In this video and article, Attorneys Gregory Dell and Stephen Jessup discuss how UNUM defines disability. UNUM‘s disability policy is very lengthy and every policy holder will have a better understanding of:
- UNUM’s Definition of “Own Occupation”
- How Can a Claimant Prove What Their “Own Occupation” Is?
- What Is “Any Gainful Occupation”?
GREG DELL: Hi, Greg Dell with attorneys Dell & Schaefer. And Stephen, today’s question is, “How does Unum define disability?” It’s a very– it’s a great question and because every policy does things differently. But how would you start generally in the beginning of a claim? How does Unum define disability?
STEPHEN JESSUP: Generally, in the beginning of a claim, it’s going to be “the you’re unable to perform the material and substantial duties of your regular or own occupation due to an injury or sickness.” Generally, that’ll cure you for about 24 months. And then the language will then change to “the inability to perform the material and substantial duties of any gainful occupation based upon your training, education, and experience.”
If a UNUM Claimant Can Still Perform Normal Daily Activities Are They Entitled To Benefits?
GREG DELL: All right, so let’s dive into this definition of disability because a lot of people think it’s “I can’t do anything.” Is that – I mean, if they can still live their life and do normal activities, can they still qualify for benefits under the policy?
STEPHEN JESSUP: Yeah. Definitely. I mean, we see attempts by Unum to do video surveillance and show that this person is going grocery shopping, doing these things, and trying to say that somehow correlates to the ability to work. But these policies are written in such way. And it’s important too to let a doctor know that this isn’t that you’re bedridden, and you can’t do anything. This is the inability to perform work duties, whether in your own occupation or any occupation with some resemblance of reasonable continuity.
Like, can you show up and do the job? So this is not a limit on what you can do normally. You have to know that an insurance company, Unum‘s, going to use it against you if they find something they think is contradictory to what you’ve reported. But these policies are specifically related to the inability to work.
UNUM’s Definition of “Own Occupation”
GREG DELL: Now, the disability definition contains these words, “unable to perform the duties of your own occupation or regular occupation.” Is it really that person’s occupation? Or is there another standard often defined within the policy for the words “own occupation?”
STEPHEN JESSUP: They do. Usually, once you get down into the definitions section, it’s going to talk about your own occupation or regular occupation means the broad general idea of how the job is performed in the national economy, not how you do it for your employer, or at a specific location, but how it’s done in the national economy. So they’ll look at various different, either Department of Labor sources or other vocational resources to determine what your job is and how it’s generally performed throughout the country.
How Can a Claimant Prove What Their “Own Occupation” Is?
GREG DELL: And how can a claimant prove what their occupation is?
STEPHEN JESSUP: Well, most of the time, Unum‘s just going to go back to what the employer tells them, job description, stuff like that. And if you work for a large enough company, usually your job description will have an associated code that can be plugged into these vocational resources to give you that generalized generic description.
What Is “Any Gainful Occupation”?
GREG DELL: And the Unum definition of disability usually changes after a 24-month period to an “any gainful occupation.” What is that?
STEPHEN JESSUP: So any gainful occupation– and generally, there’s sometimes not always a caveat. Like, they’ll pay you 60% of your pre-disability earnings or roughly the amount you’re making for a benefit. But any gainful occupation, people will first get acquainted with this when they get the first claim forms for activities of daily living where they asking about your job history, your educational background, can you use the computer, what type of programs can you use.
What they’re doing is starting to set up a vocational databank that they’ll have their vocational department look at and say, well, here are some jobs they’ve done in the past, skills they have. So we think that these are other jobs that they may be able to do. So after that point, Unum‘s not looking, can you do your job? It’s rather, can you do some other type of job? And quite often, we see denials of benefits during that transition.
GREG DELL: So I would say that understanding your definition of disability as the claim evolves, even from the beginning through every stage is essential key to keeping yourself on benefits or even getting your claim approved. We have tons of videos about handling appeals, ongoing claim handling, lawsuits, everything to deal with Unum, and tons of articles and information available on our website that we recommend that you take a look at. Information about unum lawsuits can be seen on this page.
We also encourage you to subscribe to our YouTube channel because we’re regularly doing videos such as this where we’re answering your questions. But most importantly, if you have a direct question related to your claim, no matter what stage you’re at, feel free to give us a call. Any of our lawyers will help you.
We always provide initial free consultation to discuss your claim. We help claimants all over the country. And we look forward to the opportunity to speak with you.
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