You have made a wise decision to get more information about UNUM Disability Insurance so you understand before you stop working what you have to prove to get your benefits, how much you will get and how strategic planning can make all the difference.
You must understand the tricks and games disability carriers like Unum make every day to improve their bottom line by denying or terminating benefits. It is not and has never been about being faithful to the promise they make to you when you bought your policy and paid premiums or doing right when you desperately need your disability insurance benefit.
You made a wise decision to get more information from an experienced disability insurance lawyer when Unum issued its denial of your appeals, and are now faced with the need to sue Unum to get your benefits.
Working with an attorney who has been inside the family of a disabled breadwinner and who has had a ringside seat to the personal fight with a disability carrier is the right thing to do.
Remember you only have one chance to get your disability application right, one chance to file a winning appeal and one chance to convince a judge that Unum was wrong!
Unum, once known as Union Mutual, was one of the United States largest disability insurance companies until the recent merger of Liberty Mutual and Lincoln Financial.
Unum has grown over the years as a result of mergers with Provident Life Insurance Company, who pioneered the concept of disability insurance, and the Paul Revere Life Insurance Company. Paul Revere was one of the only sources of disability insurance for medical professionals and had a history of paying claims until its merger with Provident in 1997.
Unum Provident was formed in 1999 as a result of the merger and they adopted the UNUM Group name in 2007.
Unum owns a number of smaller insurance companies that include:
In my opinion, the Paul Revere merger was the beginning of the end of fair claims handling and the newly merged company made a business decision to change the way it handled disability claims.
In Merrick v. Paul Revere Life Insurance Co., Unum Provident Corp, dba Unum Life Ins. Co. of Am. & Provident Life & Accid. Ins. Co., 2008 U.S. Dist. LEXIS 106976 (D.NV. Nov. 1, 2008), the court took judicial notice that the Ninth Circuit had “previously found that evidence exists that these Defendants had a conscious course of conduct firmly grounded in established company policies that disregarded the rights of insureds.”
Every Unum policy holder should read the series of opinions in this case. The court made it clear how pervasive Unum’s institutional bad faith pollutes the claims handling process.
The courts, amazingly, used terms like “a scheme engaged in”, “profits at the expense of insureds”, and “unfair and unlawful claims handling practices” to describe Unum’s conduct.
Unfortunately, nothing has changed since that decision. Unum just tries to hide it conduct better.
Unum was heavily criticized about their profit at all costs model and the “kick it up a notch and get pizza if you deny more claims” contests. It offered adjusters rewards for closing files and favorable employment reviews.
It was sued by 48 states because of its claims handling and denial process and, ultimately, entered into a Multi-State Agreement which provides that it make revisions to the claims handling process.
The result was a temporary correction in Unum’s claims handling process. However, it has, in my opinion, returned to the bad behavior that got it into trouble to begin with. Only now, UNUM knows how to cover its tracks much better. It still uses the old playbook but has dressed it up in a new cover.
Unum is back to playing games with initial applications and making endless and multiple requests for medical, financial and vocational information before it figures out a way to deny benefits. This delay and denial strategy drains the policy holder’s bank accounts as they try to stay financially afloat.
Unum is back to its old tricks by using “liar for hire” doctors who give Unum the ammunition it needs to justify a claims denial or termination. Unum rarely tells a denied policy holder the real reasons the claim was denied. Worse yet, Unum fails to fully explain what the denied policy holder needs to submit to successfully win an appeal.
That’s why it is crucial that you be represented at both the initial application and appeal stages of a Unum claim by an experienced lawyer, like me, who battles Unum daily. Some Unum policy holders make the mistake of going it alone and they pay dearly for “doing it yourself.”
Once the appeals process is exhausted (and that really means you are exhausted by the endless requests for information and battling with Unum), the only recourse is to file a lawsuit. If you purchased your insurance through your employer, the policy is most likely governed by the Employee Retirement Security Act or ERISA.
Despite its name, the ERISA statute and regulations are NOT policy holder friendly. You CANNOT add anything to the claims file after the last denial so all the Federal judge gets to see is what is in Unum’s file. If you didn’t know enough to get the claims file when you appealed, didn’t know enough to add medical, vocational or lay evidence to the file, or didn’t make the right arguments, you have all but destroyed your case.
An appeal of a denied Unum claim is the trial of your case. Of course, you are a very smart person and may have many degrees, but taking on Unum is the job of a specialist. A Federal judge will give Unum the benefit of the doubt because your Unum policy requires you to prove they are wrong and not the other way around. You owe it to yourself and your family to have an experienced disability attorney, like me, take on Unum. After all this is about getting the disability benefits you deserve and you paid for.
Some policy holders have bought their own disability policy through an agent and that is known as an individual disability insurance policy. The game is the same but the playing field is more level because any claims denial can be challenged in state court which is a friendlier place to be if you have to sue Unum.
Don’t think that Unum isn’t playing the claims delay, denial or termination game with individual disability policies. They are, and the policy benefits at stake are high and there is much more to lose if you aren’t represented by a Unum individual disability attorney like Nancy Cavey. After all, you invested hundreds of thousands of dollars in your education and bought the Unum policy to protect your finances and lifestyle.
UNUM, the nation’s largest disability insurance company, routinely requires long-term disability applicants to apply for Social Security Disability benefits, regardless of whether the applicant is really entitled to Social Security benefits. Why do they do that? Because most long-term disability policies have a provision that allows them to reduce your long-term disability benefits by the amount of any Social Security disability benefits you may receive. If you do not apply, companies like UNUM take the position that you are getting Social Security benefits, and will automatically reduce your long-term disability benefits.
