How Can Improve My Chances Of Winning A Unum Appeal?
Unum Appeal Process Explained
Before diving into strategies, it’s crucial to understand the appeal process. If Unum denies your LTD claim, you have the right to appeal, typically within 180 days for ERISA-governed policies. This appeal is often your only chance to submit new evidence before pursuing legal action. A 2004 multi-state settlement forced Unum to reassess 200,000 claims due to unfair denials, underscoring the importance of a robust appeal. Success hinges on addressing Unum’s denial reasons and presenting compelling evidence.
Facing a denial of your Unum long-term disability (LTD) claim can be overwhelming, but a well-prepared appeal can significantly increase your chances of overturning the decision. Unum, one of the largest disability insurance providers in the U.S., is known for its stringent claims process. The question many policyholders ask is, “How can I improve my chances of winning a Unum appeal?” At DarrasLaw, we’ve successfully guided countless clients through this process. In this blog, we’ll share actionable strategies, key steps, and expert tips to strengthen your Unum appeal, complete with a visual guide and relevant statistics.
Why Winning a Unum Appeal Is Challenging
Unum’s rigorous review process often involves in-house medical evaluations, independent medical examinations (IMEs), and scrutiny of policy terms like “own occupation” or “any occupation.” Common denial reasons include insufficient medical evidence, alleged pre-existing conditions, or claims that you can still work. Overcoming these hurdles requires a strategic approach tailored to Unum’s tactics.
What Strategies You Need to Improve Your Chances of Winning
Here are proven steps to strengthen your Unum appeal and maximize your likelihood of success:
- Request and Review Your Claim File: Obtain a complete copy of your claim file from Unum to understand the specific reasons for denial. This helps identify gaps in evidence or errors in Unum’s assessment.
- Gather Comprehensive Medical Evidence:
- Updated Medical Records: Include recent test results, treatment notes, and diagnoses that clearly document your disability.
- Physician’s Statement: Secure a detailed letter from your treating physician explaining how your condition limits your ability to work.
- Specialist Reports: If applicable, obtain evaluations from specialists (e.g., neurologists, orthopedists) to reinforce your claim.
- Address Denial Reasons Directly: Craft an appeal letter that systematically counters each reason for denial, using evidence to refute Unum’s claims.
- Include a Personal Narrative: Write a detailed statement describing how your disability affects your daily life, work, and overall functionality. This humanizes your case and adds context to medical records.
- Engage a Vocational Expert: A vocational expert can assess your job requirements and demonstrate how your condition prevents you from performing your occupation or any suitable work.
- Work with an Experienced Disability Attorney: An attorney familiar with Unum’s practices can anticipate their strategies, ensure compliance with ERISA or state regulations, and craft a compelling appeal.
- Meet Deadlines: Submit your appeal within the 180-day window for ERISA claims to avoid forfeiting your rights.
Appeal Preparation Process
Below we outline the key steps to prepare a strong Unum appeal:
| Step | Description | Estimated Time |
|---|---|---|
| Request Claim File | Obtain your full claim file from Unum to review denial reasons. | 1–2 weeks |
| Collect Medical Evidence | Gather updated records, physician letters, and specialist reports. | 2–4 weeks |
| Engage Experts | Consult a vocational expert and/or disability attorney. | 1–3 weeks |
| Write Appeal Letter | Draft a detailed letter addressing denial reasons with evidence. | 1–2 weeks |
| Submit Appeal | File the appeal with all supporting documentation. | Within 180 days of denial |
Note: Timelines may vary based on case complexity and availability of records.
Common Pitfalls to Avoid
To further boost your chances, steer clear of these common mistakes:
- Incomplete Evidence: Submitting partial medical records or vague documentation can weaken your case.
- Missing Deadlines: Failing to file within the 180-day window for ERISA claims can bar you from further appeals.
- Ignoring Policy Terms: Not addressing specific policy language (e.g., definitions of disability) can lead to rejection.
- Overlooking Unum’s Tactics: Unum may rely on biased in-house doctors or surveillance. Counter these with strong, independent evidence.
What If Your Appeal Is Denied?
If Unum denies your appeal, you may have options:
- Second Appeal: Some policies allow a second appeal, though this is rare for ERISA claims.
- Lawsuit: For ERISA claims, filing a federal lawsuit is often the next step. A 2022 New York case saw an accountant win benefits after suing Unum for denying her claim based on a progressive spine condition.
- State Insurance Complaints: For non-ERISA policies, filing a complaint with your state’s insurance department may pressure Unum to reconsider.
How The DarrasLaw Firm Can Help?
Navigating a Unum appeal requires expertise and persistence. At DarrasLaw, our team, led by Frank N. Darras, has decades of experience challenging Unum’s denials. Recognized as America’s top disability firm, we’ve helped clients secure benefits through strategic appeals and litigation. Our no-fee-unless-you-win model means you face no upfront costs. Winning a Unum appeal requires thorough preparation, compelling evidence, and strategic execution. Don’t let a denial discourage you—take proactive steps to build a strong case. Contact DarrasLaw at (800) 277-8154 for a free case review, or visit our page on Unum Disability Appeals to learn how we can help you secure the benefits you’re entitled to.