Unum LTD Insurance Claim Denials Attorney

The Unum Group is considered to be one of the largest providers of disability insurance in the United States. Despite this, it has garnered a reputation for also being one of the more unconscionable insurance providers. This is largely due to its proclivity for unjust claim denials

The significance of disability insurance cannot be overstated. This type of policy offers crucial benefits to those who cannot work due to illness or injury. In such difficult times, disability insurance can reduce financial stress, allowing you to prioritize your health. Regrettably, insurance companies offering long-term disability (LTD) policies often resort to unscrupulously denying valid claims in an effort to reduce payouts.

Providers, like Unum,  may assert that no “objective findings” support your disability, or argue that you can still perform your regular occupation. Alternatively, an insurer may initially approve your claim only to terminate benefits after a specified period, citing limitations — such as those related to mental health.

If Unum has wrongfully denied your disability benefits, Kantor & Kantor are ready to fight for you. We are people helping people, and we can file a lawsuit on your behalf.

Contact us at 818-886-2525 to schedule a free consultation.

What is Unum?

Unum Group is a major player in the insurance industry, offering various insurance policies, including long-term disability (LTD) coverage. Unum is exceedingly profitable and, as such, has landed itself on the Fortune 500 list.

Unum has earned a notorious reputation within the disability insurance area, ranking among the most egregious offenders for unjustly denying disability benefits. The underlying motive behind these denials is straightforward – insurance companies, like Unum, are driven by the pursuit of profit. By minimizing the number of individuals receiving benefits, they aim to boost profits for their shareholders.

Numerous court rulings have deemed Unum’s denials wrongful, highlighting the company’s use of improper incentives and unfair practices contributing to claim rejections. If you find yourself the latest victim of an unjust denial by Unum, you are not alone. Our experienced long-term disability attorneys are prepared to stand by your side, providing the necessary support to help you fight back against such wrongful denials.

Unum’s History With The Law

In 2024, Dr. Randall Chapman – an eye surgeon based in Novato, California — obtained a favorable verdict against UnumProvident to the value of $31,700,00 by proving that Unum not only denied his claim in bad faith but did so fraudulently and with malice.

Chapman purchased his disability insurance policy from Provident Life & Accident Insurance Company In 1983.  Notably, Chapman had paid his premiums in full every single month from 1983 till 1999 – until Chapman became unable to perform his duties as a surgeon as a result of his psychiatric diagnosis of a phobia. This phobia induced physical symptoms that both intervened in Chapman’s work life and his personal. Forced to retire, Chapman submitted a claim to his disability insurance. The trial revealed that Unum intentionally misread Chapman’s medical records to substantiate reasons for claim denial. This was in addition to utilizing a biased physician who, for myriad reasons, chose to identify Chapman’s condition as both treatable and fraudulent.

The Chapman v. Unum Provident case illustrated Unum Group’s questionable practices in wrongfully denying legitimate disability claims. It paved the way for many more cases akin to Chapman’s, as this would not be the last in Unum’s legal history.

In 2004, Unum faced scrutiny from state regulators, prompting a comprehensive review of 200,000 claims and resulting in a substantial fine exceeding $15 million. In 2005, California insurance regulators imposed an $8 million fine on Unum and mandated changes to its state policies, emphasizing greater consumer protections. This directive compelled Unum to reevaluate up to 26,000 disability cases in California, addressing more than 25 alleged violations of state law.

Further repercussions unfolded in 2008 when Unum reached a $676 million settlement following a thorough investigation into the company’s handling of disability claims by insurance regulators nationwide. This settlement underscored the extent of the issues identified during the examination and emphasized the importance of rectifying systemic shortcomings in Unum’s practices related to disability claims.

Unum Group Tactics in Denial of Disability Insurance Claims

Upon confirming your eligibility for benefits under your Unum LTD insurance plan, it is crucial to familiarize yourself with various strategies that Unum may employ to reject a policyholder’s rightful claims. Recognizing these tactics is essential, ensuring you are well-prepared to counter unjust denials. Unum has been known to employ the following tactics when denying claims:

