If Unum has denied your disability claim, you are one of scores of hard working Americans who have wrongfully been denied the disability benefits they paid for or received through their employment, and counted on in case they became sick or disabled.
What can you do now?
Disability attorney Jason Newfield has represented many individuals against disability insurance giant Unum and the numerous other companies under its vast umbrella (Paul Revere, Provident Life). He has seen the deliberate mistreatment of people and their claims, at a time when their lives have been upended because of an accident or an illness by a behemoth corporation with no intention of fulfilling the promises made in the insurance policy. When a devastating medical condition causes one to be unable to work, it becomes a double punch when your disability insurance claim is denied improperly.
The first step in fighting Unum for your disability benefits is to find your policy.
When engaging in your quest for disability insurance benefits, you will need the policy document for your claim, which may well be different than a new policy sold today. The disability insurance companies wrote policies ten, twenty, even thirty years ago, with very different clauses and benefits. In most cases, the older your policy is, the better your benefits are and the more favorable the policy’s’ terms.
If your is an Individual or Private Disability policy, it will have more favorable terms than a group policy. If you are unable to locate the original copy, contact the insurance agent or association who you purchased the policy from. Make sure it is the exact policy that you purchased, and not what’s being sold now.
The policy or certificate of coverage (for group ERISA claims) is like the map to the treasure chest. We must review the policy to determine what the applicable rules and terms of the claim are – to guide and strategize the process.
Next, can you read and understand the policy?
Here’s the problem: your policy is a legally-binding contract between you and Unum or one of its many subsidiary companies. And like most legally binding contracts, it is written in legalese. Unless you are a trained contracts attorney or handle long term disability insurance cases on a regular basis, you are not going to be able to fully appreciate the deliberately complex and confusing language of these provisions. Failing to understand policy terms might be critical to your claim and its chances of success, making it critical to secure guidance during this process.
It is not just that the insurance companies do not want you to understand the contracts. Over the years, with significant lawsuits against the companies, the language of Unum’s disability insurance contracts have been refined over and over again, and not in your favor; generally, with more onerous terms being placed in newer coverage.
The usual suspects when a claim is denied:
Time factors, which are numerous. Did you file a claim for Unum disability benefits when you first became ill/incapacitated, or did you struggle to keep working? Yes, they can make that work against you – despite heroic efforts to continue working in the face of disability. Did you complete your application for benefits with all of your medical reports, diagnostic test results, employer narrative (if required) and any other materials as required or requested in the Unum claims process within the time frame?
Note that if you receive a request for additional records, there will be time constraints to that request also. And you must work to ensure that your doctors comply.
If you received a termination of claim with a letter giving you a time frame for filing an appeal, that’s a firm deadline, typically with no extenuating circumstances. If you are so sick or hurt that you cannot work, Unum still demands you follow the deadlines. If you cannot respond in time because you are hospitalized or recovering from surgery, it likely does not matter. You could easily lose your right to ever appeal for benefits. If this is your situation, call our office today and find out what you need to do. There is often no flexibility with Unum or any other disability insurance company.
Did Unum claim that you aren’t disabled, as your medical condition doesn’t rise to the level of true disability?
This is a common reason for claims being denied. You know you cannot work – you’ve probably tried and it was too much, or errors and mistakes have crystalized the issues. Your doctors are sure you should not be working. We respond to these kinds of situations all the time.
Often these denials occur because the medical record is not strong enough – despite the doctor supporting your claim. Your doctor is not a long term disability insurance attorney, so they do not fully understand how much information needs to be sent to get a claim approved. They may not even know the gold-standard test for your condition. We do, and that is why our claims applications are considerably better than those sent in by claimants. We include every piece of evidence necessary (but not more), compelling the insurance company to approve your claim.
Did Unum say your job doesn’t require you to perform the tasks that you cannot do anymore?
We have seen disability insurance claim denials for dentists who lost the necessary use of their hands who are told they are fine and can continue to treat patients. Nothing surprises us, especially when it comes to Unum on private disability insurance claims. So, our claim application or appeal always includes in depth development of the physical and mental requirements of your job, whether it is working in small spaces (like a patient’s mouth) or travelling to multiple cities every week for a regional vice president of sales, or other physical or mental challenges.
Does Unum think you have a desk job and should be able to perform all of the duties sitting at your home office, taking breaks when necessary, and are otherwise able to work at peak levels despite your disability?
Ever since COVID, when the world learned how to work remotely, disability insurance companies have tried to use this argument to the detriment of claimants. An attorney who has a cognitive problem cannot function in their work, even if they are working from home. And what might have been a desk job 20 years ago is not necessarily a desk job today.
If your occupation requires being on site to provide client or patient services, yours is not a desk job. If you need to be on a job site, like an architect, and have a severe case of Meniere’s Disease, for instance, you cannot go onto a construction site with a reasonable level of safety. An attack of vertigo at a construction site while twenty stories above ground, or even five stories below ground, will not be a safe work environment.
Part of our preparation of a claim or an appeal includes a significant work up of the tasks and duties of the occupation, from traveling from home to office or job site to the typical tasks that make up a normal day and both the physical and cognitive requirements which so frequently exist. We have battled successfully against many claim denials where the insurance company relied upon a Department of Labor job description that is decades out of date.
Claims are often denied or terminated close to quarter ends, for the Corporate reporting cycle, as often Unum is seeking to demonstrate financial success to Wall Street, to disability insurance claimants’ detriment.
Unum is the largest long term disability insurance provider in the country and it is one with a long standing reputation. If you have been denied disability benefits from Unum, or if your benefits have been terminated, call Jason Newfield at the Newfield Law Group to learn how we can help.
