Understanding The UNUM Appeal Denial Process

UNUM is an important insurance provider in the United States, well-known for its group of long-term disability benefits. Its influence in the insurance landscape is undeniable, with policyholders contributing a staggering $9.5 billion in premiums in 2021 alone. Despite its prominence, UNUM has come under fire for allegedly denying claims without justification and engaging in questionable practices. Those who have had an unjust denial of a long-term disability claim by UNUM must recognize that many others share their plight, and navigating the appeal process becomes critical.

Understanding the Type of Plan

The UNUM claim appeal process is different depending on the type of plan you have. The Employee Retirement Income Security Act of 1974 (ERISA) governs most long-term disability policies, but some are not. Knowing which applies to your situation is critical.

UNUM ERISA Appeals Process

If your disability benefits come through your employer, it’s likely an ERISA plan. Here’s how the process works:

• Step 1: Review Your Claim Denial Letter: This letter will include the main reasons for denial, the medical evidence reviewed, who reviewed it, and important deadlines for your appeal. You usually have 180 days to file your appeal.
• Step 2: Gather Evidence for Your Administrative Appeal: This step is vital as it’s often the only opportunity to add new evidence to support your claim. You should request a copy of your claim file from UNUM and gather relevant additional evidence, including medical records, expert reports, vocational evaluations, personal testimonies, and more.
• Step 3: File Your Appeal: Present your evidence to UNUM along with a persuasive appeal letter. This letter should explain why you are appealing and reference the evidence you’re providing. Engaging a qualified ERISA attorney can be invaluable at this stage.
• Step 4: Wait for a Response: UNUM has up to 45 days to review your appeal, but they can request a 45-day extension, so waits of up to 90 days are common. If UNUM denies your claim again, you can file a lawsuit.

What If My Disability Insurance Plan Is Not Governed By ERISA?

If you purchased an individual long-term disability insurance plan or work for a government or church organization, your plan might not be governed by ERISA but by your state’s contract laws. The major difference in appealing denied long-term disability claims is that you don’t have to exhaust the administrative appeal process before taking UNUM to court. You can also add evidence throughout the formal discovery process and pursue bad faith damages if applicable.

Navigating UNUM’s Appeal Denial Landscape

Dealing with a UNUM appeal denial can be a complex and often frustrating experience. UNUM, known for its rigorous claim-denial practices, employs various tactics that might include surveillance, social media scrutiny, and reliance on internal medical review boards. These strategies can lead to challenges for policyholders who find themselves caught in the appeal denial process.

The Importance of Continuous Documentation

To counter UNUM’s tactics, maintaining comprehensive and consistent documentation is crucial. Regularly updating medical records to reflect the current state of your disability, staying consistent with your activities to avoid contradictions, and documenting daily struggles and pain levels can build a robust case. A diary detailing daily challenges can provide a compelling narrative of your disability.

Legal Recourse After Appeal Denial

If UNUM denies your appeal, considering legal recourse might be the next step. Engaging an attorney experienced in disability claims against UNUM can provide valuable insights and guidance. They can review your case, offer corrective measures, negotiate with UNUM, and guide you through potential litigation. Sometimes, UNUM might be open to a settlement, and discussing this possibility with your attorney can lead to a resolution without going to court.

The complexities of UNUM’s appeal denial process often necessitate legal representation. An attorney can review your case, negotiate on your behalf, and guide you through litigation if the appeal doesn’t yield a favorable outcome. Their expertise can be instrumental in ensuring that your rights are protected and that you navigate the appeal denial process effectively.

Final Thoughts: Consulting with an Expert

Dealing with a UNUM appeal denial is undoubtedly difficult. However, you can effectively challenge the denial with a strategic approach, continuous documentation, and potential legal representation. Protecting your rights by staying informed, proactive, and vigilant can make a significant difference in the outcome of your claim. The journey through UNUM’s appeal denial landscape may be difficult, but with perseverance and the right resources, you can advocate for the benefits you are entitled to.