What is the Main Reason for a Unum Lawsuit?

Why Do People Sue Unum? Unpacking the Reasons Behind Long-Term Disability Lawsuits

Every year, thousands of individuals unable to work due to medical conditions file for long-term disability benefits. For those insured by Unum, a leading disability insurance provider, this process can turn into a daunting struggle. Despite its prominence, Unum has faced criticism for denying claims, pushing policyholders toward legal action. This blog post explores the core reasons behind these disputes, shedding light on why a straightforward benefits claim can escalate into a lawsuit.

The Foundation of the Dispute: Unum’s Business Model

Unum’s business practices often lie at the heart of claim disputes. As with many insurance companies, profitability hinges on minimizing payouts, creating a potential conflict of interest. This financial incentive can lead to claim denials, even for seemingly valid cases. Key points to understand:

• Profit-Driven Decisions: Unum’s focus on financial performance may prioritize claim denials over policyholder needs.
• Scrutiny and Criticism: The company has faced legal challenges for practices that appear to favor profits over fair claim evaluations.
• Context Matters: Recognizing this business model is essential to understanding why valid claims are sometimes rejected outright.

Key Reasons for Claim Denials & Resulting Lawsuits

Unum employs several tactics that lead to claim denials, forming the basis for lawsuits. Below are the primary reasons policyholders take legal action:

Insufficient Medical Evidence

Unum frequently cites “insufficient medical evidence” as a reason for denial. This can happen when:

• Subjective Symptoms Are Downplayed: Symptoms like pain or fatigue, documented by treating physicians, may be dismissed if not supported by objective tests (e.g., MRIs, blood tests).
• High Evidence Standards: Unum may demand detailed reports, such as functional capacity evaluations, that go beyond typical medical documentation.
• Impact on Work: The company may argue that medical records fail to prove the condition prevents the claimant from working.

This practice often leaves policyholders feeling their legitimate health issues are unfairly questioned.

The Role of Unum’s “Independent” Medical Examiners

Unum often relies on in-house or contracted medical reviewers to assess claims, leading to disputes:

• No Direct Interaction: These reviewers may never meet or examine the claimant, relying solely on records.
• Contradictory Opinions: Unum’s doctors frequently dispute the findings of the claimant’s treating physicians, who have deeper knowledge of the patient’s condition.
• Bias Concerns: The reliance on company-hired reviewers raises questions about impartiality, fueling lawsuits when claims are denied based on these assessments.

Redefining Disability and Surveillance

Unum may use investigative tactics to challenge a claimant’s disability status, including:

• Surveillance: Private investigators may monitor claimants, looking for any activity that could be misconstrued as evidence of lesser disability.
• Social Media Scrutiny: A single photo or post (e.g., shopping or a past vacation) can be taken out of context to justify a denial.
• Privacy Concerns: These tactics are often perceived as invasive, becoming a focal point in lawsuits.

Such practices can feel like an overreach, prompting policyholders to seek legal recourse.

The Legal Process: From Denial to Lawsuit

When a claim is denied, policyholders face a complex path to justice:

• Internal Appeals: The first step involves Unum’s internal appeals process, which is often rigid with strict deadlines.
• Legal Action: If the appeal fails, a lawsuit may be the only option. Specialized disability lawyers are critical at this stage, helping navigate:
• ERISA Regulations: If the policy falls under ERISA, specific federal rules apply.
• Building a Case: Lawyers gather evidence to prove Unum’s denial was unjustified, leveraging medical records and expert testimony.

This process underscores the need for professional legal support to challenge Unum’s decisions effectively.

How Unum’s Systematic Claim Denials Force Policyholders to Sue

Unum lawsuits often arise from systematic claim denial practices rather than isolated errors. From demanding excessive evidence to relying on potentially biased medical reviews and invasive surveillance, these tactics push policyholders to fight for their rightful benefits. Understanding these challenges is crucial for building a strong legal case. Ultimately, these lawsuits aim to hold Unum accountable, ensuring policyholders receive the financial stability their disability benefits are designed to provide.

Reach Out to an Experienced UNUM Attorney at DarrasLaw

The main reason for a Unum lawsuit remains consistent: policyholders allege the company wrongfully denied or terminated disability benefits. These cases often involve claims of bad faith, unfair medical reviews, and regulatory violations.

If you are dealing with a denied Unum disability claim, remember:

• Time is critical under ERISA deadlines.
• Evidence matters—submit complete documentation early.
• Legal experience counts—insurance litigation is a specialized field.

By understanding the reasons behind Unum lawsuits and seeking professional guidance, policyholders can better protect their rights and improve their chances of recovering the benefits they were promised.