UNUM are topical just now, since it was revealed that they are currently involved in a closed ‘fringe event’ at the conferences of all three major political parties taking place at the moment. This is a matter of considerable concern to disability, and associated, activists who view it as further attempts by the insurance company to secure their influence over our health-related benefits no matter which party assumes power at the next election.
Coincidentally, I chanced upon a Mumsnet forum a couple of days ago. It was a Q&A session, on the topic of returning to work/carrying on working with cancer, an obviously sensitive topic. Questions were answered by the head of rehabilitation from UNUM, and centre head of ‘Maggie’s Cancer Care’, a psychologist.
Among the published questions, which generally were seeking help, one stood out in raising the ‘issues’ about UNUM that many of us find deeply troubling; the influence that many among us believe they’ve brought to bear upon our welfare system since the early 90s, in order to ultimately ‘make a killing’ in selling ‘Income Protection’ to anxious workers unnerved by a severely undermined social security system. I think that about sums it up.
Though, no doubt, there are people working for UNUM, perhaps in areas such as rehabilitation, who believe they are working for the good of their clients, the truth must be faced that this is not a company whose general demeanour I would think Mumsnet would find acceptable since they claim they
“…do not accept advertising from a number of companies including Nestle, because of their aggressive marketing of formula in breach of international standards, and for a number of products, including formula milk, cosmetic surgery or anything that we believe does not sit well with our philosophy…”
So I’ve emailed them today, and am posting the contents here because, as Mumsnet inform us, they do receive thousands of emails and I don’t have a great expectation that mine will have any particular chance of being noticed. At least posted here more people will be able to see, particularly, the list of links at the end, which are individuals who are currently taking UNUM to court for what they contend is an illegitimate non-payment of their insurance benefits, into which they have paid over many years.
Great respect is due Mumsnet for being an enterprise which has adopted an ethical attitude towards advertising, evidenced by your rejection of companies such as Nestle, and those products which you consider have a negative effect on women’s health or self-esteem.
In light of this I felt compelled to write to you about the insurance company, Unum, with whom you recently ran a Q&A session in your ‘Mumsnet Talk’ section, about return to work while/after suffering from cancer. (Link included)
This company has a more than questionable reputation in the States, having been found guilty of denying health insurance claims wholesale, and operating like a ‘disability denial factory’. Their history in this is freely available on the internet. They also stand accused by many disabled activists in the UK of infiltrating government since the 1990s in order to profit from the increasing withdrawal of benefits from the sick and disabled, as evidenced in the current ‘row’ over Atos Healthcare and the Work Capability Assessment. It is Unum’s ‘model’ which was adopted by, initially, the Conservative government, in order to ‘pare down’ eligibility for health related benefits.
Unum claim to have ‘cleaned up their act’ in the U.S. but the barest research proves that they are still ‘up to their old tricks’ of renaging on claims which people have in good faith paid in into in order protect them, should ill health prevent them working in the future. Its painfully ironic to see them use the language of ‘support’ in your Q&A, when the most evident thing about their company is their disgraceful actions in denying huge numbers of their customers the legitimate payouts that they are due.
Sick people are suffering in the States because of this company. People now in the UK are suffering too, in increasing numbers, because UNUM conspired with our government to utilise UNUM’s model towards the reduction of benefits for those who are by any reasonable measure entitled to them.
You might ask what’s in it for UNUM? The answer is that they seek to prosper from this lack of state support for the sick and disabled; the fear, essentially, that this is engendering, by selling their own ‘Income Protection’ product. If you’re not feeling a little sick by now, then please read the links I’ve put at the end of the email, because these are real people who are right now suffering at their hands.
UNUM, much like this present government, speak the language of ‘support’ while doing the opposite, removing it. And they’re doing it to the most vulnerable of the population.
Here is a list of just some of the law suits currently (2013) being actioned across the United States against UNUM, by sick people, some of whom have lost homes and faced bankruptcy on account of UNUM’s denial of their payouts. There are many, many more instances stretching back well over a decade.