1. Unum Claims You Failed to Meet the Applicable Definition of “Disability”: If Unum believes the medical evidence does not show an inability to perform your job during the “own occupation” period, they use the definition of disability as grounds for denial. After the “own occupation” period (typically 24 months), Unum may argue that you haven’t proven an inability to perform “any occupation.”
2. Unum Attacks Your Credibility and Honesty: Unum, like many other LTD carriers, often employ surveillance and character attacks to deny claims, casting doubt on the motivations behind the claims and suggesting financial motives rather than genuine concern for the claimant’s health. Common tactics include using private investigators for real-life and online monitoring, requesting in-person interviews or home meetings to observe claimants for signs of potential exaggeration of limitations, and scrutinizing medical records for perceived inconsistencies or concerns about honesty.
3. Failure to Disclose Pre-existing Health Conditions: Unum might assert that you neglected to disclose pertinent information about pre-existing health conditions, an argument often used to undermine the validity of a claim.
4. Insufficiency or Inadequacy of Medical Examinations: Unum may assert that the medical examinations conducted were insufficient or inadequate, casting doubt on the thoroughness and accuracy of the provided medical evidence.
5. Review by “Independent Peer Reviewers”: When evaluating your claim or appeal, Unum often assigns “independent” physicians to review your medical records and possibly reach out to your treating providers. These physicians form opinions based solely on a paper review without examining you. You won’t be able to question them directly, but they may contact your doctors.
6. Paperwork or Documentation Issues: Denials on the grounds of paperwork or documentation problems are not uncommon. Unum may argue that there were inaccuracies or deficiencies in the submitted paperwork, creating a pretext for denying benefits.
7. Claim for a Condition Not Covered in the Policy: Unum might contend that the filed claim pertains to a medical condition explicitly excluded from coverage under the terms of the policy, attempting to narrow the scope of benefits.
8. Elective Procedures Deemed Medically Unnecessary: Denials may be based on the assertion that the procedures in question were elective and not medically necessary, creating a basis for challenging the claim’s legitimacy.

What Can I Do if Unum Denied My Claim?

Facing a denial from Unum can be a challenging and confusing experience, but it’s essential to remember that you have options. Regulations are in place to prohibit unfair practices by insurance companies, including bad faith insurance practices. Nevertheless, the formidable resources wielded by major insurers such as Unum can pose significant challenges for individuals seeking to appeal denied claims.

Depending on the terms outlined in your Unum LTD policy, engaging the services of experienced LTD denial attorneys may prove instrumental. Kantor & Kantor is here to guide you through the steps to take if your Unum LTD insurance claim is denied, ensuring you understand your rights and providing the support needed to contest the denial.

1. Understand the Denial Letter: The first step is carefully reviewing the denial letter from Unum. Understanding the specific reasons for the denial is crucial in formulating a targeted response.
2. Filing a Unum Disability Appeal: Initiating an appeal to challenge the denial of your LTD claim, presenting compelling arguments and evidence to support your case.
3. Submitting a Unum Complaint with the State’s Insurance Department: Lodging a formal complaint against Unum with your State’s Insurance Department, prompting an official investigation into the denied claim and potential violations of insurance regulations.
4. Initiating a Unum Disability Lawsuit: In cases where appeals and complaints yield unsatisfactory outcomes, pursue legal action by filing a disability lawsuit against Unum. This legal recourse involves presenting your case before a court to seek a fair resolution.
5. Negotiating a Unum Settlement: Exploring the possibility of settling with Unum through negotiations. Our skilled attorneys can engage in discussions to secure a favorable resolution that addresses your financial needs and compensates for the denied benefits.
6. Taking Your Case to Court, if Necessary: In certain instances where a negotiated settlement is unattainable, the last resort involves bringing your case to court. Legal proceedings can be initiated to present your case before a judge and seek a judicial resolution.

How to Appeal a Unum Claim Denial

Once you’ve identified the factors leading to your denied claim, focus on gathering the necessary evidence for your appeal. Strengthen weak areas or correct errors in your initial claim to align with Unum’s policy requirements. Carefully review your policy before making amendments to ensure compliance.

Follow these steps to appeal a Unum claim denial:

1. Correct initial claim errors: Address filing inaccuracies or guideline deviations in your initial claim during the appeal, adjusting the language to meet Unum’s policy requirements. Thoroughly review your policy before making changes to ensure accuracy.
2. Obtain additional medical evidence: If your denial was due to weak or insufficient evidence, seek additional evidence to support your medical records. Obtain the latest evaluations to ensure your claim is up-to-date.
3. Request a report from your physician: A detailed report from your physician can provide essential insights that may be lacking in your medical records. Openly discuss how your condition affects you to ensure an accurate and comprehensive report for a stronger appeal.
4. Impact statements from acquaintances: Gather statements from friends, family, and coworkers who have observed how your condition affects your personal and professional life. Coworker statements, in particular, can prove that your condition stops you from performing your job.
5. Acquire vocational evidence: Seek the expertise of vocational professionals to provide occupation-based evidence. They can assess your job and evaluate your ability to perform duties while dealing with your disabling health condition. A vocational expert can be crucial, especially when appealing a policy change to the definition of ” any occupation, ” demonstrating your inability to work in any occupation in the workforce.

What Happens After You Appeal a Unum Disability Denial?

Once you’ve submitted an appeal for your denied Unum claim, there may be a considerable waiting period before receiving any updates. To ensure the proper processing of your appeal, it is advisable to proactively check with the insurer, confirming the receipt of your appeal letter and inquiring about the progress of your appeal.

