How to Gather Evidence for Unum Denial Appeals

Unum Life Insurance Co. is one of the largest providers of disability insurance policies. The company endeavors to pursue its mission to provide its clients with financial security in the event of incapacitating injuries or illnesses.

Unum benefits, available to individuals and groups, are typically offered through employers. They’re designed to offset lost income for most of the time (or the entire period) you’re unable to work.

But despite its glorious mission of offering its clients a safety net when they’re sick or injured, Unum has become infamous for delaying and denying disability claims. Unum’s reputation deteriorated so badly that the US Department of Labor had to reach a settlement with the insurer to reform its practices.

If you’ve been a victim of Unum’s disability refusals or delays, it’s important to appeal the decision immediately. However, proper evidence will be necessary to improve the appeal’s outcome.

This post explores how to gather evidence before appealing a Unum decision.

Why Do Life Insurance Companies Deny Disability Claims?

A critical step in navigating a Unum denial is understanding why life insurance companies delay or refuse disability claims. Common grounds include submitting incomplete or incorrect information, missing the claims deadline, and failing to acknowledge communication from the insurer.

Besides, your disability benefits will be forfeited (partly or entirely) if you fall behind with your premium payments.

However, in the case of Unum, denial appears to be the default outcome. The company may choose to delay your benefits or deny them altogether, cognizant that a significant percentage of legitimate claimants will not contest the decision.

Well, it turns out that philosophy is no longer tenable if recent reports are anything to go by. Many Unum policyholders are now choosing to fight against unfair claims and denials.

If you believe Unum is unjustly delaying or denying your disability benefits, it’s best to inform your disability lawyer immediately.

How Do I Know Unum Has Denied My Claim?

After filing a disability claim, Unum will send you a letter detailing the status of your claim. Review the correspondence carefully to establish whether your request is pending or denied.

In the case of delays, you could give Unum the benefit of the doubt as you follow up with them. But it’s best to begin the appeal process if it’s an outright denial.

Identify the primary reasons for Unum’s denial, paying particular attention to the medical evidence you adduced while filing the disability claim. Establish whether the evidence was reviewed and, if yes, by who.

Unum’s denial letter will also highlight critical deadlines for appealing their decision. That’s typically 180 days from the date of denial.

However, it’s best to file an appeal immediately. Acting promptly will help ace the bureaucratic channels involved in submitting Unum appeals.

Gathering Evidence for Unum Denial Appeal

Your disability lawyer’s expertise will come to bear in helping compile solid evidence for your Unum denial appeal.

Usually, the first step is to secure the pieces of evidence you initially submitted to Unum.

Capture all information, including audiovisual evidence, witness statements, admission of guilt, and, most importantly, medical reports. Go through the information and consider if Unum might have missed crucial details due to, say, lexical ambiguity or lack of visual clarity.

If possible, get everything recorded in hard print and possibly backed up.

Next, your disability attorney will help you gather new evidence. That could be critical details you inadvertently missed while filing your claim or an entirely new piece of information.

Focus on support letters from licensed physicians, additional statements from colleagues, and functional evaluations. It’s best if all these come from parties different from those already in your initial claims report.

To harmonize new evidence with the information previously submitted to Unum, obtain a copy of your claim file if it has not already been provided.

If everything looks great, your lawyer will proceed to appeal. They’ll do so by addressing an official letter to Unum’s appeal mechanism or a court of law and attaching well-documented evidence.

Handling the Appeal Phase

When appealing a Unum denial, your disability attorney will clearly articulate your case by specifying your reasons for disagreeing with Unum’s decision. The tone of the appeal letter should be persuasive yet assertive.

The Employee Retirement Income Security Act of 1974 (ERISA) allows up to 45 days to review and determine your appeal. However, the law grants another 45-day extension if the appeal meets the minimum threshold for good cause.

In most cases, Unum will process your appeal long before the window elapses. So, be sure to keep abreast of all developments pertaining to the case.

Unum may choose to revoke or stay its earlier decision. If the company denies your disability benefits a second time, you can now file an official lawsuit against them.

Wrap Up

Like most life insurance companies, Unum can deny or delay disability benefits for various reasons. Common grounds include incomplete documentation, false information, or missed deadlines.

That said, Unum has become notorious for refusing or delaying its clients’ benefits for no justifiable cause. Therefore, it’s essential to understand your rights and how to navigate the appeal process.

Working with a seasoned disability lawyer is the surest way to improve the outcome of your Unum appeals. The attorney will review Unum’s denials and then assist in gathering and compiling evidence before appealing.