I hope that you will reconsider any association with this company, who have one face for the public, but quite a different one behind the scenes.
South Carolina: Amy Avery (Disability, unspecified)
Seattle, Washington: Rachel Jacobson (Hypereosinophilic Syndrome, heart attack, chronic asthma, other conditions)
Illinois: Clark Weimer Jr (Degenerative disc disease in the lumbar, thoracic and cervical spine)
Florida: Marie Jean (Disabling chronic dyspnea with angina, shortness of breath, pulmonary nodules with hypoxia, arthritis, radiculopathy, myalgia, hypertension, GERD, cardiomegaly with mitral valve prolapse, and other conditions)
Michigan: Michael Sosinski (Brain injury, loss of hearing, brain hemorrhage, cognitive dysfunction)
Michigan: Mary Mora (Fibromyalgia)
Michigan: Sinoun Liv (Chronic debilitating back pain following surgery, nerve damage)
Michigan: Larry Tate (Debilitating IBS, Scoliosis and other conditions)
Georgia: Peggy Powell (Major Depressive Disorder, PTSD, and other conditions)
Massachusetts: Mary Paulk (Lumbar Spondylosis with degenerative disc disease)
Florida: James Randall (Disability, unspecified)
California: Victoria Arendain (Total disability due to back problems treated by multiple surgeries)
Indiana: Lisa Russ (Numerous physical impairments, unspecified)
Florida: James Maxey (Disability, unspecified)
Florida: Kevin Kyarsgaard (Disability, unspecified)
South Carolina: Andre Griffin (Disability, unspecified)
West Virginia: Katie Hall (Husband’s Death Policy Benefits)
(Dismissal due to the issue having been fully dealt with and settled.)
California: Dr Alan M. Gross (Eye surgeon whose diabetes caused blurred vision and hand numbness, complicated by co-morbidy of bone disease in feet)
Texas: Byron (Diagnosed as permanently disabled, serious heart condition. Unum claimed his doctor said he was fit for work, proven to be an untruth.)
Los Angeles: Ruben Don (Disability, unspecified)
California: Leah Bilyeu (Chronic fatigue)
California: Tanya Mondolo, (Avascular Necrosis (bone death) and fibromyalgia, both caused by chemotherapy treatments for Leukemia.)
The following three are mentioned in the link that follows them:
Portland, Oregon: Judy, (Nurse whose staff infection immoblised her for a year. Unum approved her claim, but never paid her any money. Has lost her home & medical bills continue to mount.)
Pennsylvania: Elvira (Guillain-Barre Syndrome. Initially UNUM paid her fees while she awaited government disability. When that was through demanded she pay back money they’d paid her. Lost her home, having to file bankruptcy.)
Oregon: Mason (Heart attack, Drs said he needed five more weeks off work due to delayed healing. Unum rejected doctor’s opinion.)
(Understandably) Unidentified Woman (Anal Cancer. Radiation therapy led to complete loss of control of bowels, resulting ‘accidents’ mean she must shower and wash clothes when they happen. UNUM said she was completely able to continue to work if there was a bathroom within 100 feet of her)
Which is why…
Unum was listed as number two in the American Association for Justice (AAJ)’s “Ten Worst Insurance Companies in America” in 2012.
Just a Few Bad
The government has been forced by public opinion, alongside a veritable tipping point of overturned decisions, to turn a critical eye on their WCA administrator, Atos. They’ve announced that Atos must produce a ‘performance improvement plan’ since too many of their HCP’s reports are below desired standard. Not, they quickly emphasise, that they are ‘wrong’, simply that they are not putting forward their case clearly enough. The ‘reasoning‘ underpinning a portion of ‘recommendations’ lacks ‘detail’, it seems. No mention of outright misrepresentation, or glaring errors, just the ‘quality’ of report-writing that is not robust enough to underpin the concluding recommendation (upon which DWP officers make their decisions).
Since all emphasis is on substandard ‘report writing’, with no suggestion that decisions derived from them were incorrectly made, I can only interpret this move as an attempt to make those reports ‘foolproof’ against tribunal scrutiny rather than to have them reflect more honestly the applicant’s authentic circumstances with regard to their impairments.