UNUM processed “almost 4000 disability claims in 2007, and paid out more than 4 Billion dollars in benefits.” Obviously, they want to do anything they can to reduce the payout.
Routinely requiring long-term disability applicants to apply for Social Security benefits, even though the insurance company knows they are not eligible, wastes valuable resources of the Social Security Administration, and helps create a large backlog in the processing of valid Social Security disability claims.
A federal jury in Boston found that requiring “able-bodied people to apply for Social Security could sometimes constitute fraud.” In an AARP bulletin by Mary Williams Walsh, it was noted that the lawsuit “was filed under a federal whistleblower statute that allows private citizens to sue on behalf of government programs if they believe they have evidence of fraud.” You can read Ms. Walsh’s article on how UNUM was found to be guilty of Social Security fraud here: http://bulletin.AARP.org/states/ny/articles/disability_insurer
UNUM, of course, plans to appeal! Maybe UNUM will get to experience, just like the UNUM policyholders who have their long-term disability claims wrongfully denied, how unfair the appeal process can be. I think the saying goes, “What’s good for the goose, is good for the gander.”
If you have any questions about applying for Social Security disability benefits and the interaction with your long-term disability claim, contact Florida-based long-term disability/ERISA lawyer, Nancy Cavey.
UNUM, headquartered in Chattanooga, Tennessee, is the United State’s largest provider of employer sponsored group disability benefits “providing benefits for 42% of today’s Fortune 500” businesses. Unfortunately, it is our experience as Florida UNUM Disability Denial lawyers that UNUM does not deliver what it promises to those businesses who purchase group disability insurance for its employees.
UNUM’s website would have you believe that the “focus is on recovery.” Long term disabilty benefits from UNUM “can replace part of your income so you can focus on recovery instead of worrying about your ability to pay the bill.” Unfortunately, as a Florida disability lawyer who represents many UNUM policy holders, my experience is that UNUM typically stops paying short term disability benefits just before the long term disabilty benefits are to start.
Long term disability coverage “provides benefits when you are unable to work for a longer period of time and may last until you are able to work” according to UNUM. Many times UNUM will have the file reviewed by a nurse or “independent doctor” paid by UNUM who will say you can work despite what your doctor says about you inability to work. UNUM will deny long term disability claims for 3 primary reasons:
(1) There is no “objective evidence of your diagnosis” despite testing or your doctor’s findings on examination.
(2) There is no “objective evidence of your disability” despite physical findings of disability and pain.
(3) “No relationship between your medical condition and your inability to work” despite the fact that your employer has terminated you, you can’t function at a sedenatry work level, or that you are getting Social Security Disability benefits.
If you are insured by UNUM and are thinking about applying for short or long term disability benefits or have been denied disability benefits by UNUM, get in touch with an experienced attorney. Florida UNUM Disability Denial lawyer, Nancy Cavey, has written “Robbed of Your Peace of Mind”, a must read about the policy terms you don’t want to see in your UNUM disability policy and the mistakes you can make in your UNUM long term disability claim.
Order your no-obligation copy immediately. Answering these broad-based questions isn’t easy. Help is a phone call away. You can contact Nancy Cavey, an experienced long-term disability attorney at 727-894-3188.
When you need to file an Unum disability insurance claim, it is critical to get the facts you need. You need to have a clear understanding of how Unum disability claims work, and the timelines associated with the claims process. The following is a set of frequently asked questions (FAQs) to help you learn more about this complex claims process and to obtain some of the necessary background information for discussing your claim with an experienced Unum disability attorney.
Many people purchase short-term and long-term disability insurance so that they have an option for collecting benefits in the event they become unable to work due to a disability. In theory, Unum benefits often look like they can be helpful to injured employees, given that the insurance company makes promises of paying up to 60% of the salary you earned while you were working through disability insurance coverage. Depending upon whether you have short-term or long-term disability insurance, the benefits are supposed to provide you with payments for anywhere from 9 to 52 weeks in total with short-term disability coverage and benefits up until you reach the age of retirement with long-term disability coverage. However, many people who suffer injuries or illnesses that leave them disabled and unable to work learn that their claim has been denied by Unum.
In general, this is how the Unum disability claims process should work: If you have a short-term or long-term disability insurance policy through Unum, you must have a documented disability as it is defined by Unum. Provided you have a disability that is included in the policy, you should submit your claim as soon as possible. If your claim is denied, you can go through an appeals process with help from an experienced lawyer.
If you have an Unum disability insurance policy for short-term or long-term coverage, most claims can be filed online. If you want to file a hard copy, you can do so, but you will need to obtain a claim form online or obtain one from someone in Human Resources at your place of employment. The claims process begins when you fill out the form, provide any required information, and file the claim. Whether you are filing a claim online or in hard copy, you should work with an experienced Unum disability benefits lawyer who can ensure that all of your materials are filed accurately and in a timely manner.
It is critical to understand the timeline for an Unum disability claim—both in terms of getting your claim filed in a timely manner and making certain that Unum has the supporting materials it needs. According to Unum, short-term disability claims typically receive a payment decision within 5 business days, but the company says that “more complicated” medical conditions can result in a payment decision taking up to 30 days. Long-term disability claims typically take 35 to 45 days to process, according to Unum.
You should remember that the insurance company is going to do everything it can to try to show that you are not entitled to benefits. An Unum disability benefits lawyer can help to prove that your medical condition means you are eligible for Unum disability benefits.
The type of policy that you have will determine your rights and whether you are playing on a level playing field. UNUM offers:
Click on the link above for an explanation of each and how it works with your situation. Call us with any questions you may have regarding your UNUM disability insurance claim. We help nationwide at 727-894-3188. The consultation is free.