Long-term disability insurance is meant to provide a financial safety net for people who are unable to work due to illness or injury. However, the insurance industry giant Unum has gained notoriety for its history of denying valid long-term disability claims, leaving many policyholders in dire straits when they need support the most.
Unum’s History of Systematic Long Term Disability Claim Denials
Unum has a long history of unfairly denying valid LTD claims. Instead of supporting policyholders, the company has relied on denial tactics to cut costs. Lawsuits and investigations have repeatedly exposed its pattern of wrongful claim denials. Here’s a closer look at the details:
The Systematic Approach to Claim Denials
Unum’s troubling history of claim denials isn’t a result of isolated incidents or honest mistakes. Evidence suggests that the company has systematically denied valid long-term disability claims over decades as part of a long term corporate strategy to improve its financial performance. This approach has left countless individuals without the support they desperately need and rightfully deserve.
The company’s tactics have included:
1. Misinterpreting medical evidence
2. Ignoring the advice of independent medical experts
3. Pressuring claimants to return to work prematurely
4. Employing biased in-house medical professionals
5. Using outdated occupational definitions
Regulatory Investigations and Settlements
Unum’s practices haven’t gone unnoticed by regulatory bodies. The company has faced numerous investigations and settlements related to its claim denial practices. In 2004, Unum entered into a regulatory settlement agreement with insurance commissioners from 48 states, agreeing to reassess approximately 200,000 previously denied claims and pay a $15 million fine.
Despite this settlement, problems persisted. In 2013, Unum faced another multi-state market conduct examination, resulting in a $1.8 million fine and requirements to improve its claims handling practices.
Legal Challenges and Judicial Rulings
Unum has been the subject of numerous lawsuits filed by claimants who have had their claims wrongly denied. Many of these cases have resulted in rulings against the company, with courts finding Unum’s claim denial practices to be arbitrary, capricious, and in violation of the Employee Retirement Income Security Act (ERISA) regulations and/or state laws.
For instance, in the case of Hangarter v. Provident Life and Accident Insurance Co. (a Unum subsidiary), the court found that the company had engaged in a “biased” claims process designed to achieve the goal of “claim termination.”
Impact on Vulnerable Insureds
The consequences of Unum’s wrongful claim denials extend far beyond financial implications. Many insureds, already dealing with debilitating medical conditions, face severe emotional distress and financial hardship when their claims are denied. This can lead to a cascade of negative outcomes, including:
• Inability to afford necessary medical treatments
• Loss of housing or other essential resources
• Strain on family relationships
• Exacerbation of existing health conditions due to stress
Lack of Transparency and Accountability
One of the most frustrating aspects of Unum’s claim denial practices has been the company’s lack of transparency. Claimants often struggle to understand why their claims have been denied, and the company has been criticized for providing vague or insufficient explanations for its decisions.
This lack of transparency has made it difficult for claimants to challenge denials effectively and has contributed to a perception that Unum lacks accountability for its actions. In today’s insurance climate, this erosion of public trust has had far-reaching consequences for the company’s reputation.
Impact on Industry Standards and Regulatory Reforms
Unum’s practices have not only affected its own policyholders but have also had broader implications for the long-term disability insurance industry. The company’s actions have led to increased regulatory scrutiny and calls for reforms to better protect the rights of policyholders. Some of the regulatory changes and industry reforms prompted by Unum’s practices include:
1. Enhanced oversight of claims handling processes
2. Stricter requirements for documenting claim decisions
3. Improved appeals processes for denied claims
4. Greater emphasis on independent medical reviews
5. Increased fines and penalties for unfair claim practices
Ongoing Challenges
Despite regulatory interventions and legal challenges, Unum continues to face ongoing scrutiny regarding its claim handling practices. The company has been required to reevaluate and reopen previously denied claims as part of regulatory settlements and court rulings. However, critics argue that more comprehensive reforms are needed to address the root causes of wrongful claim denials and to ensure that policyholders receive the benefits they are entitled to under their long-term disability insurance policies.
The Importance of Legal Representation
Given Unum’s history of wrongfully denying long-term disability claims, it’s crucial for policyholders to be aware of their rights and the potential challenges they may face when filing a claim. Understanding how to deal with common problems in long-term disability claims can be invaluable in navigating the process successfully.
For many claimants, a lawyer who is experienced in handling long-term disability claims can significantly improve their chances of receiving the benefits they deserve. Legal professionals can help claimants understand their policy terms, gather necessary evidence, and effectively challenge claim denials.
At Raval Trial Law, we understand the complexities of long-term disability claims and the challenges posed by insurance companies like Unum. We have regularly handled cases against Unum and will continue to do so. We are dedicated to advocating for people who need help to secure the benefits they need and deserve. If you’re facing difficulties with a long-term disability claim, contact us to learn how we can assist you in navigating this challenging process and fighting for your rights.
FAQs on Unum Long Term Disability Claim Denials
Why does Unum deny so many long-term disability claims?
Unum has a history of denying valid long-term disability claims to minimize payouts and increase profits. Investigations have shown that the company uses various tactics, including misinterpreting medical evidence, relying on biased in-house doctors, and pressuring claimants to return to work before they’re ready. This systematic approach has led to numerous lawsuits and regulatory fines.
What should I do if Unum denied my claim?
If Unum denies your claim, don’t accept it as final. First, request a written explanation for the denial. Then, gather medical records, doctor statements, and any other supporting evidence. You have the right to appeal, so follow Unum’s appeal process carefully. Consulting an attorney experienced in ERISA or insurance litigation can also improve your chances of overturning the denial.
Can I sue Unum for wrongful disability claim denial?
Yes, you can sue Unum if your claim was unfairly denied. Many lawsuits have been filed against the company, with courts ruling that Unum’s claim denials were arbitrary and unlawful. If you’re covered under an ERISA policy, you must go through the internal appeals process before suing. If your policy is non-ERISA, you may have more legal options, including suing for bad faith insurance practices.
Has Unum ever been fined for unfair claim denials?
Yes. Unum has faced multiple fines and settlements due to its wrongful claim denials. In 2004, the company was forced to reassess 200,000 denied claims and paid a $15 million fine. In 2013, it faced another $1.8 million penalty. Despite these actions, claimants still report ongoing issues with unfair denials.
How Long Does It Take Unum to Process a Claim?
Unum usually takes between 45 to 90 days to process an LTD claim. However, delays are common, especially if they request additional medical records or conduct further evaluations.
How Long Does Unum Back Pay?
If your claim is approved, Unum may provide back pay for the time between your disability onset date and the approval date. The back pay period depends on your policy's elimination period, which is usually between 90 to 180 days. However, if Unum wrongfully denied your claim and later overturns the decision, you may receive back pay for all missed payments from the original approval date.
How Long Does Unum Take to Make a Decision?
Unum generally takes 30 to 45 days to make an initial decision on a long-term disability claim, but this can be extended if they request more documentation or schedule independent medical evaluations. For appeals, ERISA policies require a decision within 45 to 90 days, but Unum may use delays to prolong the process.
