Can UNUM Deny Short-Term Disability Benefits Due to a Pre-Existing Condition?
Pre-existing condition clauses and limitations are relatively rare in short-term disability insurance policies. However, you should never assume that UNUM did not sneak exclusions and exceptions into the fine print of your disability insurance policy.
UNUM is the largest disability insurance company in the United States, and they have a history of wrongfully denying short-term disability insurance claims. Insurance companies like UNUM know that policyholders with pre-existing conditions are more likely to need to collect disability than others. So, they sometimes write policies that make it easier for them to deny these claims.
At Bryant Legal Group, we have handled (and resolved) many cases where our clients were wrongfully denied their short-term disability benefits. In this article, our experienced disability attorneys will cover how your policy may determine your claim’s success, tactics UNUM uses to deny claims, the difference between short and long-term disability claims, and how a disability lawyer can help you fight back.
- Related Article: A Claimant’s Guide to UNUM Claims and Tactics
Short-Term Disability Insurance Pre-Existing Condition Clauses Can Vary
Unlike Social Security disability, disability insurance plans are operated by for-profit insurance companies. When you or your employer purchase a short-term disability policy, you are agreeing to its specific terms and conditions. Sometimes, insurers include limitations and exclusions for pre-existing conditions.
Most people have one of two kinds of short-term disability coverage:
- ERISA: you have short-term disability coverage through an employer-sponsored plan. A federal law, ERISA (Employee Retirement Income Security Act of 1974) applies to your claim.
- Individual: you purchased your own short-term disability policy from a broker. State laws will apply to your claim.
Regardless, if you file a claim for short-term or long-term disability, your policy’s terms and conditions will help determine whether you are eligible for benefits. Make sure you review your policy or plan documents before you file a claim.
Insurance companies like UNUM are keen on avoiding payout on such claims, often going to great lengths to prove your claim is invalid. Some short-term disability plans include a pre-existing condition clause. If it applies to your disability claim, you might face a lengthy waiting period before you can file a claim—or you might be completely ineligible for monthly benefit payments.
Need help interpreting the fine print in your policy? Schedule a consultation with one of our disability insurance lawyers.
What to Look Out for if You Have an ERISA Plan
Most employer-sponsored short-term disability policies do not include a pre-existing condition exclusion or “look-back period,” but some do. Make sure you carefully review your Summary Plan Description (SPD) or other plan documents—and consult with a disability insurance lawyer if you need help interpreting their language.
If there is a pre-existing condition clause, it might make you ineligible for benefits for a period of time. For example, if you received medical treatment for a pre-existing condition within 90 to 180 days of coverage and then file for short-term disability benefits within 12 months, you might not be covered.
Again, this is relatively rare—and a lawyer can help you understand the precise terms and conditions that apply to your claim.
What to Look Out for if You Have a Private Disability Insurance Policy
If you have a private short-term disability policy, you have a lot more control over its terms and conditions. When you purchased the policy, you picked from a variety of options, which might have included pre-existing condition exclusions or limitations.
However, you might not have fully understood the implications of these decisions at the time. When you are young and relatively healthy, it is tempting to select a lower-cost policy that has more limitations and a stricter definition of disability. Then, when the unexpected happens, you are left with longer waiting periods, more red tape, or even lack of coverage.
Our team can help you understand your policy language and prepare your short-term disability claim.
- Related Article: UNUM Disability Claims: 4 Things You Need to Know
UNUM May Misinterpret Medical Records to Deny Your Claim
Even if you have short-term disability insurance coverage, insurance companies like UNUM may try to deny your claim by skewing your medical records. Insurance adjusters will look through your medical treatment history, including tests, doctor’s visits, and medication logs, looking for evidence of a “pre-existing condition.”
For example, suppose you were in a car accident and suffered a serious back injury. You file for short-term disability benefits while recovering from spine surgery. During UNUM’s investigation, the adjuster notices that 12 months before the crash you mentioned a minor back ache to your doctor. They prescribed you a short course of pain medication, and your problems resolved themselves.
Even though you know you pulled a muscle doing lawn work, UNUM might argue that those twinges of pain were signs of a pre-existing herniated disc—and deny your claim.
What an Experienced Disability Lawyer Can Do to Help Fight Back
Disability insurance companies want to deny claims like yours, so it is important to have help throughout the process. Consulting with an experienced short-term disability lawyer, even before submitting your claim, can help the overall success and ease of your case. Having an attorney available to you can help you understand the industry jargon and avoid potential pitfalls that could prevent you from getting the compensation you deserve.
Our team has handled thousands of disability insurance cases just like yours and is ready to help. Our experience dealing with UNUM gives us the knowledge to build a legal strategy that will get you justice. Having an experienced team on your side can prevent wrongful denials and lead to a quicker resolution for you and your loved ones.
We take a practical, evidence-driven approach to UNUM disability cases. Our attorneys will carefully review all your medical records, consult with your physicians and other medical experts, and build a comprehensive strategy that supports your claim.
- Related Article: What to Look for in a UNUM Long-Term Disability Lawyer
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Pre-Existing Conditions and Long-Term Disability Insurance: How It Differs From Short-Term Disability
If you suffer from a chronic health condition, it is important to look carefully over the terms and conditions of your disability policies, both short and long-term. Even if your short-term disability policy does not include exclusions for your pre-existing condition, your long-term disability policy might. Even policies offered by the same employer may have different conditions.
This difference in policy terms is not uncommon and prevents claimants from getting the help they need if their conditions worsen. Be sure to carefully compare your policies to ensure you can receive disability coverage regardless of severity. If you are unsure if your policies provide the coverage you need before filing a claim, consult an experienced disability insurance lawyer.
- Related Article: Pre-Existing Conditions and LTD: 4 Things You Need to Know
Bryant Legal Group: Chicago’s Premier Firm for UNUM Short-Term Disability Pre-Existing Condition Cases
If you or a loved one is struggling with a UNUM short-term disability insurance claim, you need to speak with a disability lawyer who understands the insurance company’s tactics. Bryant Legal Group is one of the premier disability law firms in Illinois, and we have successfully handled many UNUM claims.
To request your free consultation, contact our office by calling 312-561-3010 or completing this brief online form.
The content provided here is for informational purposes only and should not be construed as legal advice on any subject.
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