This helps not
only to facilitate good working relationships, but also
ensures that the employer is in the best possible position
to understand outcomes.
About Unum
Unum is the UK’s leading provider of group income protection
insurance, with over 35 years of experience. Our critical illness
and life insurance products enable our customers to purchase
complementary protection solutions that together make up a
comprehensive protection package.
Our income protection customers benefit from our expertise in the
specialist areas of disability, rehabilitation and return-to-work. We
enable individuals to protect their incomes, ensuring their financial
security if they are unable to work because of illness or injury.
For employers, we offer Group Income Protection policies which
provide insurance cover for employees’ salaries and safeguard one
of their most valuable resources by helping employees return to
work following long-term absence.
At the end of 2006, Unum protected almost 2 million lives through
more than 18,600 schemes. During 2006 we paid total benefit
claims of £285 million – of which more than £191 million related to
income protection claims.
Our US parent company, Unum Group, traces its history back
to 1848 and is today the market leader of group and individual
income protection insurance in the United States. Premium income
for Unum Group and its subsidiaries exceeded $7.9 billion in the
year ended 31 December 2006. Total assets were $52.8 billion
at 31 December 2006.
For more information please visit our website.

unum.co.uk
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UP1441 09/2007