Unum Games

Thursday, May 22nd, 2008

A Long Term Disability (“LTD”) claims administrator is usually the insurance company that issues the policy that is liable for paying disability benefits under an LTD Plan. Since approving a claim means the insurer has to pay for it, the insurer goes out of its way to deny claims. Securing LTD benefits usually entails fighting to make sure the insurance company fulfills its fiduciary obligation to pay LTD benefits when a claimant is disabled.

I represent a claimant who worked on the floor of the New York Stock Exchange (the “NYSE”). After a year long battle with Unum I had the claimant’s doctors and vocational expert rebut all of the findings and conclusions of Unum’s in house and outside medical and vocational reviews. Incredibly, after Unum approved the claim in writing and via telephone, it then contended that it had not approved the claim, and would now require IMEs and their doctors contacting the treating doctors.

I told Unum that any IME or contact with the treating doctors would have to take place with my presence or another person of my choosing. Unum then decided to forego the IME, and after I arranged and participated in the first “peer to peer” phone call, Unum stated that the claimant’s application had been approved. But, once again, Unum decided to play games.

Relying on verbal evidence from an H.R. person who did not even work while the claimant was employed at his former company, Unum asserted that the claimant worked for more than 30 continuous days in 2007, ending in April 2007. That conclusion meant that LTD benefits would be denied from December 2006 through May 2007. I filed a second appeal to insist that benefits commence as of December 2006.

Working on the NYSE requires a security card. On the appeal, I submitted a statement from the General Counsel of the NYSE averring that the claimant only worked in 2007 for an 8 day period. Faced with that undeniable evidence, Unum finally agreed to pay the claimant his full entitlement to LTD benefits.

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