As the largest provider of disability insurance in the U.S., Unum insures millions of people for long term disability benefits. Unum also denies many of their claimants disability benefits every year. All disability insurers, Unum included, have financial incentives to deny and terminate claims. Every dollar they save in denying claims is a dollar of profit. This creates an inherent conflict of interest because, in most instances, Unum is the entity that both decides the claim and is also the entity that pays the claim.
When filing a long term disability claim, appealing a wrongful denial, or litigating with Unum, it鈥檚 important to speak with an experienced ERISA attorney. Riemer Hess has secured and protected long term disability benefits from Unum for hundreds of our clients.
Below we鈥檒l discuss the common tactics Unum uses to deny disability claims, how to combat them, and more.
Unum has a long list of tactics that it regularly uses to deny disability claims. Many times these claim denials are unfair and unreasonable. Some common tactics we鈥檝e observed Unum use include:
A few common justifications Unum will use to deny long term disability claims include:
This list is not exhaustive.
Unum has a long-standing practice of disability claims handling practices that has been criticized and admonished throughout the country. In fact, Unum entered into a Regulatory Settlement Agreement (鈥淩SA鈥�) with state regulators in several US states in 2005, due to these practices. The RSA legal agreement was reached after a multi-state examination revealed that Unum had engaged in unfair and deceptive practices.
Under the terms of the RSA, Unum agreed to a series of reforms aimed at improving its claims handling processes and providing better customer service to its policyholders. These reforms included the establishment of new policies and procedures for claims handling, the hiring of additional claims personnel, and the implementation of an independent review process for certain types of claims. In addition, UNUM agreed to pay restitution to certain policyholders who had been adversely affected by the company鈥檚 previous practices, and to pay fines and penalties to the states that had participated in the examination.
Courts have recently confirmed that the RSA is still in full force and effect. See Moseley v. Unum Life Ins. Co. of Am., Civil Action 22-40079-RGS (D. Mass. Mar. 2, 2023). Despite the RSA being in place, Unum continues to often engage in unfair practices when handling disability claims. Research has shown that if anything, Unum's conduct has worsened since the RSA. See, e.g., Philip W Thomas, 15 Years Later 鈥� Did the Unum Group Improve Its ERISA Claims Handling Practices?, 39 Miss. C. L. Rev. 199 (2021). See also Richard P. Console, Jr., The 11 Worst Insurance Companies, National L. Rev. (Feb. 10, 2021) (available ) (naming Unum as the second worst insurance company in the US, and noting, with respect to its disability coverage, that 鈥渋t has established a poor reputation with its insureds鈥� and 鈥淸t]he media frequently investigates this company for their continual claim abuse鈥�).
Having your long term disability claim outright denied or terminated after initially receiving benefits can be devastating. Many clients come to Riemer Hess for help after facing an unfair denial from Unum. Fortunately, a denial or termination of benefits from Unum is not the end of the road.
If Unum denies or terminates your long term disability claim, here are the first steps you can take:
Unum often finds itself in court. Examples of courts criticizing Unum for their practices in denying benefits include:
Unum, like all disability insurers, is in the business of making money. If Unum believes it can find cause to deny your disability claim and save the company revenue, it will likely do so. This is why it鈥檚 so important to be prepared when filing, appealing, litigating, or protecting your long term disability claim.
When filing, appealing, or litigating a long term disability claim with Unum, it鈥檚 important to have a thought-out strategy. It鈥檚 all too easy to fall into common traps that result in your claim being denied or terminated. Unum will always scrutinize your claim for any justification to deny your disability benefits.
To get ahead of Unum, Riemer Hess works hard to proactively predict which tactics Unum is likely to use on any given claim. This can be tricky because each claim presents its own unique set of facts. We combine our experience with Unum together with the unique facts of each claim to craft a customized strategy designed to win benefits.
For example, our client Michelle worked as a high-level accountant when she began to experience debilitating back pain, fatigue, and muscle weakness. Eventually, her symptoms progressed to the point she could no longer work. Michelle applied for and received long term disability benefits from Unum.
Not wanting to give up the career she鈥檇 worked so hard for, Michelle attempted a part-time return to work after several months of receiving benefits, hoping to resume a full-time schedule over time. Unfortunately, as Michelle increased her work hours, her symptoms flared up even worse. Invasive and frequent treatment did not help subside her pain.
Unum terminated Michelle鈥檚 long term disability claim shortly thereafter, alleging that because she had attempted a return to work, even at a part-time schedule, she was no longer disabled. Unum claimed that Michelle only needed to try harder to work full-time. Michelle then hired Riemer Hess to help her fight against Unum for her long term disability benefits.
Riemer Hess filed an administrative appeal on Michelle鈥檚 behalf with Unum. The appeal included voluminous new evidence, including additional testing, medical records, supplemental letters from her treating providers, and an affidavit. Riemer Hess wins more than 85% of the appeals it files, but despite the wall of evidence Riemer Hess submitted reaffirming Michelle鈥檚 ongoing disability, Unum chose to deny her appeal. This left Michelle and Riemer Hess no choice but to sue Unum in court.
Riemer Hess filed a federal lawsuit on Michelle鈥檚 behalf, and the Court ruled in Michelle鈥檚 favor. The Court determined that Riemer Hess鈥檚 evidence demonstrated Michelle could not perform her job duties, and that Unum鈥檚 excuses for denying her benefits did not hold water. Unum was ordered to back pay Michelle鈥檚 long term disability benefits and pay her future benefits, subject to the terms of her long term disability plan.
If you鈥檙e filing a long term disability claim, appealing a wrongful denial, or litigating your claim with Unum, we recommend consulting with an experienced disability attorney. Riemer Hess has successfully filed disability claims and appealed denials with Unum for hundreds of our clients. We can review your Unum policy, claim forms, medical records, and vocational documents, and formulate a personalized strategy to give your claim the best chance of approval.
The Unum disability attorneys at Riemer Hess know the best strategies for filing, appealing, or litigating a claim with Unum and how to combat their tactics to deny the benefits you deserve.
If you are filing a long term disability claim, appealing a wrongful denial or termination of benefits, or facing litigation with Unum, the New York disability attorneys at Riemer Hess can help. Call 糖心直播 at (212) 297-0700 or click the button below to schedule a consultation on your disability case.