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Model State Legislation to
Ban Discrimination in Sale of
Long Term Disability Insurance

CFIDS patient Sharon Simone worked with her state legislator to introduce the following into the 1997 session of the Massachusetts State Legislature. The language of this proposed law is very short and simple, and could be replicated in additional states.

The content of this site is a duplicate of that made available by UK M.E. activist Kay Robinson at the following website: http://community-care.oaktree.co.uk/html/ins4.html. For more information about M.E. (CFS), go to Kay's U.K.-M.E. Web at http://www.community-care.org.uk/ME/. Many thanks to Kay for all the work she does for PWC's.


The Commonwealth of Massachusetts, 1997

An Act To Prohibit Discrimination in Disability Insurance

Be it enacted by the Senate and House of Representatives in General court assembled, and by the authority of the same, as follows:

SECTION 1. Chapter 175 of the General Laws, as most recently amended by chapter 376 of the acts of l996, is hereby amended by inserting after section 108E the following section:-

Section 108F. No benefit under a policy of insurance insuring against disability from injury or disease shall be terminated or subject to time limits solely on the basis of diagnosis or type of diagnosis including, but not limited to, a diagnosis or type of diagnosis based upon a psychiatric or mental impairment or a "self-reported" impairment. Standards governing the termination or time limits applicable to said diagnoses or types of diagnoses shall be consistent with the standards governing the termination or time limits governing other diagnoses or types of diagnoses.

Sample Letters to State Legislators

Sample Letters to State Legislators regarding the need for special state legislation to ban discrimination against persons with CFIDS in the sale of disability insurance products: Here are two letters which could be used as models by persons wishing to introduce similar legislation in their own states.

Chairman Byron Rushing
Joint Committee on Insurance
Massachusetts State House
Room 254
Boston, MA 02133

Attn: Ms. Linda Long

Dear Chairman Rushing:

I would like the help of the Joint Committee on Insurance on an urgent matter. Massachusetts may be allowing UNUM Life Insurance Company of America (Portland, ME) to discriminate against citizens of the Commonwealth who have a devastating illness: Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS).

Although UNUM is not my Long Term Disability insurer, I am following a disturbing unfolding of events, lead by UNUM, as a victim of CFIDS myself since l987. I also have a civil suit pending against MassMutual for discriminatory insurance practices relating to their handling of my two disability claims with them, one for CIFDS, and one for post-traumatic stress disorder (PTSD) stemming from childhood trauma.

I have a vested interest in confronting abuses of power and discriminatory practices which are tantamount to an abuse of power. I know the damage, to the individual and to society, that is incurred when abuses of power go unstopped . I also know the power of using the legal and legislative processes to confront these abuses of power. I helped initiate legislation in Washington with the support of Congresswoman Schroeder which passed in l994--The Child Abuse Accountability Act which allows federal pensions, life my father's, to be garnished for child abuse judgments.

In addition to that effort, in April of l995, I testified here in Massachusetts before the Joint Insurance Committee concerning legislation under consideration that would prohibit insurers from discriminating, in their insurance practices, against victims of domestic violence. I grew up in domestic violence and won one of the first civil suits in this country against my father who was a nationally recognized child abuse expert and an FBI agent. At the time of my testimony before the Joint Insurance Committee in MA, I asked that the legislation under consideration be written to include disability insurance as well as the others already drafted into the legislation. The legislation passed that summer and did include my proposed change. My lawsuit, filed in Middlesex Superior court against MassMutual, includes a complaint citing a violation of this amended section of 93 A and M.G.L. Section 153, Chapter 175. I think this legislation could be a model for legislation I see needed to address UNUM's new disability contract "approved" in Massachusetts. Background Information: On July 25, l996 The Wall Street Journal published an article by Nancy Ann Jeffrey describing how UNUM, the nation's largest group disability carrier, had received approval in 39 states (an update via personal communication with UNUM's Director of PR yesterday said there is approval now in all but four states) for a "two-year benefit limit for "self-reported" symptoms or illnesses where tests fail to identify an underlying cause." Other companies mentioned in this article (Standard, Fortis and Metropolitan Life) have followed suit. There is an illness "hit list" which includes Chronic Fatigue Syndrome, Sprains and Strains, Back, Joint and Muscle Pain or Soreness, Numbness and Stress. This list was blocked off in the WSJ article and discussed in terms of impact to sufferers and savings for companies.

I believe, as do many other individuals with such diseases as CFIDS, Fibromyalgia, Multiple Chemical Sensitivity and Post-traumatic Stress Disorder do, that this singling out to treat differently, a select group of ill individuals because there is no test that can yet identify their illness as legitimate, constitutes discrimination.

The horrific LTD practices nationwide concerning these illnesses has spawned a multitude of lawsuits that are unnecessarily taking up court time. Now there is a bold move, by UNUM and other companies, to outright discriminate against us. Insurance regulations should be in place to prohibit discrimination of this nature. If there were legislation in place, companies such as UNUM would have to figure out a way to make good on their promises when they sell disability policies rather than harass those they supposedly serve.

