What is the Process for Appealing a Unum Insurance Claim Denial?

Receiving a denial for your Unum disability insurance claim can feel like a punch to the gut, especially when you’re already navigating health challenges. Unum, one of the largest disability insurers in the U.S., is notorious for denying valid claims using complex policy language, selective evidence, and procedural hurdles. But a denial isn’t the final word—you have the right to appeal, and with a clear strategy, you can fight back effectively.

In this guide, we outline the step-by-step process for appealing a Unum insurance claim denial, offering practical tips to strengthen your case and maximize your chances of securing the benefits you deserve.

Step 1: Understand the Denial Letter

The first thing to do after receiving a denial from Unum is to carefully read the denial letter. This document explains why your claim was denied, cites specific policy terms, and provides critical details like the deadline for filing an appeal (typically 180 days under ERISA regulations). Missing this deadline could mean losing your right to challenge the decision, so mark it on your calendar.

Pay close attention to the reasons for denial—whether it’s “insufficient medical evidence,” a claim you can still work, or another justification. These points will guide your appeal strategy.

Tip: Save a copy of the denial letter and take notes on each reason provided. You’ll need to address every point directly in your appeal.

Step 2: Request Your Complete Claim File

Under the Employee Retirement Income Security Act (ERISA), you’re entitled to a full copy of your claim file. This includes all documents Unum relied on to make their decision, such as medical records, internal notes, and correspondence. Request this file immediately, as it can reveal what evidence Unum used, what they overlooked, or any inconsistencies in their evaluation.

Reviewing the file helps you understand Unum’s perspective and identify gaps in your original claim that need to be addressed.

Tip: Submit your request for the claim file in writing and keep a record of all communications with Unum.

Step 3: Gather Strong Supporting Evidence

A successful appeal hinges on robust evidence that counters Unum’s reasons for denial. Focus on collecting comprehensive, up-to-date documentation that clearly demonstrates your disability and its impact on your ability to work. This may include:

• Medical Records: Updated diagnostic tests (e.g., MRIs, lab results), treatment notes, and physician letters detailing your functional limitations.Specialist Opinions: Statements from specialists who treat your condition, explaining how it prevents you from performing your job duties.Functional Capacity Evaluations (FCEs): Objective assessments of your physical or cognitive limitations.
• Personal and Vocational Evidence: A personal statement about your symptoms, letters from coworkers or family, and a detailed job description outlining your role’s demands.

Make sure your evidence directly addresses the denial reasons. For example, if Unum claims your condition isn’t severe enough, include test results or doctor statements that prove otherwise.

Tip: Ask your doctor to explicitly connect your medical condition to your inability to work, using language that aligns with your policy’s definition of disability.

Step 4: Draft and Submit a Detailed Appeal

Your appeal is your chance to set the record straight, so it needs to be thorough, organized, and persuasive. Write a formal appeal letter that:

• Summarizes why the denial was incorrect.
• Addresses each point in the denial letter with specific evidence.
• References your policy’s definition of disability and shows how your condition meets it.
• Includes all supporting documents, clearly labeled and organized.

File your appeal within the 180-day deadline, and submit it via certified mail or another trackable method to confirm receipt. Unum is required to review your appeal and respond, typically within 45 days (or 90 days in special circumstances).

Tip: Include a table of contents or cover letter to make your appeal easy to navigate. A well-organized submission signals professionalism and strengthens your case.

Step 5: Be Prepared for Unum’s Response

After reviewing your appeal, Unum will either approve your claim, request more information, or uphold the denial. If approved, you’ll begin receiving benefits. If denied again, the response will outline their reasoning, which may include new justifications or reliance on biased evaluations like Independent Medical Examinations (IMEs).

At this stage, you may have the option to file a second appeal (depending on your policy) or pursue legal action. ERISA cases often rely solely on the evidence submitted during the appeal, so it’s critical to make your initial appeal as strong as possible.

Tip: Be cautious of Unum’s tactics during this process, such as surveillance or requests for repetitive documentation. Assume your actions and social media may be monitored.

Step 6: Consider Legal Representation

Appealing a Unum denial can be complex, especially given their history of aggressive denial tactics. Consulting an attorney experienced in ERISA and Unum claims can make a significant difference. A lawyer can:

• Analyze your denial letter and policy for loopholes or misinterpretations.
• Help gather compelling medical and vocational evidence.
• Craft a persuasive appeal that anticipates Unum’s arguments.
• Represent you in court if the appeal is denied and litigation is necessary.

Because ERISA appeals are typically paper-based, courts won’t consider new evidence if your case goes to trial. An attorney ensures your appeal is comprehensive from the start.
Tip: Look for a lawyer with specific experience handling Unum denials, as they’ll be familiar with the insurer’s strategies.

Why You Shouldn’t Give Up After a Unum Appeal

Unum’s denial tactics are designed to discourage claimants, but persistence pays off. Many denied claims are overturned on appeal when supported by strong evidence and a clear strategy. By understanding the appeals process and building a solid case, you can challenge Unum’s decision and fight for the financial support you’re entitled to.

How Darras Law Can Secure the Benefits You Deserve in an Appeal?

At Darras Law, we’ve spent decades taking on Unum and other major disability insurers, recovering millions in wrongfully denied benefits for clients nationwide. Our Unum disability insurance claim know the ins and outs of the appeals process and how to counter Unum’s delay-and-deny strategies. From reviewing your claim file to crafting a compelling appeal, we provide the expertise and advocacy you need to win.

Don’t let Unum’s denial stand in the way of your benefits. Contact Darras Law today for a free consultation, and let us help you navigate the appeals process with confidence.