UNUM INSURANCE

by Jane Mundy

Unum Group (formerly UnumProvident) is one of the largest disability insurance underwriters in the U.S. More than 50 million US workers rely on disability insurance -- Unum has about a quarter of the market -- and without it, many families would suffer needless hardship. Disability insurance is usually offered as a benefit to employees through their place of employment and if an employee has a legitimate claim, it usually represents at least half their income.

But Unum also receives countless complaints of denials of legitimate disability insurance claims.

Insurance companies such as Unum practice bad faith when it fails to pay a claim without justification or if it violates the insurance coverage policy. A few of Unum's tactics to deny a claim include:

Failure to properly investigate a claim;
Unreasonable delay in making payments to the policy holder;
Unreasonable termination of an insurance claim that should have been paid;
Use biased medical exams that deem someone fit to work even against the advice of their treating physician

Legal settlements were reached by regulators in 2004 and 2005 that required UnumProvident Corp. (now Unum Group) to re-evaluate hundreds of thousands of disability insurance claims that it had rejected. They also required Unum to change its medical review process by considering treating physicians' opinions.

However, according to the LA Times (April 12, 2007), Unum has reviewed fewer than 10% of the 290,000 claims eligible for a second chance, including 25,000 in California. Unum replied that only a small percentage of cases were reviewed because most worker claimants chose not to reopen their cases; instead claimants apparently accepted the company's decision.

This means that legitimate disability claims from Unum policyholders continue to be rejected, causing families to suffer financial and emotional hardships. As well, workers are often forced to return to the workplace against their doctor's advice.

But Unum said it expected to overturn about 9,000 cases nationwide and pay $478 million in claims. That is yet to be seen.

Unum recently changed its name from UnumProvident as part of a rebranding and possibly an attempt to distance itself from its bad image and history of bad faith insurance practices. A spokesperson for the company said it is a "new company" and the new brand has three components it wishes to present:

Offers products and benefit plans that go beyond disability insurance;
Is focused on customer service;
Is people-oriented.

Unum Lawsuit

Many policy holders would disagree with Unum's new company components. Currently, in the lawsuit Weiss v. First Unum Life Insurance Co., the 3rd U.S. Circuit Court of Appeals has revived a RICO suit against First Unum Life Insurance Co., a major setback for the insurance company.

Plaintiff Richard Weiss claims that First Unum terminated his long-term disability claim because it exceeded $11,000. Unum allegedly cut off his benefits without consulting his medical records or ordering tests that would have confirmed the severity of his disability: Weiss, an investment banker, suffered a heart attack and is subsequently disabled.

During litigation, Unum resumed paying Weiss' disability benefits, but Weiss has continued with the lawsuit, stating that denying his benefits was illegal and triggered damages under RICO. It is thought that Weiss will triumph at his trial and his claim that First Unum engaged in an illegal pattern of denying claims for no valid medical reasons.

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Enter the information about your UNUM case and we will contact you. Fields marked * are required.

First Name: *

Last Name: *

Email Address: *

Phone Number: *

State: *

Date of Disability:

Date Benefits first Received:

Date Benefits Terminated:

Date for claim of Benefits:

Date for claim of Benefits denied:

What are your monthly benefits?

What condition(s) renders you disabled?

Please list medical support for this/these condition(s) i.e. x-rays, doctors, etc.:

Date of Birth:

Benefits from age 65, Life or Other:

If Other, please explain:

When did you purchase your benefits?

Occupation at time of disability:

Have you appealed your denial?

Yes No

If yes, what is the status of your appeal?

Is your policy an employer-sponsored group policy?

Yes No

Is your policy an individual policy?

Yes No

Occupation at the time of Application:

Occupation the day before you were disabled:

Name of Employer:

Name of Insurance Co.:

Policy #:

Claim #:

Type of disability policy:

Was the insurance premium paid by you or your company or both?

Do you have a copy of the policy?

Yes No

Monthly salary at disability:

Nature of disability:

When did you first apply for disability?

Were you denied?

Yes No

If yes, what date:

Did the carrier send you a denial letter?

Yes No

If yes, what is the date of the letter:

Reason for denial:

Did the carier inform you of an appeal deadline?

Yes No

If yes, what is the date of the deadline:

Did you appeal?

Yes No

If yes, what date:

Was your appeal denied?

Yes No

If yes, what date:

What was the amount of your monthly disability benefit:

What percent of monthly salary did policy pay:

Are you receiving SSDI?

Yes No

If yes, what is the benefit amount:

What date did SSDI benefit begin:

Any dependent SSDI benefits?

Yes No

If no, have you applied for SSDI?

Yes No

What is the status of SSDI application:

If denied, are you in appeal stage?

Yes No

What was your benefit after SSDI offset:

Are you receiving WCAB?

Yes No

If yes, what is the benefit amount:

What date did WCAB benefit begin:

Are you receiving State Disability Insurance?

Yes No

If yes, what is the benefit amount:

What date did State Disability Insurance begin:

Were you sent for an IME?

Yes No

If yes, what date:

Were there additional IMEs?

Yes No

If yes, what date:

Did the carriersend a field representative to interview you or your doctor?

Yes No

Who are the doctors treating you?

What are your doctors' specialities:

What meds were you on at date of denial:

What meds were you on at date of appeal denial:

What meds are you on today:

Are you behind in your mortgage, rent, car payments, credit cards, etc.:

Yes No

Any criminal or tax problems we should know about:

Did you take early retirement benefits?

Yes No

If yes, were they deducted from your disability benefits?

Yes No

If this claim is not for you please identify the person you are making this inquiry for:

Have you ever contacted a lawyer about this?

Yes No

Are you currently working with a lawyer on this?

Yes No

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