Companies like UNUM and MassMutual promise to protect your income and happily sell you a policy and collect premiums but when you fall sick and try to use the benefit you are treated as a criminal. I was surveilled for a six week period eventhough I have a court Order of Judgment that states that I have permanent damage, both physical and psychological! Yet, MassMutual terminated my benefits following their surveillance because I was out at coffee shops eating breakfast and lunch frequently! It wouldn't surprise me if I discovered that MassMutual had already written new contracts to limit coverage like UNUM has.

There are problems with the two-year limit and the "hit list" which requires that a test identify the medical problem or it becomes classified as "self-reported" and subject to a two-year coverage limit. For a long time, AIDS would have fallen into this category. As would MS and diabetes and any number of illnesses. It is my understanding that in order to impose a two-year limit, there must be actuarial data to support it. I don't believe there could be actuarial data yet for CFIDS (or some of the other conditions not mentioned overtly in the WSJ article but rather disguised by symptoms). CFIDS represents 1-2% of disability claims in most companies at this point. And, it hasn't been classified or understood long enough to achieve actuarial rating.

There is also another problem. When I spoke with Ms. Tracy Sherman, UNUM's Director of PR, she told me that disability contract changes or new contracts are applied for differently in each state. She told me that Massachusetts is an "Exempt State" meaning that if the contract under consideration has "home state approval" no forms or listings have to even be completed or registered in Massachusetts. If this is true, Massachusetts is not protecting its citizens from potential discrimination in insurance marketing and sales. I, for one, am appalled to find this out.

An important piece of information: Dr. Anthony Komaroff, Chief of Internal Medicine at Brigham and Women's Hosptial and a leader in the Harvard Medical Community in many of his endeavors happens to be the foremost expert internationally on this illness. He has been a pioneer in research and advocacy for CFIDS and individuals afflicted. He has carried on substantial research, funded by the NIH and was instrumental in getting both "case definitions" drafted and approved by the Center for Disease Control (CDC). This disease has recently been classified as a "priority one illness" by the CDC. It is no longer considered "a yuppie flu." Dr. Komaroff has patients, like myself, from all over the world in his research projects and would be a good resource should you want medical and/or political information concerning CFIDS.

Here is what I would like from your Committee:

I would like you to verify the information I was given by the UNUM PR person that Massachusetts is considered an "exempt state" and hence UNUM, because it has "home state approval" can sell a group disability policy in Massachusetts that has a two-year limit on "self- reported conditions" without so much as filing a form with us let alone undergo a review process. I would like to know what you find out as soon as possible. If it turns out to be true, then I would like to see this status changed by whatever means is available or proper.

Secondly, I would like you to consider drafting legislation that prohibits UNUM and any other insurance company from discriminating against its insureds by insisting that if a "test" cannot be produced that verifies the condition, then that condition can get labelled "self- reported" and become subject to a two-year-limit. I think the language utilized in the legislation prohibiting insurance discrimination against victims of domestic violence would be very close to what is needed in this current situation.

Thirdly, you may see some other way to approach this problem. If so, I would greatly appreciate hearing your thoughts and being informed. I would be glad to help and to mobilize resources I am in touch with nationwide to help as well.

I would like to see Massachusetts take a lead in the country on this issue. No state has any legislation pending in this regard at this time but there is a very strong movement at a grass roots level, like there was with the domestic violence legislation, to get legislative efforts going to respond to UNUM's new contract with the limits. Their approval process, nationwide, seems to have taken place very quietly, without any opportunity for afflicted individuals or their physicians, families or representatives to raise their concerns and objections.

I will send a letter like this to Rep. Anne Paulsen and Sen. Warren Tolman from my District asking for their support and help. I will also send you the WSJ article and a couple of recent articles from the CFIDS Chronicle that flesh out this problem with LTD carriers and CFIDS. My son, Tim Simone is an intern with Sen. Jacques and I will have him drop the copies by tomarrow. Thank you for your serious attention to my request.

Sincerely,
Sharon E. Simone


Sen. Warren Tolman
Massachusetts State House
Room 424
Boston, MA 02133

Dear Senator Tolman:

I would like your assistance in addressing the issue explained pretty thoroughly in my letter to Chairman Byron Rushing that is attached. Any suggestions you have, or any help you can offer would be greatly appreciated. It's a troublesome scenario and I'd like Massachusetts to make a difference in how UNUM and other companies are treating persons with CFIDS and other so-called fringe illnesses. I think there is discrimination going on. Further, as you will see in my letter to the Chairman, I believe Massachusetts may be being lax in its protection of citizens who purchase policies that are discriminatory. Thanks for any help you can offer.

Sincerely,
Sharon Simone


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