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Disability Denial from UNUM

Victor Peña Oct. 12, 2021

Being forced out of work long term because of a disability can cause huge disruptions and challenges. A 2019 bankruptcy study found that 44.3 percent of filers cited loss of income due to medical issues as the reason for their filing.

Many people purchase long-term disability (LTD) policies either through their place of work or from a private insurer they seek out on their own. The problem with LTD policies is that the insurance company underwriting them can cite a number of reasons for not honoring your claim when you do file for disability.

Notable among the claim-denying insurers is UNUM, a Fortune 500 company and one of the nation’s top insurers for long-term disability.

Reasons UNUM May Deny Your Claim

All insurance companies are in the business of making money, so they uniformly seek ways to lowball or deny any claim you submit, whether it’s for auto, home, disability, or other. When it comes to LTD policies, insurers can cite a variety of factors. In UNUM’s case, denials are often based on:

  • Contending you did not supply sufficient medical documentation

  • Utilizing in-house medical and vocational experts who say you are not disabled

  • Claiming your policy excludes coverage for your particular medical condition

By law, the insurer needs to cite the factors behind their decision in a denial letter sent to you. However, UNUM denial letters have been known to contain incomplete, misleading, and even wrong information. Don’t take these letters at face value and don’t give up. You have a right to appeal, and if the appeal is denied, you can file a lawsuit.

Appealing a Denial Letter

If your policy is covered by the Employee Retirement Income Security Act (ERISA), as most policies purchased through work are, you have 180 days after the denial letter to file an administrative appeal. If your policy is not covered by ERISA, you can still file an appeal.

When you send an appeal letter, you need to provide as much documentation as possible from physicians and others helping you with your disability to state your case. You will want to specifically address any reason for denial that UNUM cited.

Some of the documents to include in your appeal are:

  • Medical records (past and present)

  • Your physician’s evaluation of your restrictions and inability to work

  • Letters from family, friends, and others familiar with your disability

Your best bet is to get an experienced long-term disability insurance attorney to help you with the appeal. You will definitely need an attorney’s help if your appeal is denied.

Once UNUM receives your appeal, it has 45 days (under ERISA) to evaluate it and respond to you. However, they can ask for a 45-day extension if they claim they need more time to evaluate your appeal.

If Your Appeal Is Denied

If your administrative appeal is denied, under ERISA, you have the option of suing the company and asking a judge to rule on whether the denial of benefits was justified.

The problem with a lawsuit under ERISA is that ERISA favors the big insurers. For instance, you are not allowed to introduce new evidence, call witnesses, or conduct what is called “discovery,” meaning you cannot ask UNUM to supply further information or provide interviews with company personnel.

Despite signing a multistate agreement in 2004 to reform its claims practices due to a high number of complaints and lawsuits, UNUM is still denying claims unreasonably. The findings that led to the 2004 settlement are illustrative. California insurance regulators found that UNUM:

  • Cherry-picked from the claimant’s medical file to find a reason to deny or invalidate valid disability claims

  • Relied on in-house medical reviewers for many of their decisions, but the reviewers conducted only paper reviews and never interviewed the claimants

  • Forced its claims adjusters to target certain types of claims for denial, essentially creating a denial quota system

So, if your UNUM LTD claim is denied or terminated, you’re not alone. Seek out an experienced long-term disability attorney and explore all your administrative and legal options. Don’t take “no” for an answer.