Many among the disabled activists and those campaigning on their behalf see this news as a positive development. And it certainly is ‘something’, rather than ‘nothing’. As others have pointed out it is pathetically little, and is nothing like the wholesale denouncement that most would wish for. Sadly, even this last perception is wide of base when it comes to the WCA, and its construction and delivery.
In this situation the position that Atos hold in the system of administration of welfare to the sick and disabled is akin more to ‘useful corporate idiot’ and proof of this is available for anyone to see in the government’s own ESA Regulations.
The Convenient Shield of Atos
Atos is the government’s shield in the symbiotic relationship between them and the DWP. From this relationship Atos draws status, legitimacy and above all massive profits. In this way it is similar to the companies who administer the Work Programme, which itself has been proven to do little more than line private pockets with massive amounts of public money (its actual results assessed as “worse than doing nothing”).
Sadly Atos’ activity, by contrast, definitely does more than nothing. It helps to cast people, whose only offence is to be ill, off health related benefits and either into destitution, or to join the competitive arena of seeking work against the able-bodied and healthy. The latter will, after a year, proceed onto the afore-mentioned, and certified useless, Work Programme, where they are likely to be ‘parked’ in favour of those it is more easy to find work for.
Atos Just Make the I.T., That’s All
What the government get in return from Atos, which is a ‘black box’ in itself, since scrutiny is inhibited by ‘commercial confidentiality’, is a defensive buffer against criticism of their policies. Atos are, in the final analysis, only the administrators of the government’s instrument. The government, through their ESA Regulations, say “This is how you assess people”, “These are the criteria to be used”. The computer driven LIMA system is simply the interface through which the government’s set criteria is ‘operationalised’, made digital. The WCA, as delivered, is an IT construct that is merely the government’s word made technological flesh, the digitalised manifestation of DWP-designed instructions. Because: Atos is an IT company. That’s what they do. They apply their undoubted expertise and experience to produce computerised IT ‘solutions’ to meet real world criteria. They don’t invent the criteria themselves, its provided to them, in this case by the UK government’s DWP.
The DWP Created the WCA
So what’s happening now? Its taken deaths, suicides in increasing numbers, at least two solid years of intensified activity by mainly sick people, who are derided as ‘extremists’ for their efforts, to arrive at this point. This point at which the evidence is so damning, so incriminating, that the facade of legitimacy of the WCA can no longer stand. The outrage that Atos draws from a sizeable portion of the public has become publically visible. But the shield which is Atos, which protects the government, which deflects from government criticism of their instrument, their descriptors, their model of sickness/disability, their deliberately designed construction of what they will acknowledge as a sick or disabled person in need of help, still stands.
The Slickness of the Hand Deceives the Eye
Direct all your ire at Atos, they say, have said, these past years. It is the administration which is flawed, not the foundation, they claim. But that is not the case. In truth Atos are simply IT specialists who have accurately interpreted their government bosses’ instructions and are now ‘taking one for the team’. And its not a particularly harsh ‘one’ at that; some reports are not up to scratch, its a ‘quality control’ issue, bring in more ‘experts’, retrain the assessors. What a wonderful misdirection, a stage magician’s sleight of hand using smoke and mirrors. Atos is as insubstantial in the WCA process as smoke. The cards are, and have always been, the government’s own, designed, printed and laminated by them in the dark, shadowy recesses offstage. Their construction of the WCA (with the help of dispreputable insurance company, UNUM) will never be seen as long as a company like Atos is available to take the flak. And if Atos are ‘phased out’, as it seems is being prepared, the new Atos will then be the expediter of the government’s hidden programme. A programme that has a compound objective:
- To choke off the outflow of public money to the sick and disabled, and, as a direct consequence, deter people from perceiving themselves as ill, worthy of support, and therefore inhibiting their take-up of entitled benefits. But possibly incentivising them to take up private insurance instead. (See Unum below)
- To pull away the safety net of social security, without disturbing the inflow into government coffers of National Insurance contributions. (Another magician’s trick, coincidentally UNUM’s choice of visual metaphor for their ‘Backup Plan‘ tv ads -‘Whip away the tablecloth, but leave the crockery undisturbed’)
- To change the very definition of sickness/disability itself, limiting qualification for benefits to only the most, and I mean most, seriously impaired – the paraplegic, those with only six months to live (I struggle to find any other categories deemed worthy, at this point).
