Given the current state of the economy, more and more claimants and insureds are attempting their own appeals and are getting taken to the cleaners. This may turn out to be one of the most important posts you will read this year.
There are two clearly defined governing jurisdictions for disability claims, 1) Federal – Employment Retirement Income Security Act of 1974, and 2) State – Individual Disability Claims, underwritten separately, not obtained from an Employer. Of the two, State jurisdiction is by far the most advantageous for the insured. Federal vs. State jurisdiction is very important, especially when claims are denied and insureds are trying to appeal to get the denial decision overturned.
Over the last 30 years, Unum has always been shady when it comes to appeals, and in some types litigating cases as well.Today, Unum communicates ERISA timelines for IDI claims, 180 days for this, 90 days for that, even when the issued policies have state jurisdiction and are not subject to the same timelines as ERISA claims.
Unum does this for two reasons. First, the company hopes to to petition the court (in case of litigation) to remove claims from state jurisdiction to federal court, a much less favorable position for insureds. And second, if ALL claims are lumped together with the same requirements, administratively, it’s much easier to manage them.
And so, IDI insureds are told lies that do not apply to them and their policy. IDI insureds are told they have 180 days to file an appeal. THAT’S FALSE. IDI insured DO NOT have the right of appeal the way ERISA claimants do. In fact, IDI insureds, while allowed to submit additional information as “proof of claim” is limited only by their state statute of limitations (insurance is usually a tort). There’s no 180 days about it. IDI insureds can continue to submit information in support of claim within the statute of limitations. Unum also uses the 30-45 day time line for submission of update information when state polices DO NOT SAY THAT. IDI policies usually contain provisions that write that the insured must submit proof of claim within 90 days of any claimed period of disability.”
Therefore, one might say that Unum treats all claims as if they had a federal jurisdiction (ERISA) and holds all IDI insureds to the same timelines. Insured individuals who do not know the difference, might get pulled in to the deadlines even when they don’t apply. This deliberate “error” should always be officially corrected for the record. No IDI insured wants to have an ERISA claim, or have to follow the ERISA timelines!
Unum’s appeals unit is the most unfriendly, prejudicial and biased department on the planet. Believe me, I’ve come into contact with several of Unum’s appeals representatives and they are as dishonest as they come; others are bumbling idiots and bungle the process. For those who are lost in the process, insureds often ask Unum’s appeals reps, “well, what do you need?” or, “tell me what to get, and I’ll get it.” No one at any insurance company, especially appeals, is going to tell you what you need, or school you on how to do an appeal. It will not happen, so don’t ask.
Again, no one who is attempting to process an appeal should be speaking on the phone with appeals reps. It’s likely they won’t be honest with you.
Other information you need to know is that IDI insureds are not “entitled” to copies of their claim files like the ERISA folks are. While most IDI companies will generally provide the copies, some won’t. In addition, there are no timelines associated with IDI appeals, insureds just have to hang in there and keep submitting information.
Let’s also admit that Unum is still targeting claims by “biggest bang for the buck”, and by all accounts is refusing to over turn denials for the wealthier IDI claims between $3,000-$5,000, potentially reaching $1M in financial reserve.
To my knowledge, there is no evidence to suggest that Unum ever complied with the Multi-State Settlement Agreement after 2008 when the company re-branded itself as Unum Group. Despite the fact that the original RSA (Regulatory Settlement Agreement) included future penalties for non-compliance, state DOIs have had no interest in prosecuting Unum again.
It is not a good idea for individual insureds to try appeals on their own, at least without knowing more about what they’re doing. In my opinion, Unum is by far the most deceptive disability insurer and insureds have cause to be concerned.