Disability Insurance Blog

Why UNUM Denied Your Disability Insurance Claim

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Monday, April 26th, 2021

Unum is a giant of long and short term disability insurance in the US, and the largest provider of disability insurance in the world. To gain a larger understanding of just how big this company is, in 2020 the company reported revenues of $13.2 billion, according to its website, and provided $7.6 billion in benefits.

Several class action lawsuits have been filed against Unum for creating a corporate culture and processes focused on denying claims, including using a bonus system and tying compensation to how many disability claims were denied. Several news reports over the years, including 60 Minutes and Dateline, exposed the way that the company rewarded employees to deny claims. How can one person possibly protect their long term ERISA disability claim from such a big company, with limitless resources and employees who are trying to save their own jobs?

You Don’t Want to Try to Fight Unum On Your Own

Our firm has been fighting against Unum disability denials for decades. We have battled against in-house counsel and doctors hired to engage in a battle of experts over the true health state of disabled people. Unum is a tough nut to crack, one that we have had good successes with.

Our years of experience gives us certain advantages in knowing the tactics employed by Unum for denying ERISA appeals. Our current cases against Unum keep us up to date with the ever-changing tactics the company takes when seeking to deny disability claims. This knowledge helps us to be more effective in protecting our clients.

Lately, we have been seeing cuts in the number of people working in the claims area for Unum disability policies. A smaller group can’t keep up with the enormous number of claims that come to Unum every day, even when much of the initial sorting and processing is done by AI (Artificial Intelligence) systems. Phone calls go unanswered, or into voicemail messages where responding to a claimant is simply not a priority.

Unum has turned to the tactic of having a small group of in-house doctors, generalists who probably didn’t like working in patient care medicine and chose to work instead for an insurance company and likely have not practiced active medicine in years.  We are sure the hours and the pressure are far less than if they were working in a regular medical practice. As generalists who have not had an in-person medical consultation with patients, they are taking an aggressive approach to denying claims for people they have never met, and we know from experience that they may not even have been given the entire medical record.  Yet these defective medical reviews are being used with more frequency.

It’s far easier to deny a claim when all you are reading is a chart from a few years back and not the entire medical record or the most recent records from specialists. We know this happens, as we have filed successful ERISA appeals against flawed medical evaluations. We know that Unum and other disability insurance companies will often fail to provide the doctor with a complete medical record. Even a well-meaning physician who wants to do the right thing can’t overcome a medical evaluation when the disability insurance company has provided an incomplete record.

In recent months, Unum has been denying disability claims using these flawed medical reports and refusing to consider medical records which have been carefully prepared by experts in diseases and injuries. Frankel & Newfield has had the experience of having medical reports prepared by leading medical experts in specialized areas being misunderstood by doctors, nurses and even medical reviewers lacking the proper medical background. That includes published physicians, medical educators and practitioners who are well-regarded by colleagues in their respective fields.

The denied disability claim is vulnerable when the medical reports have not been prepared to be defended against flawed medical reviews.

Another tactic embraced by Unum has been directed specifically against private, or individual, disability insurance claims. These claims are more costly to Unum, as the private policies generally pay larger benefits to high-income earners who purchase these disability policies. In-house insurance company doctors are attacking the etiology of the condition of the claimant. They are seeking a cause of the condition, whether an injury or an illness, that would impact the length of the claim payment period. Depending on the reason for the condition, the claimant may be eligible to have benefits paid for the rest of their lives, which is clearly a larger liability for Unum than if the claim terminates at age 65.

This is a similar tactic to that of trying to change a physical condition to a mental/nervous condition. Most disability insurance policies limit coverage for mental/nervous conditions to 24 months. Frankel & Newfield has successfully defended many claimants whose treating physicians have nothing more than made a note in the medical reports that the patient was anxious, and the disability insurance company sought to shift the claim to a mental/nervous one.

Frankel & Newfield has successfully defended many people who have had their claims denied by Unum, including people whose group disability claims were denied and needed to file an ERISA appeal and claimants with private or individual disability policies.

 

Unum Hopes You’ll Give Up First—Frankel & Newfield Will Fight Back For You

 

The idea is to wear claimants down, through what seems like a never-ending series of delays, requests for more information, refusal to accept physician reports, refusal to acknowledge receipt of important documents, and so on, until the claimant is so overwhelmed that they stop fighting back. This is not unique to Unum.

If Unum has denied your disability insurance claim, Frankel & Newfield is able to help. We represent individuals across the country and have done so for many years. We invite you to call our office at 877-583-2524 for a free consultation. You’ll learn what your options are, and you’ll also learn that you are not alone.

Jason A. Newfield

Written By:

Jason A. Newfield

Disability Insurance Attorney