Attorney for Long-Term Disability Denials from Unum Insurance
Workers involved in serious accidents can often rely on their long-term disability (LTD) insurance benefits provided by their employer to help them through. If you were hurt and you file a claim with your employer’s plan through Unum insurance, you should expect to get the benefits you are owed under the plan.
Many injured workers find themselves being denied coverage by Unum and other long-term disability insurance providers. However, the reasons for the denial are not always clear – or the denial could be based on pretextual excuses or unjust reasons.
If your long-term disability claim was denied, call (215) 515-2954 to get in touch with Young, Marr, Mallis & Associates. Our attorneys for long-term disability denials from Unum insurance help injury victims get the benefits they need. For help, call our lawyers to set up a free case consultation.
Reasons for Denials from Unum Insurance’s Long-Term Disability Benefits in Pennsylvania
Long-term disability benefits are designed to cover most injuries and illnesses. Plans through Unum or any other insurance provider often have limitations and technicalities you should understand before filing your claim. These terms and conditions are all listed in the insurance policy, which is like a contract between the insurer and the insured. Many denials are based on these grounds, on technical issues with your application, or by other bad-faith reasons discussed below:
Denials Based on Policy Limitations
Long-term disability claims must be based on certain conditions to qualify. Generally speaking, the conditions covered under these plans must be long-term conditions, so a common cold or a sprained wrist might not qualify (though some injuries/illnesses might qualify under workers’ comp., short-term disability, or some other plan). Additionally, some plans deny coverage for certain conditions or deny coverage to certain workers. If your condition or your work status does not entitle you to coverage, your denial might be based on these grounds.
Technical Application Issues
Many denials are based on issues with the application. Failing to fully fill out an application could lead to a denial, as could missing information in your application. Insurance companies could also claim that there is not enough information to prove your disability, or they could think that your condition is not bad enough to keep you out of work. It is always important to work with a lawyer to make sure all the info you need is included.
If your claim was denied based on these kinds of issues, you can often cure your application and resubmit it as part of an appeal. Every insurance company, including Unum, has its own internal appeals process where you can have the claim reviewed again, potentially with additional or corrected information attached.
Talk to a lawyer about this kind of appeal. Claims appealed with the help of an attorney are often accepted if all of the issues have been corrected and the application has been resubmitted without errors.
Long-term disability applications are sometimes denied without a good excuse, or they are denied without providing a reason at all. In these cases, obscure technicalities, pretextual excuses, and even lies might be used to deny claims.
When a claim is based on these kinds of issues, appealing the claim could put additional pressure on the insurance company to accept the claim. If they do not relent during the administrative appeal, you could be entitled to take them to court or to arbitration in order to have the policy enforced.
Getting Paid Through an Appeal for Unum Long-Term Disability Denials in Pennsylvania
When your case is appealed, you usually will not be able to claim additional damages beyond what the plan originally entitled you to. This means that things like punitive damages might not be paid, but your claim should be accepted, and you should get access to all of the benefits you were entitled to all along.
Claims surrounding long-term disability insurance companies like Unum often deal with employer-provided benefit plans. That means that these claims are governed by ERISA (the Employee Retirement Income Security Act), and those rules are used over any state rules that might typically allow punitive damages in insurance claims. While this means you do not get paid additional damages, it could actually help your case.
Since insurance companies do not get punished by paying additional damages, there is no reason they should continue to deny a claim that they are required to pay. When facing litigation or lengthy appeals from denied claims, insurance companies will often stop putting up a fight and pay what they were supposed to pay. That is cheaper for them than spending money to fight the case only to lose later in court. Hiring an attorney to put this additional pressure on the insurance company is incredibly important.
If the insurance company still refuses to pay, an experienced attorney for long-term disability denials from Unum insurance may be able to take legal action to get the case overturned and have your benefits paid.
The Process for Appealing Long-Term Disability Benefit Denials from Unum in Pennsylvania
With Unum LTD plans, there is typically a 180-day window in which you can appeal the case. Most ERISA claims – which include denials by employer-provided long-term disability insurance – must be filed through this process first before you can try going to court. Unum’s website says that it typically takes 45 days to reach a decision after appealing.
If your appeal was already denied, talk to a lawyer about your next steps. Often, these claims can be filed in court to have a judge overturn unjust denials or to force the long-term insurance company to follow its insurance policy’s rules and pay your claim.
Free Legal Consultations on Unum Insurance Long-Term Disability Denials
If you have long-term disability insurance from your employer through Unum insurance and your claim was denied, call Young, Marr, Mallis & Associates. Our attorneys for long-term disability denials from Unum insurance offer free case consultations. Call today at (215) 515-2954.