Fla. Man Says Unum Wrongly Denied His Disability Insurance Claim

By TopClassActions | December 3, 2013

Category: Labor & Employment

By Jessica Tyner

Unum is one of the largest providers of long-term disability (LTD) coverage in the United States. According to a number of policy holders, Unum preys on their customers by giving them the run around, denying benefits with no foundation, stopping or lowering payments with no communication and basically illegally making the process impossible to follow.

“I found out first hand that Unum is the second worst insurance company in the world,” notes Jacksonville, Fla. Resident named Herman who was denied his LTD coverage. “I am still in shock from their bad faith practice and so are my doctors,” he adds.

There are many other Unum claim denial stories where a policyholder’s doctors have provided supporting documentation which Unum seemingly ignores. One of Unum’s practices reportedly includes a policy to only act on information provided by their own doctors — many of whom have never even seen the patient.

According to the American Association for Justice, Allstate tops the list of the “world’s worst insurance company” but Unum is nipping on its heels. Herman says he began paying into his plan in 1982 when he was teaching at a Native American tribe’s system. Herman was diagnosed with renal disease in 1997, which requires dialysis and eventually a kidney transplant.

“I got the denial letter from Unum out of the blue. The reason they gave for denial was that my transplant center had not sent them my medical records. But that is puzzling because every two years I signed a medical release from the center. And I have never seen one of Unum’s independent medical examiners, so how could they determine that I can return to work?” Claiming that information was never received is a tactic that has been reported in many Unum lawsuits.

In an effort to get his LTD coverage moving forward, Herman called the transplant center to ask why Unum was saying they never received any records.

“Initially, they thought Unum’s form was not conforming to the HIPAA regulations and it was an invasion of my privacy, so there was a hold up but nothing of any consequence. Then the center reversed their decision and said that Unum received my records.”

For other Unum victims filing a lawsuit, this kind of run around isn’t surprising at all. There are instances when policy holders have to re-send documentation or have their doctors do so many times and Unum still claims they were never received. Employees at Unum revealed in a CBS expose that there was an official bonus system that handsomely rewarded employees who closed the biggest claims or otherwise denied benefits.

Herman was confused where the mistake was being made — was the transplant center not sending the forms or was Unum claiming not to receive them when that wasn’t the case? Herman dug deeper and found that the rule at the transplant center was that insurance companies should contact them directly if they hadn’t received the documents. However, the center did attempt to contact Unum in the spring and also got the run around. However, that wasn’t the worst of things. Herman then discovered that Unum had entirely misclassified him and his case.

In the midst of Herman being forced to play the middle man while undergoing dialysis — a very taxing process — and hoping for a kidney match, he discovered that Unum seemed to be making classification mistakes in their favor.

“Unum has me classified as a two, but I should be a one, which is a classification for all federally certified teachers,” he reveals. When classified as a two, it’s required that Herman returns to work in some capacity, but a one classification means that he doesn’t have to go back to work because he doesn’t have the capability to do the duties.

“Misinterpreting my policy is yet another bad faith tactic,” he says.

Like many other Unum policyholders, Herman sees an Unum lawsuit as his only option. He’s tried to get things straightened out on his own, and even with the help of doctors it’s not happening.

“I have held onto a copy of my policy like it’s water in the desert so I can prove that I have been misclassified. After reading about so many Unum disability claims, I expected this from Unum. Unum knows that someone with a meager income cannot fight them. I have seven more years until I reach 65 years of age, so I guess Unum prefers to challenge me knowing I am defenseless.”

Unum requires most LTD claimants to also apply for Social Security benefits — when Herman applied, he was immediately approved, but that didn’t make Unum approve him. “My nephrologist never told Unum that I could return back to work. Unum’s independent medical examiner called him and said that I was indeed capable of working — Unum diagnosed me without seeing me.”

Herman got his kidney transplant in 2002, but still lives on the $588 per month Social Security provides even with a massive medical bill and the inability to work.

Was Your Disability Insurance Claim Denied?

Do you relate to Herman’s story and are you facing an ongoing battle with an Unum denial? You don’t need to fight this battle alone because you might qualify for an Unum legal claim. Find out if you qualify today by visiting the Unum/UnumProvident Disability Insurance Claim Denial Class Action Lawsuit Investigation. You’ll be able to submit your information, and an attorney will contact you if you have a case for a free Unum claim review.