When it comes to ERISA long-term disability claims, UNUM has what can be charitably described as a poor record. The company has been in trouble with the government numerous times for conspiring to deny claims. This has become part of the corporate culture. UNUM is known as one of the country’s worst insurance companies. While its business practices make it billions of dollars, there is a long trail of hundreds of thousands of people who faced extreme financial hardship so UNUM can make money.
ERISA Is a Law That Favors Long-Term Disability Insurers
When you are unable to work over the long term, you may have the ability to apply for long-term disability benefits. Your company may offer you a policy as a benefit. Since long-term disability through your job is an employee benefit, it is governed by the Employee Retirement Income Security Act of 1974 (ERISA). While you may think that this helps you, the reality is quite the opposite. ERISA actually gives insurance companies even more cover to do as they please with fewer consequences.
In order to receive long-term disability benefits, you must file a claim with the insurance company that your company uses for the policy. You must submit evidence that you are unable to work and that your condition meets the policy’s definition of a disability. Many times, the insurance company will deny the claim. As long as they follow the rules of ERISA, they have the ability to deny claims if they believe that you do not deserve benefits. Many times, they will end up putting their finger on the scale and denying your claim.
Even the appeals process is skewed towards them. The initial appeal of a claims denial is filed with the insurance company itself. They have the right to review their own decision. It is only after they deny your appeal that you have the right to go to federal court. When you do, you do not have the ability to call witnesses or introduce new evidence. You can understand why the ERISA process favors the insurance company.
Update- 8/16/22- “A hospital point of care technician sued Unum Life Insurance Co. of America for long-term disability benefits, telling an Ohio federal judge she’s unable to perform her heavy-duty job after contracting Covid-19 and experiencing lingering cardiovascular, neurologic, and respiratory symptoms. The technician says Unum paid her short-term benefits for about six months but refused to pay her long-term benefits, even though the disability standards for both types of benefits are the same under her employer-sponsored plan. Unum also misclassified her job as being of “medium” intensity, when it requires significant standing and lifting and falls within the category of “heavy” … Bloomberg law
2-11-2022- “Insurance services provider Unum Group faces a proposed class action over a more than two-week data breach last fall. The 32-page case alleges Unum Group failed to properly secure and safeguard the sensitive personal and financial information stored within its network. According to the lawsuit, the “massive and preventable” ransomware attack occurred between roughly October 28 and November 15, 2021, and saw cybercriminals infiltrate Unum’s “inadequately protected” network servers. Per the lawsuit, the data compromised in the incident was not maintained “in a manner consistent with industry and other relevant standards.” Class action
12-1-2021- “A former attorney with Dickstein Shapiro LLP won disability benefits from Unum Life Insurance Co. of America when an Oregon federal judge applied a “heightened level of skepticism” to the insurer’s decision following instructions from the Ninth Circuit. Unum’s determination that Alison Gary could recover from surgery and resume working within six months was an abuse of discretion, because it overlooked the “overwhelming post-surgical medical evidence that anticipated a longer recovery,” Judge Marco A. Hernández of the U.S. District Court for the District of Oregon held in a decision docketed Tuesday. Unum also failed to conduct an in-person examination of Gary, cherry-picked medical evidence, and rejected the opinions of her treating physicians in favor of internal doctors who lacked expertise in her rare condition, Hernández said.” Bloomberg
Companies Like UNUM Do Not Have Free Rein to Do Whatever They Want
While ERISA gives the insurance company quite a bit of power, they do not have unlimited license to do whatever they want. Even though they cannot be sued for bad faith, there is still an outer limit on what they are allowed to do. Apparently, UNUM crossed this line. In what turned out to be a major scandal, years of bad behavior came to light. Just over a decade, UNUM unreasonably denied hundreds of thousands of claims.
The Department of Labor opened an investigation into UNUM and punished it severely. Multiple states also opened their own investigations into the company’s claims practices. The company was ordered to pay a $15 million fine. In addition, the Department of Labor ordered the company to change the way that they evaluate and process long-term disability claims. Finally, the government ordered UNUM to reopen over 200,000 claims that were unfairly denied.
UNUM Has Not Changed, Even After Big Fines and Lawsuits
Unfortunately, despite an agreement with the government, nothing really changed at UNUM. The claimants who were promised a fair shot at disability benefits never got it, as UNUM only reopened a very small fraction of the claims. In addition, it was business as usual at the company. For UNUM, business means putting profits over people and denying claims in any way that they can.
Not only does UNUM deny claims whenever they can, but they also look for reasons to terminate benefits. They hide behind their large team of in-house doctors and lawyers to do everything that they can to take away the long-term disability benefits that you desperately need.
You Can Take Action When UNUM Has Denied Your Long-Term Disability Claim
You can hold UNUM accountable for what they have done to you. People who have had their claims unfairly denied may be able to file or join a class action lawsuit against the company. UNUM has faced numerous class actions lawsuits for the way that it has handled and processed disability claims.
There are two ways to take action against UNUM when it has unfairly denied your claim. Of course, you have the ability to file an ERISA appeal. You can and should take your appeal as far as you can to hopefully get the benefits that you deserve.
Second, you can consult with an attorney with the aim of suing the company itself for damages. UNUM faced class action lawsuits in both 2004 and 2005, and the company has not cleaned up its act since then. Courts have certified classes of plaintiffs when they were based on a corporate scheme to use all methods to deny as many claims as possible.
UNUM continues to be called to account in various lawsuits
In addition, the ERISA rules have been changed to make it easier to sue an insurer directly. Now, you have the legal ability to sue UNUM directly when they violate certain legal rules of the claims process, even if you cannot sue them for a bad faith denial. In the meantime, UNUM continues to be called to account in various lawsuits after it denied benefits and appeals. In one case, the company denied benefits for a double amputee, combing through every nook and cranny of the record and surveilling her social media to try to argue that she had not proven that she was disabled and could work. In this case, UNUM never even examined the claimant in person.
This is just one of many cases where UNUM has not only denied a claim that should have been persuasive, but it also denied the appeal. Courts have routinely slapped down the insurer and have expressed amazement that claims had to go this far in court. The conditions are ripe for another investigation and class action lawsuit against UNUM.
Contact an Attorney to Take Action Against UNUM
First, you need to see an attorney to learn more about your legal options. Before you can sue UNUM directly for damages, you must fully appeal your ERISA disability denial. If you are looking to file a case against UNUM to make them pay for the unreasonable hell that they have put you through, we can help you. In the end, while UNUM may never clean up its act, cases like yours could teach it a lesson that arbitrarily denying claims to save money may be more trouble than it is worth.