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OTHER PFR AGENCIES
Maine.gov > PFR Home > Insurance Regulation > UNUMProvident Multistate Examination/Settlement Agreement
CHANGES IN CLAIM ORGANIZATION
Exhibit 2 is responsive to Paragraph B.3.a. of the Regulatory Settlement Agreement.
In the current organization of the Companies’ claims operation the primary responsibility for making a claim decision rests with a Disability Benefit Specialist (“DBS”) who generally receives guidance on a given claim from a Consultant who has more claim handling experience. The DBS also has access to additional internal resources, including nurses, physicians, vocational rehabilitation specialists, accountants and lawyers. The DBS’s are in units that report to Managers and Directors, who have more claims handling experience but generally perform management roles and are not involved in individual claim files. Consultants generally do not have management responsibilities.
Changes in Claim Organization
In order to address areas of concern noted in the Multistate Examination Report and increase the effectiveness of the claims operation in processing claims, changes are being made to increase the claim handling experience of personnel involved at the earliest stage of reviewing a claim, add to the accountability for compliance and increase the involvement of higher level management in approving claim decisions. The primary changes are as follows:
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