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Can I Sue Unum If My Appeal Is Denied?

Receiving a final denial from Unum after appealing a disability insurance claim can be devastating, especially when you’re counting on those benefits to support yourself and your family. Unum, a leading disability insurer in the U.S., is known for its aggressive denial tactics, often leaving policyholders feeling helpless. But a denied appeal doesn’t have to be the end of the road—you may have the option to sue Unum to fight for the benefits you’re owed.

In this guide, we’ll explain when and how you can sue Unum after an appeal denial, what to expect from the legal process, and how to strengthen your case against one of the nation’s largest insurers.

Understanding Your Right to Sue Unum

If Unum denies your appeal, you can typically file a lawsuit, especially if your disability plan is governed by the Employee Retirement Income Security Act (ERISA), which applies to most employer-sponsored plans. ERISA allows you to challenge Unum’s decision in federal court if you believe the denial was unfair, arbitrary, or based on incorrect interpretations of your policy or medical evidence.

However, suing Unum is not a simple process. There are strict deadlines, complex legal requirements, and limitations on what evidence can be presented. Understanding these factors is critical to building a strong case.

For ERISA-governed plans, you must exhaust all appeal options with Unum before filing a lawsuit. Non-ERISA plans (like individual policies) may have different rules, so check your policy or consult an attorney.

Step 1: Confirm the Deadline to File a Lawsuit

ERISA lawsuits typically have a statute of limitations, meaning you must file your case within a specific timeframe—often one year from the date of Unum’s final appeal denial. However, this deadline can vary depending on your policy or state laws, especially for non-ERISA plans.

Review your denial letter and policy documents to identify any time limits, and act quickly to avoid missing your window to sue. Mark the denial date and consult an attorney as soon as possible to ensure you meet all deadlines.

Step 2: Gather All Relevant Documentation

A successful lawsuit against Unum depends on a strong evidentiary record. Since ERISA cases are generally decided based on the “administrative record” (the documents Unum reviewed during your claim and appeal), you’ll need to compile everything related to your case, including:

The original denial letter and final appeal denial letter.
Your complete claim file, including medical records, correspondence, and internal Unum notes (request this under ERISA if you haven’t already).
All appeal submissions, including medical evidence, personal statements, and vocational reports.
Your insurance policy, highlighting the definition of disability and relevant terms.
Any additional evidence of Unum’s bad faith tactics, such as inconsistent reasoning or reliance on biased Independent Medical Examinations (IMEs).

For non-ERISA cases, courts may allow new evidence, which could include updated medical records or expert testimony. Be sure to organize your documents clearly and keep copies of everything. An attorney can help identify gaps or weaknesses in your record.

Step 3: Work with an Experienced Disability Attorney

Suing Unum is a complex legal battle, and going up against a major insurer without professional help can be daunting. An attorney specializing in ERISA or insurance litigation can make a significant difference by:

Analyzing Unum’s denial to identify errors, arbitrary decisions, or misinterpretations of policy language.
Proving that Unum’s decision was “arbitrary and capricious” (the legal standard for ERISA cases), such as ignoring your treating physician’s opinions or misrepresenting surveillance footage.
Navigating federal court procedures and filing requirements.
Advising on whether to pursue a settlement or take the case to trial.

Look for a lawyer with specific experience handling Unum cases, as they’ll be familiar with the insurer’s tactics, such as selective use of medical evidence or vague policy interpretations. Many disability attorneys offer free consultations and work on a contingency basis, meaning you pay only if you win.

Step 4: File the Lawsuit in Federal Court

For ERISA cases, your lawsuit must be filed in federal court, as ERISA is a federal law. Your attorney will draft a complaint outlining why Unum’s denial was wrongful and how it violated your rights under the policy or ERISA regulations. The goal is to convince the court that Unum’s decision was unreasonable or unsupported by the evidence.

In non-ERISA cases, you may file in state court, depending on your policy and jurisdiction. These cases often allow for broader claims, such as bad faith, which could lead to additional damages beyond your benefits. In ERISA lawsuits, courts typically review only the administrative record, so the strength of your appeal submission is critical. This is why a robust appeal is essential before litigation.

Step 5: Understand Possible Outcomes

A successful lawsuit against Unum can result in several outcomes:

Benefits Awarded: The court may order Unum to pay your benefits, including back payments for the period you were denied.
Remand to Unum: The court may send your claim back to Unum for further review, giving you another chance to present your case.
Settlement: Unum may offer a lump-sum settlement to resolve the case before or during litigation. An attorney can help evaluate whether the offer is fair.

However, ERISA lawsuits rarely award punitive damages or compensation for emotional distress, which is why non-ERISA cases can sometimes yield higher payouts. Be cautious about accepting a lowball settlement. Unum may offer a quick payout to avoid ongoing litigation, but it could be far less than the value of your benefits.

Challenges to Anticipate

Suing Unum comes with hurdles. The insurer has significant resources, experienced legal teams, and a history of fighting claims aggressively. Common challenges include:

Limited Evidence in ERISA Cases: You can’t typically introduce new evidence in court, making your appeal record critical.
Unum’s Defense Tactics: They may argue that their decision was reasonable, even if it relied on biased IMEs or selective evidence.
Time and Stress: Litigation can be lengthy, sometimes taking a year or more, and emotionally taxing during a difficult time.

An experienced attorney can help you navigate these challenges and keep your case on track.

Why Legal Action Against Unum Matters

Unum’s denial tactics—such as downplaying medical evidence, using surveillance out of context, or terminating benefits without cause—are designed to protect their profits, not your well-being. Taking legal action holds Unum accountable and can secure the financial support you need to manage your disability.

How Darras Law Can Fight for You

At Darras Law, we’ve spent decades fighting Unum and other major disability insurers, recovering millions for clients wrongfully denied benefits. Our Unum appeal attorneys understand the complexities of ERISA and non-ERISA litigation and know how to build compelling cases against Unum’s tactics. From reviewing your claim file to representing you in federal court, we provide the expertise and determination you need to win.

Don’t let Unum’s denial have the final say. Contact Darras Law today for a free consultation, and let us help you fight for the benefits you deserve.