When a large insurance company like Unum denies your long-term disability (LTD) claim, you may feel powerless. Large corporations like Unum have a way of making their determinations feel final.
However, it is important to remember that regardless of the situation, you still have rights. Most insurance companies have an internal appeals process, which must be exhausted before seeking legal solutions. If you feel your LTD claim is denied wrongly, you must take several steps to appeal your case.
Here are five ways to help you appeal a denied insurance claim:
First, you need to get several critical pieces of information. Most importantly, you need to make sure you’re aware of every deadline. Many internal rules, as well as legal remedies, have a rigid timeline that you must work within. But these deadlines aren’t the only type of information you need to proceed. You must also procure as much information about the denial. Collect all information from the denied claim, and press the company for additional information. Some critical questions include:
- Which specific policy clauses led to the long term disability claim denial?
- What occupation does the company believe you can perform?
- What job description are they using?
- What documentation or proof do they feel is lacking? What do they need?
You need to keep a cool head and continue to follow the rules. Document every contact you have with your insurance company, in case you take legal action later. Never let anger of frustration determine your actions. While the situation may be frustrating or threatening, acting out of anger can make things much worse. Remember that every communication you have with the insurance company is an effort to obtain information, and remain true to this ultimate mission.
After you know the reasons behind your long term disability claim denial, you need to get information that will fill the gaps. For example, if they need more medical documentation, you should start keeping a journal of your symptoms, and get a detailed letter from your doctor explaining your illness and symptoms. You can even ask family members to write up statements of how your symptoms have affected your daily life. Since most LTD claims involve the inability to work, ask your last employer for a statement regarding how your illness has affected your work. In all of these statements, you must remember that the devil is in the details. Specifically, you must make sure your statement captures as much detail as possible.
File Your Appeal
Once you’ve amassed all of your documentation, write an appeal letter. Make sure it’s in compliance with any format the insurance company needs. First, write up an overview of the situation, explaining how the evidence shows that you are disabled per the policy’s terms. Again, keep a cool head and do not make any insulting or attacking comments. You must also avoid threats. Just CCing the document to your attorney and your state’s insurance commissioner is sufficient to show your resolve. Once you’ve sent them your appeal, wait a few weeks, then call and make sure the materials have been received. You may have to go through the appeals process more than once.
Consider Legal Action
If your appeals are denied—and many insurers have a set number of appeals—you may need to seek legal action. Many lawsuits have been filed against companies like Unum, seeking the reinstatement of insurance benefits.
In general, Unum lawsuits are filed individually by each plaintiff and are not class actions.
Do YOU have a legal claim? Fill out the form on this page now for a free, immediate, and confidential case evaluation. The attorneys who work with Top Class Actions will contact you if you qualify to let you know if an individual lawsuit or class action lawsuit is best for you. Hurry — statutes of limitations may apply.
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If you were denied a disability claim or had your Unum disability benefits terminated without reason, you may be able to take legal action against the insurer. See if you qualify by filling out the short form below.
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