As the largest provider of disability insurance in the U.S., Unum insures millions of people for long term disability benefits. Unum also denies many of their claimants disability benefits every year. All disability insurers, Unum included, have financial incentives to deny and terminate claims. Every dollar they save in denying claims is a dollar of profit. This creates an inherent conflict of interest because, in most instances, Unum is the entity that both decides the claim and is also the entity that pays the claim.
When filing a long term disability claim, appealing a wrongful denial, or litigating with Unum, it’s important to speak with an experienced ERISA attorney. Riemer Hess has secured and protected long term disability benefits from Unum for hundreds of our clients.
Below we’ll discuss the common tactics Unum uses to deny disability claims, how to combat them, and more.
Unum has a long list of tactics that it regularly uses to deny disability claims. Many times these claim denials are unfair and unreasonable. Some common tactics we’ve observed Unum use include:
A few common justifications Unum will use to deny long term disability claims include:
This list is not exhaustive.
Unum has a long-standing practice of disability claims handling practices that has been criticized and admonished throughout the country. In fact, Unum entered into a Regulatory Settlement Agreement (“RSA”) with state regulators in several US states in 2005, due to these practices. The RSA legal agreement was reached after a multi-state examination revealed that Unum had engaged in unfair and deceptive practices.
Under the terms of the RSA, Unum agreed to a series of reforms aimed at improving its claims handling processes and providing better customer service to its policyholders. These reforms included the establishment of new policies and procedures for claims handling, the hiring of additional claims personnel, and the implementation of an independent review process for certain types of claims. In addition, UNUM agreed to pay restitution to certain policyholders who had been adversely affected by the company’s previous practices, and to pay fines and penalties to the states that had participated in the examination.
Courts have recently confirmed that the RSA is still in full force and effect. See Moseley v. Unum Life Ins. Co. of Am., Civil Action 22-40079-RGS (D. Mass. Mar. 2, 2023). Despite the RSA being in place, Unum continues to often engage in unfair practices when handling disability claims. Research has shown that if anything, Unum's conduct has worsened since the RSA. See, e.g., Philip W Thomas, 15 Years Later – Did the Unum Group Improve Its ERISA Claims Handling Practices?, 39 Miss. C. L. Rev. 199 (2021). See also Richard P. Console, Jr., The 11 Worst Insurance Companies, National L. Rev. (Feb. 10, 2021) (available here) (naming Unum as the second worst insurance company in the US, and noting, with respect to its disability coverage, that “it has established a poor reputation with its insureds” and “[t]he media frequently investigates this company for their continual claim abuse”).
Having your long term disability claim outright denied or terminated after initially receiving benefits can be devastating. Many clients come to Riemer Hess for help after facing an unfair denial from Unum. Fortunately, a denial or termination of benefits from Unum is not the end of the road.
If Unum denies or terminates your long term disability claim, here are the first steps you can take:
Unum often finds itself in court. Examples of courts criticizing Unum for their practices in denying benefits include:
Unum, like all disability insurers, is in the business of making money. If Unum believes it can find cause to deny your disability claim and save the company revenue, it will likely do so. This is why it’s so important to be prepared when filing, appealing, litigating, or protecting your long term disability claim.
When filing, appealing, or litigating a long term disability claim with Unum, it’s important to have a thought-out strategy. It’s all too easy to fall into common traps that result in your claim being denied or terminated. Unum will always scrutinize your claim for any justification to deny your disability benefits.
To get ahead of Unum, Riemer Hess works hard to proactively predict which tactics Unum is likely to use on any given claim. This can be tricky because each claim presents its own unique set of facts. We combine our experience with Unum together with the unique facts of each claim to craft a customized strategy designed to win benefits.
For example, our client Michelle worked as a high-level accountant when she began to experience debilitating back pain, fatigue, and muscle weakness. Eventually, her symptoms progressed to the point she could no longer work. Michelle applied for and received long term disability benefits from Unum.
Not wanting to give up the career she’d worked so hard for, Michelle attempted a part-time return to work after several months of receiving benefits, hoping to resume a full-time schedule over time. Unfortunately, as Michelle increased her work hours, her symptoms flared up even worse. Invasive and frequent treatment did not help subside her pain.
Unum terminated Michelle’s long term disability claim shortly thereafter, alleging that because she had attempted a return to work, even at a part-time schedule, she was no longer disabled. Unum claimed that Michelle only needed to try harder to work full-time. Michelle then hired Riemer Hess to help her fight against Unum for her long term disability benefits.
Riemer Hess filed an administrative appeal on Michelle’s behalf with Unum. The appeal included voluminous new evidence, including additional testing, medical records, supplemental letters from her treating providers, and an affidavit. Riemer Hess wins more than 85% of the appeals it files, but despite the wall of evidence Riemer Hess submitted reaffirming Michelle’s ongoing disability, Unum chose to deny her appeal. This left Michelle and Riemer Hess no choice but to sue Unum in court.
Riemer Hess filed a federal lawsuit on Michelle’s behalf, and the Court ruled in Michelle’s favor. The Court determined that Riemer Hess’s evidence demonstrated Michelle could not perform her job duties, and that Unum’s excuses for denying her benefits did not hold water. Unum was ordered to back pay Michelle’s long term disability benefits and pay her future benefits, subject to the terms of her long term disability plan.
If you’re filing a long term disability claim, appealing a wrongful denial, or litigating your claim with Unum, we recommend consulting with an experienced disability attorney. Riemer Hess has successfully filed disability claims and appealed denials with Unum for hundreds of our clients. We can review your Unum policy, claim forms, medical records, and vocational documents, and formulate a personalized strategy to give your claim the best chance of approval.
The Unum disability attorneys at Riemer Hess know the best strategies for filing, appealing, or litigating a claim with Unum and how to combat their tactics to deny the benefits you deserve.
If you are filing a long term disability claim, appealing a wrongful denial or termination of benefits, or facing litigation with Unum, the New York disability attorneys at Riemer Hess can help. Call Riemer Hess LLC at (212) 297-0700 or click the button below to schedule a consultation on your disability case.