Unum Long-Term Disability Denial: How to Appeal
Unum Group, or simply Unum, is among the largest long-term disability (LTD) insurance companies in the United States. Founded in 1848 as Union Mutual, it would eventually merge with Provident Life, the first insurer to offer disability benefits. Union Mutual would go on to merge with several other companies, eventually renaming itself Unum and becoming the major presence that it is today, insuring about 39 million people worldwide.
While Unum is a top disability insurance company, that does not mean that filing or appealing a disability claim through their company is always smooth. Unum was the subject of a settlement agreement in 2004 in which they were required to reevaluate its procedures due to wrongful denials and paid $676 million in reparations. It is important to know that insurance companies may prioritize their own needs as a business over yours, and it is possible that appealing a claim with Unum can be a long, difficult process.
Fortunately, you do not have to go through the appeal process on your own. The long-term disability attorneys at Chisholm Chisholm & Kilpatrick are available to assist you in your appeal against Unum. We have years of experience handling difficult cases against insurance companies. If you would like to speak with us about your case, you can call 800-544-9144 to speak with a member of our team for a free consultation.
Why Did Unum Deny My Claim?
Your long-term disability policy with Unum will require that you meet a specific definition of disability, which outlines the terms you must meet in order to qualify for benefits. If you fail to meet this definition and are denied, a letter will arrive by mail informing you of the denial. You may also have previously been approved for benefits but later terminated, which Unum will also inform you of by mail. This can be difficult news to receive, but you will want to read the denial letter carefully to understand why your claim has been denied. This will help you understand how you need to move forward with your appeal.
There are many reasons Unum might deny your claim. You may lack strong evidence or have missed a deadline. Insurance companies also can enact certain measures that make it difficult for claimants to get their claim approved, such as requiring evaluations with their own hired doctors, who may be subjective in their evaluations.
Reasons your claim may have been denied by Unum can include:
- Insufficient evidence of your disability: For your claim, you will need to submit medical records documenting your condition. However, medical records alone are often not enough to prove that your condition meets the definition of disability in your policy. Unum may subsequently deny your claim, citing insufficient or weak evidence. To fight this in an appeal, you may want to see additional medical or vocational evaluations to add to your claim as evidence. These can build a stronger case by showcasing additional ways your condition disables you.
- Video surveillance: If you had been approved for monthly benefits and those benefits were terminated, it may be because Unum was keeping surveillance on you and believed they saw something in your activities that disproved your disability. For example, if your medical records indicate that your condition, in general, does not allow you to lift more than five pounds, but you were caught on camera holding a shopping bag, Unum might use this as grounds to end your benefits. It is important to keep in mind that insurance companies will use any evidence to disprove your claim because it is in their best interest as a business not to pay you. In your appeal, you will want to be sure that your medical evidence is as accurate as possible and does not include generalizations.
- Social media investigation: Unum may have investigators keep an eye on your social media. Like video surveillance, this is to catch you posting anything that may disprove your disability. For instance, if there are pictures posted online of you on vacation, at a concert, or simply doing anything that may be possible on a “good day,” while most of the time you are unable to leave your house or even get out of bed, they may use these as grounds to deny your claim. You may want to have discretion about what goes online so that Unum does not flag anything as suspicious.
- Own occupation/any occupation policies: Definitions of disability in long-term disability policies often follow the own occupation or any occupation terms of disability. The own occupation definition refers to your condition rendering you too disabled to perform your personal occupation, while the any occupation definition means you are prevented from working any occupation in the workforce. Often, long-term disability plans may require you to be disabled from your own occupation during the first 24-48 months you are receiving benefits. After this period, it is common for plans to switch over to the any occupation definition of disability. This is often where people fail to continue to successfully prove themselves as disabled and are denied benefits. To fight this in your appeal, a vocational expert may be able to aid you in acquiring evidence that proves your condition disables you from all occupations.
How to Appeal a Denied Unum Long-Term Disability Claim
After you ascertain the factors that resulted in your denied claim, you will want to go about determining what evidence you will need in your appeal. You will likely want to strengthen any weak areas of your claim or correct any errors. Making sure you have the strongest evidence on your record is particularly crucial during the appeal process. In ERISA-governed cases, the appeal will be your last chance to get any new evidence onto your record, as you will not be allowed to introduce anything further should your case be taken to court.
Steps you can take to strengthen your case during the appeal process include:
- Correct errors in your initial claim: If you were denied benefits because your initial claim was filed incorrectly, or did not follow all guidelines, you can fix this in your appeal. You may want to adjust the language you use in your claim to more appropriately suit Unum’s policy requirements. It is good practice to read your policy carefully before you begin amending your claim to guarantee you are doing everything properly the second time.
- Obtain additional medical evidence: If you were denied for weak or insufficient evidence, you will likely want to seek additional forms of evidence that can back up your medical records. If time has passed between your initial claim and your appeal, it is smart to get the very latest evaluations on your condition to ensure that your claim is as up to date as possible.
- Request a report from your physician: A report from your physician can be essential evidence to your claim, as your physician may be able to provide insight that your medical records lack. Be open and honest with your physician about how your condition affects you so that no generalizations are made. This way, their report can be as detailed and accurate as possible, which is important for the strength of your appeal.
- Impact statements from friends, family, and coworkers: Personal acquaintances have likely seen how your condition impacts your personal and professional life. Obtaining witness testimony from them can demonstrate to Unum that your condition impairs you in your daily activities. Statements from coworkers can be especially helpful as evidence that your condition prevents you from working your job.
- Acquire vocational evidence: Vocational experts can provide occupation-based evidence. They can assess your job and your ability to perform its duties while suffering your disabling health condition. It can be particularly important to seek a vocational expert if you are fighting an appeal based on a change in the definition of disability in your policy. If your policy is transitioning to the any occupation of definition, a vocational expert may be able to prove that you are unable to work any occupation in the workforce, not just your own.
How Chisholm Chisholm & Kilpatrick Can Help You with Your Appeal Against Unum
You can handle your appeal on your own, but it can be beneficial to seek an attorney for the appeal process. If your claim is ERISA-governed, you may not be able to introduce new evidence if your case is taken to the final stage of the process, court. It is crucial that you get the strongest possible evidence on the record for your appeal. The experienced long-term disability attorneys at Chisholm Chisholm & Kilpatrick can help you obtain what your claim requires in order to be approved for LTD benefits by Unum.
Our attorneys will carefully review your policy and assess your definition of disability. We have experience working cases for Unum and know how they tend to operate. If you suspect your case has been denied due to bad faith, it can be especially helpful to seek an attorney who can help you fight for your case against Unum.
CCK works with a variety of professionals, both medical and vocational, who can provide additional evaluations for you. This can be easier than trying to seek out experts on your own, especially when you are trying to manage your health. We understand that appealing a long-term disability claim can be stressful and exhausting, and we want to help you with your case so that you can focus on your health. We can lessen your stress by collecting the evidence needed for your claim and acting as a point of contact between yourself and your doctors, as well as Unum, so that you do not have to handle your case alone. We will make sure you feel confident that your appeal is in good hands.
Contact the Attorneys at Chisholm Chisholm & Kilpatrick LTD Today
Our experienced attorneys are ready to help you with your long-term disability appeal against Unum. We have over 33 years of collective professional experience with cases such as Unum and understand what they demand in their policies. We want you to be able to focus on your health condition while we take care of the legal burden for you.
We are prepared to help you get the benefits you deserve. You can call us for a free consultation at 800-544-9144 or contact us online today.
