You’ve submitted a long term disability claim to UNUM and just received notice your request for benefits was approved – congratulations! But if, like many claimants, you assume this approval letter is the end of the story when it comes to your receipt of disability benefits, you may be mistaken. Below, the attorneys at Dell & Schaefer will explain more about UNUM’s claim re-evaluation process, lifetime disability clauses, and what claimants should do to preserve their right to receive long term disability benefits from UNUM.
GREG DELL: Hi. I’m Greg Dell with attorneys Dell & Schaefer. And today’s disability question is, how long does Unum long-term disability last? And Stephen, I think this is an excellent question because every policy is written differently, which you’re going to talk about in a minute. But also it really doesn’t matter in a sense how long the policy is because just because you get approved doesn’t mean you’re staying on it–
STEPHEN JESSUP: –that long.
GREG DELL: And talk about first why just getting approved doesn’t mean you’re going to get the maximum duration under the policy.
Why Getting Approved for Disability Insurance Benefits Does Not Mean You Won’t Get Denied in the Future
STEPHEN JESSUP: So getting approved is the first step of a disability claim. It’s a important vital step because there are a lot of denials on the initial application. But just because you’re approved doesn’t mean that Unum is not going to continue to review, request updated information, put you under video surveillance, speak to your doctors. They’re going to investigate your claim to make sure that basically each month you are entitled to those benefits. And if they ever give information or happen to formulate an opinion that you aren’t, they’re going to terminate the benefit and put you through an appeal process and potential lawsuit.
How Often Does UNUM Have the Right to Evaluate a LTD Claim?
GREG DELL: How often does Unum have the right to evaluate the claim?
STEPHEN JESSUP: Monthly– monthly. Since the benefit’s paid monthly, each month is its own separate period of disability. It’s Groundhog’s Day each month. The claims examiner is reviewing everything that’s coming in if they’ve sent you claim forms, your doctor forms, your medical records. And they’re making an evaluation is, all right. We think this person still meets our definition of disability. So even though your policy may say it pays out to the age of 65 or you’re Social Security retirement age, it’s only if you continue to meet the terms and conditions of the policies, not as you believe them to be but as how Unum sees them, how Unum interprets them, and how they apply them.
What are Life Time Provisions?
GREG DELL: And some policies also have more so in the individual disability policies, not the ERISA policies– have lifetime provisions. Talk about those that you’ve seen and how those work.
STEPHEN JESSUP: Lifetime provisions– those are going to vary because Unum purchased a bunch of different policies from Paul Revere or Provident Life and Accident, Provident Unum. So each one has their own. A lot of them require that, say, for a lifetime total disability, you have to be disabled before the age of 55 or 60, continue to be totally disabled through the age 65. And then, you would be eligible for a lifetime benefit.
And then, depending if you bought riders for total disability in your own occupation versus their generic one, that’s also going to make a determination as to whether or not you will continue that lifetime benefit if you were working in another occupation or decide to after the age of 65 work in another occupation. So understanding an individual disability policy that Unum is going to handle is really, really important and a big business decision for the insured in figuring out what their future finances may be.
The 3 Most Important Things to Do to Stay on Claim with UNUM Until the Age 65
GREG DELL: We have so many videos we’ve done on Unum. But in a quick snapshot, if you said someone has a benefit that’s going to last to age 65, and assuming they believe they can’t go back to work and they really need these benefits to age 65, give us three most important things to do to keep themselves on claim to age 65.
STEPHEN JESSUP: Well, first and foremost, the relationship with your doctor, getting the treatment, making sure those are information on all your problems are being documented properly. Two, even in your own claim forms that you are doing, they seem like, oh, we’re filling these out again. And people sometimes– they either over embellish. They try to prove their disability, if they will. And if Unum ever puts them under any type of investigation, they look for inconsistencies. But if they come out to talk to you– all these types of things.
And three, which is really out of a lot of people’s control is understanding your policy language. Unum rights restrictive language– 24-month limitations for mental health conditions, conditions due to self report. And not commonly seen in denial letters but in policy language– and I’ve had Unum’s attorneys bring it up– is if during the first 24 months you’re able to work in your own occupation on a part-time basis but choose not to, they can terminate a claim.
Same with after that– that any occupation, if they determine you can work part time in any occupation and choose not to, they can deny your claim. So that’s not a very common basis for them to deny. But it is something that they can use. So with this idea that if even if you can work part time, they can deny the benefit, it really makes sure that you have to control the dialogue and what’s in the information with your medical records as well because Unum will try to use that against you.
So one, your medical information needs to be well documented. Two, your own personal information you’re relaying. You have to be consistent because if they find that any surveillance they do that’s contradictory. And three, understanding how your policy is going to work.
GREG DELL: Those were three great tips. Thank you. So overall, though, no matter what happens with your Unum disability claim, the bottom line is you’ve always got to be prepared. And you’ve always got to anticipate and understand that Unum is constantly investigating the claim. So at any given time, that claim could be denied. And there’s lots of steps that you can take to protect yourself and that you should be doing.
And so, we welcome you to watch many of our other videos on Unum. We always encourage you to contact any of our lawyers for an initial free consultation to discuss your claim. We do these videos answering your questions all the time. And we encourage you to send us your questions. Put comments on our website. Most importantly, subscribe to our channel so that you can continue to get updates such as these that will help you with your claim. And we appreciate you considering our law firm should you need our help in the future.
As you’ve heard, it’s extremely important for disability claimants to avoid becoming complacent after they receive their UNUM approval letter. Showing one’s continued entitlement to disability benefits can be an ongoing process that may span years, not months, and partnering with the experienced disability attorneys at Dell & Schaefer can help. Our team of disability attorneys has handled hundreds of UNUM claims and, as a result, we’re better equipped to anticipate the questions UNUM will ask (and the concerns they may have) when evaluating whether a claimant’s benefits should continue. Reach out to set up your FREE consultation, where you can discuss your UNUM disability claim with a disability insurance attorney.