Unum Life Insurance Company of America is one of the largest disability insurance companies in the United States. Headquartered in Chattanooga, Tennessee, Unum writes disability policies across the entire country. Although headquartered in Tennessee, many of Unum’s disability reviewers operate out of its Portland, Maine office.
As part of Keller & Keller’s long-term disability practice, we have faced Unum in disputes of denied short term or long term disability benefits. Although Unum’s denial tactics may vary based on the group disability policy or specific health conditions causing disability, below are several common tactics used by Unum to deny long-term disability claims:
Common Tactics Unum Life Insurance Uses to Deny Disability Benefits
1. Unum Claims You Fail to Meet the Applicable Definition of “Disability”
This broad reason for denying benefits can be found in nearly all denial letters written by Unum. If Unum believes that medical evidence does not establish an inability to perform your job during the “own occupation” period, then Unum will cite to the definition of disability as a basis for its denial. After the “own occupation” period is exhausted—usually after 24 months of receiving disability benefits—then Unum may claim that you have not proven an inability to perform the duties of “any occupation.” However, the definition of disability varies from policy to policy, so it is incumbent on you or your attorney to obtain the policy that governs your long-term disability to ensure that Unum is citing the correct provisions. If you have been denied disability benefits, it is in your best interest to contact an attorney today to help review the entire policy.
2. Unum Cites Policy Limitations Specific to Your Condition
A common provision contained within group disability policies is a limitation to the duration of benefits paid for mental health disabilities. Most often, the policy will limit payment to only 24 months when a disability is due to depression, anxiety, bipolar, or some other form of mental disability. Again, the policy language is crucial to determine whether or not your condition is limited to 24 months of payment. For example, an “organic brain disorder” is often an exception to this policy limitation, but every policy is different. There may also be exceptions to this limitation if you remain hospitalized due to mental health reasons.
In some policies, Unum may limit the duration of benefits for other conditions, including drug or alcohol dependence, fibromyalgia, chronic pain disorders, chronic fatigue syndromes, or other difficult to diagnose diseases. Again, it is essential to gather the complete disability policy for review by an attorney to determine if Unum is correctly interpreting its own policy.
3. Review by "Independent Peer Reviewers"
When reviewing your claim or appeal, Unum will often refer your claim to a contracted “independent” physicians to review your medical records and possibly contact your treating providers. These physicians have not examined you and will only form a medical opinion based on a paper review of your evidence. You will not get the chance to question these doctors in-person, although these doctors may attempt to contact your doctors by phone or letter. Through attorney representation, you may have the chance to ensure that there are no miscommunications between these “independent” physicians and your doctors. Additionally, an attorney may prepare a response to the doctor’s findings, which so often guide Unum’s decision to deny claims or appeals. There are other ways in which Unum may attempt to deny your claim as well.
Don’t Let a Denial Stop You. Contact Keller & Keller’s Disability Attorneys for Help
Keller & Keller represents individuals with disabilities who can no longer work. We can assist those who have been denied Social Security Disability benefits or long-term disability benefits. Keller & Keller can help you in every step of the way: initial application, appeal process, representation at an administrative hearing, and litigating your case in court if benefits are wrongly denied.