Unum is one of the largest insurance companies in the United States. According to recent research published by Statista, Unum (along with Unum group companies including Paul Revere Life Insurance Company and Provident) was estimated to be the country’s single largest provider of group long-term disability benefits. In 2021 alone, policyholders paid the company $9.5 billion in premiums.
Unfortunately, Unum has also earned a reputation for wrongfully denying claims and general bad behavior. After several state investigations (market conduct examinations) into its faulty claims handling processes and unfair practices, it was forced to settle with 49 state insurance commissioners and reassess or re-evaluate more than 200,000 previous disability claims. Courts have repeatedly found that Unum’s claim denials are capricious and in flagrant defiance of medical science. Unum took the No. 2 spot on the American Association for Justice’s 2008 list of worst insurance companies in America, and the situation hasn’t improved much since.
In short, if you’ve had an Unum long-term disability claim unfairly denied, you are not alone. Read on to learn more about how to fight back.
The Unum Claim Appeal Process Depends on the Type of Plan
If you disagree with Unum’s claim denial, you’ll need to file an appeal. However, the rules and procedures you’ll need to follow will depend on several factors. One of the most important is whether your plan is governed by the Employee Retirement Income Security Act of 1974, more commonly known as ERISA. Since most claims will be ERISA claims, we’ll outline this process first, then follow up with information about non-ERISA policies.
Unum ERISA Appeals Process
Most long-term disability policies are ERISA policies. If you get your disability benefits through your employer, it’s probably going to be an ERISA plan unless your employer is a church or government entity. (If you’re not sure whether ERISA applies to your case, contact our office for help.)
Step 1: Review Your Claim Denial Letter
You should carefully review your denial letter before taking your next step, as it will contain important information you’ll need for your appeal. The letter, at minimum, should include:
- A breakdown of the main reasons why Unum denied your claim, including the medical evidence it reviewed and who reviewed it
- The company’s reason for denying your claim
- Important deadlines to file your appeal
In most ERISA cases, you will have 180 days from the date Unum denied the claim to file your appeal. While that might seem like plenty of time, you need to get started right away.
Step 2: Begin Gathering Evidence for Your Administrative Appeal
After reading your claim denial letter, you may believe that the administrative appeals process is a simple and routine step. But nothing could be further from the truth.
In most cases, this appeal will be your only remaining opportunity to add new evidence to support your claim. If Unum denies your claim again, and you have to sue, the court will only be allowed to review the evidence provided in your administrative appeal. So, it must be comprehensive and accurate.
As soon as possible, you should request a copy of your claim file from Unum if it has not been provided to you. This will include all the records and information the insurance company currently has regarding your case.
From there, you will need to gather and organize as much relevant additional evidence as possible in support of your claim to ensure you have the best chance to win your appeal (either in the administrative process or in court). Do not assume that the insurance company is going to gather all the evidence on their own.
This might include, but is certainly not limited to:
- Medical records
- Expert reports
- Vocational evaluations
- Functional evaluations
- Letters of support from physicians
- Personal testimony from colleagues and acquaintances
- Copies of documents in your claim file
- Photos and video evidence
- Pain journals
Step 3: File Your Appeal
Once you have all your evidence gathered, reviewed, and organized, you will need to present that evidence to Unum along with your appeal letter.
The ideal appeal letter will provide a concise, persuasive explanation of why you are appealing the claim and the specific rulings you are contesting, with references to the documentary evidence that you are providing, as well as applicable citations to your plan documents and relevant case law.
This is not a simple process, although Unum would very much like you to believe that it is. Writing a few paragraphs in an online form about why you disagree with Unum’s decision to deny your claim almost certainly will not cut it. A qualified ERISA attorney who knows the law and has experience working with Unum directly will be invaluable for most claimants.
Step 4: Wait for a Response
Under ERISA, Unum ordinarily has up to 45 days from receiving your appeal letter to review and either approve or deny your appeal. However, the law allows them to request a single 45-day extension if there is “good cause,” so waits of up to 90 days are common.
If Unum denies your long-term disability claim again, and you still believe that your benefits were wrongfully denied you will be able to file a lawsuit against them.
Again, remember that the court can only review information that is already in your claim file. You will not be able to add new evidence or correct mistakes in the record.
What If My Disability Insurance Plan Is Not Governed By ERISA?
If you purchased an individual long-term disability insurance plan on your own (not through an employer), or you work for a government or church organization, your plan is likely not governed by ERISA, but instead by your state’s contract laws.
There are many differences between ERISA and non-ERISA plans. However, in Illinois, the major difference when it comes to appealing denied long-term disability claims is that you do not have to exhaust the administrative appeal process before you can take Unum to court. You’ll also likely be able to add evidence throughout the formal discovery process, can ask for a full jury trial, and even pursue bad faith damages if you believe Unum acted with malicious intent or willful negligence in delaying or denying your claim.
Did Unum Deny Your Disability Claim? Contact an Experienced Attorney Today
In our experience Unum insurance will regularly deny claims, even valid ones, for any number of reasons. And if they deny yours, you only have a very short period of time to review their denial letter, gather all the evidence you need (which may be extensive), and fight back.
Your chances of successfully overturning a long-term disability denial will be significantly greater if you have a qualified disability attorney handling your appeal. Do not let Unum use unfair tactics or take advantage of your inexperienced to deny you the LTD benefits you deserve.
Bryant Legal Group has earned a strong reputation for handling Unum disability claims and appeals throughout Illinois. To schedule your free consultation with our law firm, call us today at 312-586-9543 or complete our online form.