Long Term Disability Law Blog
When applying for a long-term or short-term disability insurance benefit with Unum, it literally pays to know what you’re up against. The Unum Group, home to one of the world’s largest disability insurance companies, has reported over a billion dollars in annual profits. Not assets, but profits. Suffice it to say they’ve been around a long time selling disability policies.
You don’t have to hire a disability lawyer to apply for benefits when a debilitating condition prevents you from working, but it’s crucial to get your claim right straight out of the box. Rather than backtracking and fixing it later, you can avoid the dreaded UNUM disability claim denial and subsequent appeals. At Dell & Schaefer disability insurance law firm, we’ve helped hundreds of disabled claimants apply for benefits. This puts us in a unique position to highlight some important tips for UNUM claim approval.
Doctor Support
The single most important thing to obtain before making an UNUM claim is doctor support. This means much more than having your physician write a letter saying he or she believes you are disabled and cannot work. It requires documentation in medical records clearly stating your restrictions, limitations, ongoing issues and the specific reasons you are unable to perform the duties of your job.
UNUM, in particular, is going to be examining those medical records in detail, searching for a history with the doctor and a pattern of consistent documentation. Ideally, there should be records dating back at least three to six months. During this time, it shows you are following doctor recommendations, whether it’s back-related treatments, injections, medications or physical therapy – but none of that is working.
A knowledgeable disability insurance attorney is going to recommend that you delay filing the claim until you have that history in your medical records. It’s also worth pointing out that UNUM policies can have pre-existing condition clauses or require that you’ve been at your job at least 12 months. Therefore, even if you file only one day early, UNUM could deny your entire claim.
“Get some advice before you file the claim,” cautions Dell & Schaefer attorney Rachel Alters, “because you can make a mistake like that and then your whole claim is blown.”
Documenting the Claim
It’s easy to assume a policyholder who becomes disabled will just fill out the forms, prove the disability, and receive the stated UNUM benefits. Unfortunately, it just doesn’t happen that way. The key is to be prepared, so pay close attention to how your physician is filling out the medical forms.
Doctors treat patients. They aren’t necessarily documenting their charts with the insurance company in mind, so it may take some open conversation with the doctor to stress how crucial her input is to your claim. Some medical professionals are unwilling to spend time filling out the forms or simply don’t have the time or expertise in how disability claims work.
The attending physician form sent by UNUM will likely be very generic with little space for including details. It’s useful to have a disability insurance lawyer create a customized attending physician form that includes questions specific to the “definition of disability” as related to the patient’s ability to work.
UNUM or one of their peer-review doctors will often contact a treating doctor, ask leading questions, and get him on record saying something that will harm the disabled claimant’s case. They can also call one time, leave a message, and then say they never heard back from the doctor. That’s why it’s very important to let your doctor know that you’ll be filing a disability claim and that the questions should be answered with specificity regarding the restrictions and limitations of the disabling condition.
Better yet, the physician could help your case by not accepting a cold call from UNUM, but instead requesting that the insurance company send their questions in writing. This ensures proper representation of what the physician actually says.
The physician also needs to know that this claim is for a disability policy rather than a Social Security disability claim, and that the disability is not about daily living but about the inability to perform the duties of your occupation. Those duties will vary depending on factors such as whether the job is sedentary, light duty, or medium duty, or whether you have the ability to sit for six out of eight hours per day. Will pain or medications affect your job performance?
The Notification and Phone Interview
Depending on the policy, it is not always necessary to notify UNUM immediately when you are out of work. If you have a 180-day elimination period, you can avoid giving them more time to build a case against your claim. The timing of your “date of disability” is a huge consideration as it must coordinate with the attending physician’s statement, the date you stopped working, and any language in the policy regarding pre-existing conditions.
After filing a long-term or short-term disability claim, UNUM will contact you by phone for an initial interview, which will be recorded. An ERISA disability attorney can prepare you for this interview and even be on the call with you. It’s essential to avoid giving too much information, to only answer the questions asked of you, and to always be honest.
They will likely be running surveillance on you from early in the claim period, so never make statements that they can use against you. For example, if you say that you are unable to sit for more than 10 minutes at a time, but they catch you on video doing differently, they can use that against you in denying the claim.
The UNUM Claim Rep and Internal Resources
After the initial phone interview, you’ll be assigned an UNUM claim rep who will utilize a vast network of internal resources, including medical nurses and vocational consultants to evaluate your occupation. They’ll likely hire a doctor to help identify what’s lacking in your medical files. Knowing what they’ll be looking for can make all the difference between claim approval or an ERISA denial.
Being aware of how the “definition of occupation” works can also make or break you claim. Many policies have an initial period in which you must only prove that you’re unable to perform your “own occupation.” But after 12 or 24 months, it switches to your inability to do “any gainful occupation.” If you feel that your disability will prevent you from returning to work in any capacity at all, it’s best to establish that right out of the box, rather than having to prove it later when the second definition of disability comes into play.
At Dell & Schaefer, we’ll help you make that transition, but it’s much better to establish it from the very beginning.
Be Aware of Policy Limitations
Knowing your policy limitations allows you to make your initial claim with those considerations in mind. For example, the vast majority of UNUM policies have a 24-month limitation on mental nervous conditions, which could present as severe anxiety and depression. But that depression could actually stem from pain related to a physical disability such as back, neck or shoulder injury. Establishing your claim correctly could mean proving that the mental condition is secondary to the physical one – thus avoiding the 24-month limitation.
The same goes for self-reported musculoskeletal conditions such as fibromyalgia, migraines, or back pain unassociated with a radiculopathy or a myelopathy, which are harder to prove with an objective test. A disability insurance law firm would ensure you document any medical conditions with these issues in mind, including going to a neurologist, orthopedic doctor or any appropriate medical testing that can bolster your claim.
Many people come to us wishing they had known these things before they started their claim, but regardless of where you are in your disability journey, we can still help. We assist clients all over the country and always offer a free initial consultation. There will be no fees or costs unless we make a recovery for you. Just reach out to us a Dell & Schaefer, and we’ll let you know how we can help.