Disability insurance attorneys Gregory Dell and Stephen Jessup answer the question: Can You Sue UNUM? In this video and article learn what to expect in a group policy lawsuit with UNUM and advantages of suing UNUM with a group policy.
- What To Expect in a Group Policy (ERISA) Lawsuit with UNUM
- An Advantage of Suing UNUM With a Group Policy (ERISA)
GREG DELL: Hi, I’m Greg Dell with attorneys Dell & Schaefer. And today’s question is: Can I sue Unum? Now, Stephen, we get this question and a call like this daily, if not tons of these calls on a weekly basis. And when can a person actually sue Unum if their disability claim has been denied.
STEPHEN JESSUP: OK. So that’s a good starting point. So you can only sue Unum following a claim denial. But first, you have to go through an administrative appeal process. So whether short term or long term, if your claim’s denied, Unum requires, under the law, under ERISA, one mandatory level of appeal.
If that appeal is denied, then you can sue Unum for unpaid benefits. Some people ask, hey, can I sue them for pain and suffering or from being jerks or whatever the case may be? And unfortunately, under ERISA, and more than likely, if you’re watching this, your policy is an employer-provided policy governed by the federal statute, your only means of actually suing them is just for the benefits that they haven’t paid you, not even future benefits, or any guarantee that they won’t do it again. So yes, you can sue Unum, but always with caveat.
GREG DELL: OK. And I want to clarify because of the fact that 98% of the claims we do from Unum are group disability policies, which means an employer – an employee received the policy from their employer. That’s governed by ERISA, which means you have to do an appeal. But there are some ERISA-exempt policies. In that scenario, if your claim gets denied and not governed by ERISA, then you could sue the…
STEPHEN JESSUP: That’s right.
GREG DELL: …you could sue Unum right away. And I know you just brushed on the differences between a private policy and a group policy. But what types of expectations in terms of a jury trial, things of that nature, should someone expect in a lawsuit because it’s not your typical lawsuit?
What to expect in a Group Policy (ERISA) lawsuit with UNUM
STEPHEN JESSUP: Yeah. And the group policy, so the employer-provided. If you do end up having to file a lawsuit, first and foremost, once the appeal’s denied, no new information can come in for a judge to consider. You could get in a car accident, two weeks later need back surgery. But that’s outside the scope of the administrative record.
GREG DELL: And another thing to show how detailed that is – how often does someone do their appeal? They call us and go, I want to sue. And they go, oh, by the way, I got approved for Social Security disability. Can the judge be made aware of that?
STEPHEN JESSUP: If it happens after the final denial, no. The only time a judge would be made aware is if you win your case in court, then for the computation of back benefits. So after that appeal, you file a lawsuit, you go into federal court. There’s no jury trials. There’s no live testimony.
You’re not going to testify. Your doctors aren’t going to testify. No one from Unum will. And a judge is just going to decide based on motions filed by attorneys as a default. It’s a 2-step process. One, do they think you’re disabled? And then two, if yes, did you Unum arbitrary and capricious? Or did they have a reasonable basis to deny the claim?
So a judge could find that, hey, I think Unum got it wrong. But I think their reviewing the conclusions were reasonable. And another thing to also consider is these policies have this discretionary language in it. And that requires that the court also defer to Unum’s interpretations of its plan provisions as opposed to what you think it should mean. So you can sue them.
The risks of litigation on a Unum group – ERISA, are much different than a private policy. That’s why if you get to the point where you’re thinking about, hey, can I sue them because they denied your benefits? It’s a good reminder that you have to go through the appeal process. So it’s really important to prepare yourself for that.
An advantage of suing UNUM with a Group Policy (ERISA)
GREG DELL: One advantage of suing Unum with an ERISA group-governed policy is that the claimant is never going to have to go to court. It’s extremely rare because the judge is not taking any testimony. So the claimant doesn’t have to go.
So once you hire our law firm, you basically – there’s almost nothing for you to do. You kind of just sit back. If we need something, we’ll get it from you. But there’s no interrogatories, no request for productions, no deposition, usually.
STEPHEN JESSUP: And no updated requests for information from Unum.
GREG DELL: Right. So I mean, you could even be back to work, and Unum has no idea what’s going on. So that’s an advantage because the process becomes very easy. A lot of people don’t even want to pursue a lawsuit because they know, from what they’ve heard from friends or people in other traditional lawsuits, that it’s a big annoyance, a lot of effort on that person’s behalf. And that’s not the case with these ERISA lawsuits.
So if you have a Unum claim that’s been denied, feel free to give Stephen or myself or any of our disability lawyers a call. We will immediately want to review a copy of your denial letter, which you can email or fax to us. We’ll set a phone conference with you right away, and we’ll let you know immediately whether or not we can help you.
Now, it’s important for you to know that our clients are located all over the country. So you’re never going to have to leave your home to meet with us. And we try to make the process as easy as possible for you. So thank you for considering our law firm.