Over the last several months it’s come to my attention that claimants are representing themselves with ERISA Appeals and are doing themselves a grave disservice. Approximately only 1% or less of individuals who file their own appeals are successful.
I’m sure the downturn of the economy, lack of cash flow, and money hungry attorneys are to blame. A claimant recently reported that one attorney wanted $800/hour just to submit a new application. Regardless, filing an ERISA appeal on your own is defeatist from the beginning. (If you’re thinking of sending me an email to say you won your own appeal, please don’t. You are within the 1% who actually ARE successful, but the remaining 99% still are not.These are the people I’m speaking to today.)
Some really clever claimants believe if they do enough research on the Internet they can be successful with an ERISA appeal. Perhaps. But, not with a UNUM Appeal. Unum is very clever and knows from the onset that claimants are not ERISA experts, nor do they know their rights sufficient to keep the company honest.
Once an appeal is lost, (and Unum denies the majority of them), the only option left is to file a lawsuit. Unfortunately, there won’t be too many attorneys who will want to take on litigation for, let’s say, 30% of a meager claim of a $1,500/month benefit. A denial to overturn a wrong claim decision is the last step in the Administrative process, and of course, Unum will tell you that, “you have exhausted your rights to any further administrative appeals.” Literally, the only option at that point is to sue Unum. A few claimants actually attempt to sue pro se, but Unum gobbles these people up for lunch.
I do hope that readers of this article make note of its importance in terms of unsuccessfully filing an ERISA appeal. For example, I spoke with a non-client last night who during his self-written appeal was refused the right to a requested IME, guaranteed by the Multi-State Settlement Agreement. He continued to ask Unum “what he should do” and “asked that he be examined by one of Unum’s doctors.” What? My guess is that Unum is not required to pay for an IME on appeal since new additions to the Administrative Record are shut down after 180 days. Technically, the purpose of an appeal is to prove that the original denial decision was wrong, not present new evidence after-the-fact.
Claimants should NEVER ask any insurance company “what they should do.” Do you really think Unum will tell you what to do to win your case? Claimants have the right to ask for an IME prior to a claim denial, which nearly every Unum letter informs them. In my opinion, a good attorney in this case might point out to Unum the omission of the IME and negotiate another opportunity to appeal on behalf of the claimant. Even then, Unum will probably say “no” assuming the claim is already beyond the allotted 180-day review period.
We are now only 2 days from the end of the 3rd Qtr. UNUM profitability reporting. Unum isn’t going to be making favorable decisions anyway until after September 30th. Subsequently, the “big one”, year-end is three months away and Unum will NOT be making favorable decisions on anything that doesn’t fit in with its timing on profitability.
The best defense for an appeal is to make sure the denial doesn’t happen. Years ago, I took on clients and represented them on Appeal, but Maine’s then Attorney General sided with Unum who strongly objected when I won every one of them. Janet Mills is now Governor and still takes a jack hammer to small business. But, that’s a story for a different day.
Filing one’s own appeal is rarely successful and requires more information about ERISA than you can research on the Internet. This is also an area where most claimants can ask 5 people for their opinions and get 10 answers, including from attorneys. Finally, filing one’s own appeal demonstrates work capacity, since it requires clear thinking, computer work, writing etc. Don’t bother telling Unum you had help and someone else wrote the appeal – it won’t believe you.
Filing one’s own appeal is a mistake because claimants throw their appeal rights away. Again, Unum is not stupid and it knows most claimants will just go away if the appeal is denied. Some claimants over time have said to me, “I don’t have any money for an attorney and I have to DO something. Something is better than nothing, Linda.” Maybe so, as long as those same claimants understand what they are risking.
Attorneys, you need to smarten up too! Just how many ERISA folks do you think can pay $800/hour, which in my articles I have often called, HIGHWAY ROBBERY? The average working person needs your assistance to file Appeals and win. Without legal representation, claimants are filing their appeals on their own, and are losing in large numbers. Please consider reasonable fees for your ERISA Appeal business and be a menche.
If after reading this article you still decide to file your own ERISA appeal, prepare yourself for the inevitable. I do not recommend filing appeals on your own. What little rights you do have are at risk.
