How Long Does a Unum Appeal Take to Process?
When your Unum long-term disability (LTD) claim is denied, the appeals process becomes a critical step in securing the benefits you deserve. One of the most common questions policyholders ask is, “How long does a Unum appeal take to process?” Understanding the timeline and what influences it can help you prepare effectively and manage expectations. At DarrasLaw, we’ve helped countless clients navigate Unum’s complex appeals process, and in this blog, we’ll break down the timeline, key factors, and strategies to strengthen your appeal.
Understanding the Unum Appeal Process
Unum, one of the largest disability insurance providers in the United States, is known for its rigorous claims and appeals processes. If your LTD claim is denied, you have the right to appeal, but the process can feel daunting. The timeline for processing a Unum appeal depends on several factors, including whether your policy is governed by the Employee Retirement Income Security Act (ERISA) or state law, the complexity of your case, and the quality of your appeal submission.
Why Appeals Matter
Appealing a denial is often your only opportunity to submit new evidence to support your claim, especially for ERISA-governed policies. A well-prepared appeal can overturn a wrongful denial, but it requires careful planning and comprehensive documentation. According to a 2004 multi-state settlement, Unum was required to reevaluate 200,000 claims due to unfair practices, highlighting the importance of persistence in the appeals process.
Standard Timeline for a Unum Appeal
For most Unum disability appeals, the processing time is governed by federal regulations, particularly for ERISA plans. Here’s a breakdown of the typical timeline:
- Initial Review Period: Under ERISA, Unum is required to review and decide on your appeal within 45 days of receiving your appeal letter.
- Possible Extension: Unum may request a single 45-day extension if they can demonstrate “good cause” for needing additional time, such as requiring further medical or vocational evidence. This means the total processing time could extend to 90 days.
- Non-ERISA Policies: If your policy is not governed by ERISA (e.g., individual policies or those through government or church employers), the timeline may vary depending on state regulations, but it typically aligns with the 45- to 90-day range.
Factors That Affect Processing Time
Several variables can influence how long your Unum appeal takes to process:
- Complexity of the Case: Appeals involving complex medical conditions or disputes over policy definitions (e.g., “own occupation” vs. “any occupation”) may require more time for review.
- Completeness of Evidence: Submitting comprehensive medical records, physician statements, and vocational reports upfront can expedite the process. Incomplete submissions often lead to delays as Unum requests additional information.
- Unum’s Review Practices: Unum has a history of thorough (and sometimes intrusive) reviews, including reliance on in-house medical professionals or independent medical examinations (IMEs). These practices can extend the timeline.
- Attorney Involvement: Working with an experienced disability attorney can streamline the process by ensuring all documentation is thorough and meets Unum’s requirements, potentially avoiding unnecessary delays.
Key Steps to Prepare a Strong Unum Appeal
To minimize delays and improve your chances of a successful appeal, follow these steps:
- Request Your Claim File: Obtain a copy of your claim file from Unum to understand the reasons for denial and identify gaps in evidence.
- Gather Comprehensive Evidence:
- Medical Records: Include all relevant medical exams, treatments, and physician notes documenting your disability.
- Physician’s Letter: A detailed letter from your doctor explaining how your condition prevents you from working.
- Personal Narrative: Write a statement describing how your disability impacts your daily life and work capacity.
- Vocational Reports: Engage a vocational expert to assess your ability to work given your condition, education, and skills.
- Meet Deadlines: For ERISA claims, you typically have 180 days from the denial date to file your appeal. Missing this deadline can jeopardize your claim.
- Consult an Attorney: An experienced disability attorney can craft a strategic appeal letter, address Unum’s denial reasons, and ensure compliance with legal requirements.
Visualizing the Appeal Timeline
Below is a simplified timeline to help you visualize the Unum appeal process:
| Stage | Timeframe | Key Actions |
|---|---|---|
| Receive Denial Letter | Day 0 | Review denial reasons, request claim file |
| Gather Evidence | Days 1–60 | Collect medical records, statements, reports |
| Submit Appeal | Within 180 days | File appeal letter with supporting evidence |
| Unum’s Initial Review | Up to 45 days | Unum evaluates appeal |
| Possible Extension | Additional 45 days | Unum requests more time if needed |
| Decision Notification | 45–90 days total | Receive approval, denial, or further requests |
Note: This table assumes an ERISA-governed policy. Non-ERISA timelines may vary by state.
What Happens After the Appeal?
Once Unum completes its review, you’ll receive one of three outcomes:
- Approval: Your benefits are reinstated, and you may receive back payments for the period of denial.
- Denial: If your appeal is denied, you may have the option to file a second appeal (depending on your policy) or pursue a lawsuit. For ERISA claims, a lawsuit is typically the next step after exhausting appeals.
- Request for More Information: Unum may request additional evidence, which could reset the 45-day review period.
If your appeal is denied, don’t lose hope. Legal action can still secure your benefits. For example, in 2022, a New York federal court ruled in favor of an accountant with a progressive spine condition who sued Unum after a denial, demonstrating that persistence can pay off.
Statistics on Unum Appeals
- Denial Rates: Unum has faced scrutiny for high denial rates, with a 2004 settlement revealing systemic unfair practices in claim handling.
- Success with Legal Help: Firms like DarrasLaw have recovered nearly $1 billion in wrongfully denied benefits, with a significant portion from Unum cases.
- Litigation Outcomes: Over 95% of Unum cases handled by specialized disability law firms result in benefit reinstatement or settlements.
Tips to Expedite Your Unum Appeal
To avoid unnecessary delays:
- Act Quickly: Start gathering evidence immediately after receiving a denial letter to meet the 180-day deadline.
- Be Proactive: Follow up with Unum to confirm receipt of your appeal and inquire about its progress.
- Avoid Common Pitfalls: Ensure your appeal addresses specific denial reasons and includes robust evidence to counter Unum’s claims, such as insufficient medical evidence or policy exclusions.
- Work with Experts: Partner with a disability attorney who understands Unum’s tactics, such as reliance on biased in-house doctors or surveillance.
Why Choose DarrasLaw for Your Unum Appeal?
At DarrasLaw, our team, led by founder Frank N. Darras, has earned national recognition as America’s top disability firm. We’ve confronted Unum’s unfair practices for decades, helping clients recover benefits through strategic appeals and, when necessary, lawsuits. Our no-fee-unless-you-win model ensures you face no financial risk when seeking our help.
Ready to Fight Your Unum Denial?
If you’re facing a Unum disability denial, time is critical. The appeals process typically takes 45–90 days, but preparation is key to success. Contact DarrasLaw at (800) 277-8154 for a free case review, or visit our Unum Disability Appeal page to learn how we can help you secure the benefits you deserve.