Austin Personal Injury Lawyer Blog

Austin Long Term Disability Lawyer: UNUM Policies Often Denied after 24 Mos.

  

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Unum life insurance Company of America, and its subsidiaries Provident Life & Accident insurance Company and Paul Revere life insurance company, are among the most aggressive long-term disability carriers in the country.  As Austin long term disability denial lawyers, we have litigated against Unum many time. If you have employer-provided long-term disability insurance with Unum, there’s a good chance you’re going to be denied, if you have not been already. 

Most UNUM policies contain a change in the definition of disability after 24 months of benefits have been paid.  For the first 24 months, a claimant typically qualifies for benefits so long as he is unable to perform the material duties of his own occupation.  After 24 months, a claimant qualifies for benefits only if he is unable to perform the material duties of any occupation for which he is reasonably fit.  Most claimants are denied at the 24 month own occupation/any occupation transition.

In a practice that is almost unique among major long-term disability insurance carriers, Unum uses, almost exclusively, in-house medical professionals to conduct appellate reviews of denied claims.  This means the “doctor” conducting a claimant’s appellate review is, in actuality, an employee of Unum itself. It is not surprising that many times these appellate reviews conducted by in-house medical personnel contain numerous mistakes.  

In a recent case I argued before the Fifth Circuit Court of Appeals, the court found that multiple mistakes committed by Unum reviewing doctors affected those appellate reviews to the extent that they could not be considered substantial evidence in support of Unum’s decision to deny benefits.   If your claim and appeal have been denied by Unum, it is therefore crucial to go through the entire administrative record carefully in order to locate any mistakes committed by Unum review personnel. These mistakes can often be used to overturn a wrongful denial of benefits. View that decision, Scheurmann v Unum.