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UnumProvident Must Reopen All Long Term Disability Claim Denials from 1997 to the Present!

On November 30, 2004, UNUMProvident reached a tentative settlement with State Insurance Regulators, which required UNUM, and its subsidiaries, Paul Revere Life and Provident Life & Accident to reconsider more than 200,000 long term disability claims which had been terminated or denied from January 1, 1997 to the present. This settlement is intended to resolve issues raised by insurance regulators concerning UNUM's claims handling practices. These investigations focused on assertions that UNUM and its subsidiaries had improperly denied claims for benefits under individual and group long-term disability insurance policies. They concluded that UNUM had committed numerous violations of its obligation to fairly administer claims.

The settlement requires UNUMProvident Companies to:

  • Reassess approximately 200,000 claims that previously had been terminated or denied.
  • Restructure their claim handling procedures to ensure objectivity and fairness.
  • Pay a $15 million fine.

The settlement agreement gives thousands of current and former UNUMProvident Companies' policyholders an opportunity to have their terminated or denied claims reassessed.

Under the settlement agreement, the majority of persons whose claims for group or individual long-term disability benefits were either terminated or denied after January 1, 2000, will receive notice via mail of their right to have their claim reassessed.

Persons whose individual or group disability claims were denied prior to January 1, 2000, although not receiving notice directly from UNUM, will also be able to request to have their claims reviewed by applying to their specific UNUMProvident Company.

In addition, any individual whose claim has been terminated or cut short after two years based on an assertion that their disability was a mental and nervous condition rather than a physical condition, can apply to have their case reopened.

UNUMProvident officials estimate that the settlement will cost them over $100 million in restitution to policyholders making claims. If UNUM fails to implement the required changes in a timely manner, it will be subject to penalties of $100,000 per day until compliance is achieved. In addition, failure to meet acceptable levels of accuracy in making disability claim determinations will result in an additional penalty of $145 million. The reasons for these penalties are primarily because of Insurance Department findings that UNUMProvident failed to consider Social Security Disability awards as evidence of disability, failed to make sure that claims were reviewed by competent and impartial doctors, failed to have competent vocational assessments completed by competent vocational practitioners, failed to account for the assertions of claimants and their treating doctors, and failed to properly consider medical documentation establishing disability.

For a free consultation, call (818) 886-2525.

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Client Testimonials

  • You are the light in the darkness for all of us.

    “Lisa- You are the light in the darkness for all of us in the eating disorder community. I believe that you were born to take on these challenges.”

    Pam S.

  • I won the appeal.

    “Hi Glenn- This is a very belated thank you for your generous assistance and advice last summer, when I was appealing UBH's decision for my son. I won the appeal, at least for care at the partial hospitalization level (they wouldn't budge on residential, but the facility was accepting the partial care reimbursement for residential treatment). But the appeal was a great moral victory, and I think it's a great thing to have in the record, just in case he needs to go for treatment again. Thanks again for your generous help, I was very grateful for it. Wishing you a most happy Thanksgiving.”

    Terry S.

  • There are no words that can express the feelings of gratitude and relief I have that you helped us.

    “I wanted to thank you again for all of your help. My daughter would not be in treatment without your help. I can never thank you enough, there are no words that can express the feelings of gratitude and relief I have that you helped us, and I believe saved my little girl. Taking her back to Timberline Knolls was very difficult in many ways, I wish UBH could know the damage they have done to her by having her go in and out like this. When she went into Timberline Knolls the first time she was not happy to go exactly, no one wants to go into treatment, but she was open to going in and ready, for the first time, to really look at her issues and work hard to get better. When she had to leave Timberline she expressed that she wished she could have stayed because she felt like she was finally at a place where she was getting better and, though it was hard, she was really opening up and dealing with her issues for the first time, something she has had a hard time doing. I just wanted you to know that she was going down to a really bad place and without you I don't know what would have happened except that she would not be at Timberline Knolls right now getting better and I thought you should know this. With unending gratitude.”

    R.

  • Finding, and working with your team has been such a blessing to me.

    “Thanks again for all your help. Finding, and working with your team has been such a blessing to me. Deepest regards.”

    M.

  • First of all, I want to express my extreme gratitude for probably saving my daughter's life.

    “First of all, I want to express my extreme gratitude for probably saving my daughter's life. By staying in treatment, the improvement is remarkable. She had been in eating disorder facilities many times, and treatment had been interrupted repeatedly by Anthem Blue Cross's denying benefits. Many of the health professionals were telling me that maybe my daughter was a hopeless case. You both gave me hope. She is still struggling with some residual issues around eating, but the change in her attitude, her ability to assess her own recovery, and her wish to live instead of to die, is evident in her life. Now she is back in school, after years of having her education disrupted by the eating disorder. She goes places with friends, and even goes out to restaurants for fun! This year marked the first holiday season for many years, when she had not been in a treatment facility. Other people gave up and you didn't. I can't thank you enough. You took the action that was necessary to keep my daughter in treatment long enough for it to work.”

    Anonymous