If your initial appeal is denied, exploring additional avenues to strengthen your case becomes crucial. Working with a qualified Unum disability attorney can be instrumental in several ways. An experienced attorney can potentially facilitate a second appeal, employing strategic approaches to enhance the merits of your claim.

Even if the second appeal meets with denial, it’s essential to recognize that viable options may still be available. Having exhausted the appeals process, your legal team may explore the possibility of filing a Unum insurance lawsuit. This legal action aims to challenge and overturn the denial of your claim, leveraging legal arguments and evidence to advocate for the rightful approval of your disability benefits.

How to File a Lawsuit Against Unum for LTD Denial

Filing a lawsuit against Unum for the denial of your long-term disability (LTD) claim is a crucial step in seeking the justice you deserve. Here is how to file a lawsuit against Unum.

1. Gather Documentation

Collect all relevant documentation related to your LTD claim, including medical records, doctor’s opinions, correspondence with Unum, and any other supporting evidence. These documents will be crucial in establishing the legitimacy of your claim during legal proceedings.

2. Exhaust Administrative Remedies

Before filing a lawsuit, it may be necessary to exhaust all administrative remedies, including the appeals process outlined in your LTD policy. Failure to follow these procedures could impact the success of your legal claim.

3. Draft a Complaint

If administrative remedies prove unsuccessful, your attorney will help you draft a complaint to initiate the lawsuit. The complaint should outline the facts of your case, the legal basis for your claim, and the relief sought.

4. Serve Unum

Once the complaint is filed, the next step is to serve Unum with the legal documents. This involves delivering the complaint and a summons to Unum, notifying them of the lawsuit. Proper service is essential to ensure Unum is aware of the legal proceedings.

5. Discovery Process

During the discovery phase, both parties exchange information and gather evidence. This may involve written questions (interrogatories), document requests, and depositions. Your attorney will guide you through the discovery process and help build a compelling case.

6. Negotiation or Trial

After discovery, there may be opportunities for negotiation and settlement. The case may proceed to trial if a resolution cannot be reached.

When Can a Dedicated Insurance Claim Denial Lawyer Help You?

We provide comprehensive assistance to clients facing disability insurance denial challenges, addressing a range of issues, including:

1. Investigation Delays

During an ongoing investigation, we support clients who encounter delays orchestrated by insurers. This may involve stalling tactics, excessive requests for burdensome information and document dumps, or instances of complete non-communication. Our expertise extends to navigating these complexities, ensuring a fair and timely investigation.

2. Post-Denial Internal Appeals

After a denial, we offer guidance- and support in initiating an internal appeal. Our team works diligently to strengthen the appeal, addressing deficiencies, refining arguments, and presenting compelling evidence to overturn the initial denial and secure the deserved disability benefits.

3. Assistance with Ongoing Appeals

Clients who have already initiated the appeals process can benefit from our guidance. Whether it involves refining existing appeal strategies, gathering additional evidence, or enhancing the overall presentation of the case, we tailor our services to meet each client’s unique needs.

4. Lawsuit Against Unum

When the need arises to escalate the dispute, we stand ready to assist clients in filing a lawsuit against Unum. Our legal team leverages extensive experience in disability insurance cases to construct a robust legal argument, presenting a compelling case in court to challenge the denial and pursue the rightful entitlement to disability benefits.

Why Choose Kantor & Kantor?

When you choose Kantor & Kantor, you align yourself with a legal team with a history of success against Unum. Our commitment to justice is unwavering, and our experienced attorneys are ready to fight for you, ensuring you receive the benefits you deserve. Here are some reasons to choose us:

Comprehensive Understanding of Unum’s Tactics

Our attorneys understand the tactics employed by Unum in denying disability insurance claims. Our in-depth knowledge allows us to anticipate and counteract UNUM’s strategies effectively. We leverage this understanding to build robust cases that withstand scrutiny, giving our clients the best chance of success in challenging UNUM’s denials.

A History of Winning Cases Against Unum

We have a history of success against Unum in various legal settings. Our legal victories include cases where Unum’s denial tactics were rigorously contested, and we emerged triumphant. These successes illustrate our prowess in dismantling Unum’s defense strategies and advocating effectively for our clients. Here are some cases we have won against Unum:

Radmilovich v. Unum Life Insurance Company of America

— F.Supp.3d —- 2023 WL 7457118 (CD CA, 2012)

Claimant who suffered a cardiac arrest and resulting cognitive impairment, intermittent chest pain, fatigue, dizziness, and nausea proved by a preponderance of the evidence that he was disabled and thus entitled to long-term disability (LTD) benefits under policy governed by ERISA; reports by claimant’s treating physicians confirmed his symptoms and provided a physical etiology explaining them that stemmed from his cardiac arrest, insurer’s own hired expert agreed that claimant suffered from mild neurocognitive disorder, and it was statistically extremely unlikely that claimant would survive his cardiac arrest, and accompanying deprivation of oxygen for five to 20 minutes, without cognitive deficits.  Employee Retirement Income Security Act of 1974 § 2 et seq., 29 USCA § 1001 et seq.

