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Appealing an Unum Long-term Disability Claim Denial

Appealing an Unum Long-term Disability Claim Denial

 

Long-Term Disability Insurance is a stop-gap benefit, designed to supplement your income when you are not able to earn a wage due to injury.  Your Long-Term Disability Insurance will provide an income so you can pay your mortgage, manage your other bills, and stay afloat.  Too often, however, a reasonable claim for insurance benefits through your insurer results in an adverse benefits decision, a denial.

If you are insured by Unum Long-Term Disability, here are a few steps you can take to begin an appeal to your denial.

 

Read Your Unum Disability Denial Letter

The most important step in beginning an Unum disability appeal is to read your denial letter to determine exactly why you were denied.

There should be a list of reasons as to why Unum believes you do not qualify.  It can be something as simple as you forgot to sign something or as complicated as you not fitting their description of disabled.

 

Request All The Important Documents

Request your claim file (C-File), insurance policy, and your long-term disability plan. You can use these documents to see what Unum requires in their long-term disability claims, what they have evaluated as part of your claim, and what is missing.  You can also see if there were any errors in your original application.

 

Gather Additional Evidence

Gather any additional medical evidence you may need to stack your administrative record and make your claim stronger. You want to include medical records from your primary doctor, and also any documentation from Urgent Cares and emergency rooms that have treated you for your disability.  Do not forget lab reports, x-rays, and reports from occupational and physical therapists are important as well.

You should also collect opinion letters from your doctor and loved ones.  Even though you are submitting your medical records, your doctor writing a letter stating that he/she does not think that you are able to perform your duties for your job adds extra evidence.

Having your spouse write a letter explaining how your day to day activities are gravely affected also adds supporting evidence.  This is the last time you will be able to add to your claim file.  If your case goes to court, you will not be able to add any evidence.  Try to get everything you can collected and included in your claim.

 

Be Aware That You’re Under Scrutiny

During the appeals process, you will more than likely be under camera surveillance. Insurance companies use surveillance to prove or demonstrate their opinion that you are not as disabled as you claim.  It is imperative that you follow your doctor’s orders and be honest about what you can do.  If you do these things, their snooping will not work, and may even hurt them.

 

Write An Appeal Letter

You need to write an appeal letter.  Here are some tips on writing a long-term disability insurance appeal letter.  In the letter, be sure to include why you disagree with the denial, point out any errors you may have found in your file, and include any additional medical evidence you may have.  Don’t forget to include you case number!  Of course, if you are uncomfortable writing this very important letter, contact an attorney!

 

Hire An Attorney

Consider hiring a long-term disability lawyer that has experience working with Unum long-term disability. A long-term disability lawyer will know the ins and outs of long-term disability denial appeals.  They are familiar with the strict timelines and guidelines that need to be followed. They will know what to add to your claim to make it stronger.  They also have had experience working with the Administrative Law Judges should your case go to court.  If you find an attorney that has fought and beat Unum before, that is even better.  Nothing beats experience, and the insurance companies are hoping you do not figure this out.

 

About the Author
In 1998, Chris obtained his law degree from the University of Oregon, and in 1999, he accepted his first job as an attorney with the Washington State Attorney General’s Office. In 2000, Chris entered a private litigation practice in Vancouver, Washington. In private practice, Chris litigated a variety matters including administrative, criminal, real estate, construction, business, and insurance.