Top Reasons Why UNUM Denied Your LTD Claim

If you received a long-term disability denial (LTD) from UNUM, you’re not alone. Considered by many ERISA lawyers as the worst LTD insurer, UNUM sometimes uses aggressive and unfair tactics to reduce the number of disability insurance claims they pay out.  

The Bryant Legal Group team has been fighting UNUM for decades, and we understand how they approach their claims. In this blog, we explain some of the most common excuses its adjusters use to deny legitimate LTD claims. 

UNUM Earned Its Reputation Among the Worst Insurers in the U.S. 

In 2008, the American Association for Justice (AAJ) reported that, in its opinion, UNUM was the second-worst insurance company in the United States. How did the AAJ arrive at this conclusion? UNUM’s record speaks for itself. 

Facing nationwide investigations for its unfair business practices, UNUM eventually settled disputes with 49 state insurance commissioners for $23 million and empty promises that it would fix its faulty claims handling systems. In the end, the company only reopened roughly 10% of its mishandled claims. 

Today, UNUM continues to reject legitimate insurance claims  and ERISA lawyers continue appealing these denials.  

1. You Don’t Have a “Qualifying” Disability  

Every long-term disability policy has its own definition of disability. Typically, it falls into one of two general categories: 

  1. Own occupation: You cannot perform your actual job due to an illness, injury, or chronic condition. 
  1. All occupations: You cannot perform any job due to your medical and psychological limitations. 

Most, but not all, UNUM LTD policies contain the more difficult “all occupations” standard. 

While the adjuster might agree that you have serious health conditions, they could argue that there’s still work you can do. For example, while you might be unable to perform your job as a neurosurgeon, UNUM could claim that you can work as a grocery store greeter  even though you need to elevate your feet above heart level every two hours. 

To combat these tactics, your ERISA lawyer will collaborate with your doctors, other medical experts, and vocational consultants to identify and quantify your exact abilities and transferable skills. 

2. UNUM Attacks Your Credibility and Honesty  

Like many LTD carriers, UNUM loves using surveillance and character attacks to deny claims. Its adjusters frequently suggest that claims are motivated by financial gain rather than people’s physical or mental health.  

Common tactics include: 

  • Using private investigators to monitor your activity in real life and online 
  • Requesting in-person interviews or meetings at your house to observe you and look for signs that you’re overstating your limitations 
  • Searching your medical records for seemingly inconsistent statements or concerns about your honesty 

Notably, you do not have to permit investigators on your property, and they cannot film you in areas that you have a reasonable expectation of privacy (like bathrooms and bedrooms). However, if you’re filing an LTD claim, you should lock down your social media and online accounts and try not to push yourself beyond your abilities. 

3. The LTD Policy Excludes Your Claim 

Most UNUM disability insurance policies include numerous exclusions. If your claim arguably falls under one of these exclusionary clauses, the adjuster will promptly deny your claim.  

Common exclusions include: 

  • Pre-existing conditions 
  • Self-inflicted injuries and medical conditions 
  • When an insured made misrepresentations when they applied for coverage 
  • Claims that qualify for workers’ compensation benefits 
  • Injuries suffered during a riot, conflict, or war 

UNUM will read these exclusions broadly and might try to frame your circumstances unfairly. In response, your ERISA lawyer will carefully examine the facts, your medical records, and the policy language to determine whether your situation truly falls into an exclusion. 

RELATED: “Self-Reported” Symptoms: How to Fight Back With Medical Evidence 

4. UNUM’s Doctors Disagree With Your Treating Providers 

Your treating physicians and therapists might unequivocally agree that you meet your LTD policy’s definition of disability. However, that doesn’t mean that UNUM will pay your benefits. Sometimes, the company asks its own doctors to perform “independent medical examinations” or review records and issue an opinion about your ability to work. Unsurprisingly, these hired guns rarely side with disabled claimants. 

However, in Illinois, UNUM and other disability insurance companies cannot reject your treating physicians’ opinions in favor of a consulting doctor unless it’s consistent with the evidence as a whole. Our attorneys frequently can demonstrate that UNUM’s reliance on a consulting or IME physician was unreasonable. 

5. Your Claim Isn’t Supported by the Evidence 

Other times, UNUM might present a more nuanced argument. Instead of claiming that you can work, it will argue that your symptoms simply don’t match up with your objective findings on MRIs, X-rays, and other tests. Then, the adjuster will deny your claim because your symptoms are “self-reported.” 

Fighting allegations of “self-reported” symptoms requires extensive medical knowledge and strong relationships with medical experts. At Bryant Legal Group, our team has decades of experience interpreting medical records and also includes a physician consultant. 

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The content provided here is for informational purposes only and should not be construed as legal advice on any subject.

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