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.

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 Using outdated occupational definitions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.