Haag v. Unum Life Insurance Company of America

United States District Court, ND. California. October 20, 2023 Slip Copy 2023 WL 6960369

Credible evidence of a disabling orthopedic injury entitles the insured to benefits, even where there is a lack of a definitive diagnosis.

Woolf v. UNUM Life Insurance Company of America

United States District Court, CD California.

2021 WL 6618866

Nathans v. Unum Life Insurance Company of America, 549 F.Supp.3d 1052

United States District Court, CD California. 2021

Kantor & Kantor prevailed on behalf of Michael Nathans on the issue of his entitlement to seek bad faith damages due to his denial of benefits by Unum.

Tam v. First UNUM Life Insurance Company,  491 F.Supp.3d 698

United States District Court, CD California 2020

Evidence showed that the plan participant, who was diagnosed with chronic fatigue syndrome and other conditions, could not perform the “material duties of her regular occupation” of senior software engineer, supporting ERISA claim for long-term disability benefits; the participant’s regular occupation required concentration, attention, and making judgments and decisions, treating and examining physicians opined that participant experienced severe fatigue and cognitive dysfunction, participant and her husband credibly testified that participant struggled with performing basic activities due to fatigue, and although physicians hired by administrator to review participant’s medical records found that she could still work, those physicians mischaracterized and ignored medical evidence. Employee Retirement Income Security Act of 1974 § 502, 29 U.S.C.A. § 1132(a)(1)(B).

Willingness to See Cases Through to Trial

Our unwavering commitment to our clients’ cases truly sets us apart. We understand that some cases require taking the fight to the courtroom, and we are not afraid to do so. Our willingness to take on UNUM in the courtroom demonstrates the depth of our dedication to obtaining justice for our clients.

Personalized and Strategic Approach

Every case is unique, and we recognize the importance of a personalized and strategic approach. We tailor our legal strategies to the specific circumstances of each client’s case, ensuring a comprehensive and effective representation. Our commitment to personalized service means that you receive the attention and advocacy your case deserves.

How We Can Help

Here’s how our experienced legal team can assist you in the fight against Unum’s LTD insurance claim denials:

1. Thorough Case Assessment

Our legal team will thoroughly evaluate your case, analyzing the details to determine its strengths and weaknesses. We understand the intricate nuances of insurance law and will assess the merit of your claim. This careful examination forms the foundation for a strategic plan tailored to your unique circumstances.

2. Strategic Appeal Preparation

We are well-versed in navigating the intricate details of Unum’s appeals process. We work closely with you to gather relevant medical evidence, testimonies, and other supporting documentation to build a robust case. Leveraging our expertise, we develop persuasive arguments supported by robust evidence to challenge Unum’s decision and increase the likelihood of a favorable outcome.

3. Pursuing Negotiations for Fair Settlements

Our negotiation skills are honed through years of experience dealing with insurance companies. We will engage in strategic discussions with Unum, seeking a fair settlement that reflects the true value of your claim. We understand the importance of tenacity and diplomacy in negotiations, ensuring that your interests are prioritized throughout the process.

4. Litigation and Trial Representation

We are prepared to take your case to court if negotiations fail to yield the desired results. With a track record of success in litigation against Unum, our legal team is skilled in presenting compelling arguments in the courtroom. We meticulously prepare for trial, leaving no stone unturned to secure the justice you deserve.

5. Class Action Assessments

In certain circumstances, your case may be eligible for inclusion in a class action lawsuit. We will assess the viability of pursuing a class action claim on behalf of a group of individuals facing similar challenges with Unum. This collective approach can amplify your voice and increase the impact of legal action against unfair insurance practices.

You Are Not Alone: Contact Kantor & Kantor Today

If you are dealing with a Unum LTD insurance claim denial, remember you are not alone. At Kantor and Kantor, we are people helping people, and our empathetic and skilled legal team is ready to listen, strategize, and advocate for your rights.

Contact Kantor & Kantor at 818-886-2525 to schedule a free consultation. Let us be your partners in the fight against Unum’s unjust denials.

Attorney Glenn R. Kantor

Glenn Kantor is a founding partner of Kantor & Kantor LLP. As a young attorney, Glenn saw the injustice of wrongful insurance denials and created a law firm to represent individuals seeking to obtain their rightful benefits. Glenn is committed to ensure that clients receive the benefits they are entitled to under their insurance policies or group health plans. [Attorney Bio]