And meanwhile, even more public money is directed into corporate coffers, through the commissioning of ‘consultants’ Price-Waterhouse-Coopers, brought in to ‘provide independent advice’ on this purported ‘quality-assurance’ issue.
Fortifying the Bad Decisions
Does anyone really think this government agenda, this
pogrom programme is going to be affected in any way by cleaning up a few reports, improving grammatical and ‘reasoning’ skills? Its more akin in actuality to a further sharpening of the blade that is already being used to cull the sick. This is what Grayling meant when he resolved to address the problem of so many overturned decisions at tribunal. Its not about getting the decisions right at assessment stage, as any reasonable person would conclude. Its about making the bad decisions stick.
Atos are the necessary blind that disguises government intent. The sad thing is that all that is required is to draw back that blind and the intent is there for all to see, in the government’s own ESA Regulations. “No need for bending, kneeling in the modern workplace”. I’ll leave you to contemplate that absolute gem of contorted, deluded thinking by your government, and consider whether you think it meets the rigours of your own experienced reality.
I feel that my last post ended on a somewhat cryptic note regarding Professor Wessely, and that I need to support the claim I made about the undermining of physical medical authority within his ‘doctrine’. This I feel I have previously done to an certain degree with regard to Professor Aylward and his colleagues (here and here), though the potential certainly exists for more to be highlighted.
An insight into what could be termed the ‘under-the-radar‘ approach to undermining the integrity of medical personnel, such as GPs, is provided by Professor Wessely’s article for Unum’s Annual Chief Medical Officer’s Report 2007 entitled “Why and When do Doctors Collude With Patients?” (The CMO for this publication was Michael O’Donnell, now occupying the same role with Atos Healthcare.)
Subtle But Significant
This notion may seem to be introduced with apparent goodwill, even humour, but the important fact is that it is introduced at all. The question should always be asked about corporately financed material “Who is set to benefit from the dissemination of these ideas?”. Is there anything to gain on the part of the Insurance firm Unum who produced the report? – Such as carving a first chink in the hitherto resilient armour of the authority of physical medicine, perhaps. This, by suggesting that doctors can be psychologically ‘vulnerable’ to forms of ‘collusion’ with those in their care in ways which might work against the patient’s welfare.
Might it not in fact be an attempt to first, construct such a thing as this type of ‘psychological failing‘ of a doctor, and second, draw it into the classification of ‘iatrogenesis‘, a term historically limited to the adverse effects on patients of drugs, medical error, or negligence through decisions taken by medical personnel. Note should be taken of Professor Wessely’s reference to the naivety of ‘ethically pure’ young doctors, new to practice, who will come to the realisation that “in real life things are not neat and simple, but grey and ambiguous”, ultimately, presumably, succumbing to this ‘necessary collusion’. Some of the reasons for colluding that Wessely lists give anything but a favourable impression of our medical practioners, including as it does such things as financial reward, lack of time and fear of complaint.
Poor NHS. Also deluded.
Just prior to introducing Professor Wessely’s article Michael O’Donnell bemoans the way that “our NHS managers [are] fixated on providing those treatments which can be measured” such as operations and injections. As opposed perhaps to psychological interventions which rest solely on, and the success of which is evaluated only by, certain ‘experts’ in that field. He then states that “until return to work is included as the objective and final measure of success, it seems likely that the NHS will continue to miss the point.” This is of course an ‘objective’ perspective, and nothing whatsoever to do with the fact that it serves insurers such as Unum’s best interests (and saves them money) to get the sick back to work.
