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.
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
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
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
Sharon E. Simone
Sen. Warren Tolman
Massachusetts State House
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.