What Are Common Reasons Unum Gives for Denying Claims?
Unum is one of the largest providers of disability insurance in the United States, but it also has a reputation for aggressively scrutinizing claims. Many policyholders are shocked to learn that despite paying premiums for years, their claim is denied when they need benefits most. Understanding the common reasons Unum gives for denying claims can help you prepare stronger applications, appeals, and—if necessary—lawsuits.
Lack of “Objective Medical Evidence”
Unum frequently denies claims by arguing there is not enough objective medical evidence to prove a disability. This is especially common with conditions that don’t always show up on X-rays, MRIs, or lab tests, such as:
- Fibromyalgia
- Chronic fatigue syndrome
- Migraines
- Mental health conditions
- Even when doctors provide detailed notes, Unum may say the evidence is “subjective” or “inconclusive.”
Contradictions With Daily Activity Reports
Unum often uses surveillance or social media reviews to argue that claimants can do more than their medical records suggest. For example, if you claim severe back pain but are seen gardening, grocery shopping, or carrying light objects, Unum may use this to deny or terminate benefits—even if those activities were isolated or caused pain afterward.
Disputes Over Policy Definitions
Every disability insurance policy contains definitions of “disability,” “own occupation,” and “any occupation.” Unum may deny claims by asserting that:
- You are still capable of performing your own occupation with reasonable accommodations.
- You are unable to work in your previous job but can work in another occupation.
- These interpretations often favor the insurer, leading to disputes that end up in appeals or lawsuits.
Reliance on In-House or Independent Medical Reviews
Unum frequently sends medical files (but not the claimant) to in-house doctors or contracted reviewers for evaluation. These reviewers may never examine you in person and may conclude that you are not disabled, even when your treating physician strongly disagrees. Lawsuits often allege that these reviews are biased toward denial.
Missed Deadlines or Incomplete Paperwork
Unum also denies claims for technical reasons, such as:
- Missing deadlines for submitting forms or medical records
- Incomplete claim packets
- Failure to provide ongoing proof of disability
- While these issues are sometimes clerical, they give the insurer a reason to stop benefits.
Claiming “Improvement” or “No Longer Disabled”
Some policyholders initially receive benefits, only to have them cut off later. Unum may argue that:
- Your condition has improved
- You can return to work full-time or part-time
- You no longer meet the policy’s disability definition
These terminations often occur without significant changes in medical records, leading many to challenge them as unfair.
Pre-Existing Condition Exclusions
Unum may deny claims if it determines the disability is linked to a pre-existing condition not covered under the policy. This is a frequent issue when claimants develop symptoms shortly after purchasing coverage.
How to Protect Yourself From an Unum Denial
If you are filing a claim or appealing a denial, here are proactive steps to take:
- Provide Detailed Medical Support: Include test results, physician statements, and treatment notes.
- Document Daily Limitations: Keep a disability journal tracking pain levels, fatigue, and functional struggles.
- Be Careful With Social Media: Even casual posts can be misinterpreted.
- Meet All Deadlines: Submit paperwork on time and keep copies of everything.
- Consult a Disability Lawyer: An attorney familiar with Unum’s tactics can help strengthen your case and navigate ERISA rules.
Don’t Face Your Unum Denial Alone
The most common reasons Unum denies claims include lack of objective medical evidence, disputes over disability definitions, reliance on biased medical reviews, and technical paperwork errors. While these tactics are frustrating, they are not the end of the road. With thorough documentation and experienced legal support, many policyholders successfully appeal or overturn denials.
If Unum has denied your disability claim, you don’t have to face the process alone—consulting with an experienced Unum disability lawyer can help you protect your rights and fight for the benefits you deserve.