If what I’m claiming seems a little exaggerated, or ‘conspiracy theory-ish’ perhaps you should also take a look at this paper by Professor Wessely from 2003. The main thrust of of which is that doctors who accept the possibility that their patients suffering from (ahem) ‘Medically Unexplained Symptoms’ (MUS) may actually be physically ill are in danger of committing an ‘iatrogenic’ offence against them. He does this by arguing that patients with ‘MUS’ conditions (an important and expensive group he alleges) are in effect made worse by doctors taking their illnesses seriously and organising physical investigations and treatments. There are, Wessely concludes, “points within the doctor-patient encounter where MUS may be iatrogenically maintained“. In simple terms, doctors need to stop ‘colluding’ with these patients because it is doing them harm.
Note: Professor Wessely’s list of MUS illnesses in the paper (detailed below) correlates very closely with those listed by fellow psychiatrist Dr Christopher Bass at the 2004 Atos Conference referenced in my earlier post. (Though he omits chronic back pain in favour of irritable bowel syndrome)
Non-cardiac chest pain
Chronic fatigue syndrome
Repetitive strain injury
Caution: Unbridled Arrogance Ahead.
An unexpected interjection to the article under the sub-heading ‘Social’ is yet more evidence of just how entitled proponents of the Biopsychosocial model perceive themselves to be in stepping out of their own field and usurping theories from Sociology to twist into their arguments. Aylward from his ‘Medical’ expertise, and Wessely from Psychiatry. It is very telling indeed that there are no qualifed Sociologists involved in the Biopsychosocial lobby. A small matter of ethics, perhaps.
Wessely’s A Sociologist Now?
In this instance Wessely attempts to appropriate Ivan Illich’s notion of ‘Social Iatrogenesis‘ and ‘invent’ his own version for his own purposes.
Illich explains the meaning of his term as referring to the “impairments to health that are due precisely to those socio-economic transformations which have been made attractive, possible, or necessary by the institutional shape health care has taken“. Note the use of the word ‘institutional’ here.
Illich’s main concern is that autonomy has been removed from the people, and he speaks about the danger of ‘radical monopolies’ such as is expressed in the idea that “When cities are built around vehicles, they devalue human feet“.
Illich asserts that “Ordinary monopolies corner the market; radical monopolies disable people from doing or making things on their own”. Disregarding this core idea, Wessely feels entitled to put his own spin on ‘Social Iatrogenesis’. Describing it as “a term for illness caused or prolonged by wider sociopolitical inputs” he uses it to discredit ‘Patient Support Groups, no less! It would be quite one thing were he a qualified Sociologist to make that assertion, and accordingly be ethically required to back it up with a full argument as to why that could be a reasonable (though inexplicably contradictory) interpretation of Illich’s theory. It is quite an extraordinary presumption to appropriate that theory towards the opposite aim of its originator. Patient Support Groups are nothing if not an attempt to restore a measure of autonomy to ‘the people’ within what has become an ever more bureaucratised, institutionalised healthcare system. This is nothing short of abominable arrogance on Wessely’s part, but oh so very symptomatic of this group of ‘experts’ including Aylward et al.
Could He Possibly Be More Wrong?
Wessely just couldn’t be more wrong in citing Illich in this context, when the latter complains that the spread of medicine “turns mutual care and self-medication into misdemeanors or felonies”. Please compare against Wessely’s rubbishing in the Unum Report of any steps that that an individual may take outside of traditional medicine to ‘self-medicate’. These potential treatments he disparages as ‘”cod-immunology [mixed with] pseudo radiation science interspersed with New Age homilies” directing us towards that reknowed ‘quack-busting’ site ‘BadScience.com’. Hardly comments or sentiments in line with Illich’s philosophy is it? No, it’s quite the opposite. Perhaps Professor needs to sign up for a beginner’s course in Sociology, or better still refrain from playing with concepts that he doesn’t understand.
I’ll leave the final word to Illich on “nosology” (the system of classification of diseases, which he notes “changes with history”)
In our society nosology is almost totally medicalized; ill-health that is not labeled by the physician is written off either as malingering or as illusion.
Oh deary me, Professor Wessely, oh deary me…