Insurance regulators investigated Unum and its sister companies because there were many complaints that those insurers were wrongfully denying and terminating disability claims. The insurance regulators issued a detailed report that concluded the complaints were valid. In November 2004, the U.S. Department of Labor and the state insurance regulators forced UnumProvident and its related companies to enter into a settlement agreement that requires it to reconsider about 200,000 disability benefit claims that it previously denied or terminated. Unum's wrongful conduct was exposed on 60 Minutes and Dateline NBC, and was the subject of one of the biggest fines in insurance history.
The reassessment requires Unum to follow new procedures to ensure objective and fair benefit claims review. The settlement also required Unum to pay a $15,000,000.00 penalty, and resolved the government’s findings that Unum had improperly denied and terminated long term disability claims under individual and group policies.
What claims can be reassessed?
Unum must notify people whose claims were denied or terminated after January 1, 2000 that there claim can be reassessed. Furthermore, people whose disability claims were denied or terminated between 1997 and 2000 can apply for reassessment.
What companies are subject to the reassessment?
The settlement covers Unum Provident and five of its subsidiaries: First Unum Life Insurance Company, Unum Life Insurance Company of America, The Paul Revere Life Insurance Company, Provident Life and Casualty Insurance Company, and Provident Life and Accident Insurance Company.
What did the government believe Unum did wrong?
The general areas of concern included: excessive reliance on Unum's medical professionals, unfair construction of the reports of a claimant's physician, failure to evaluate the totality of a claimant’s medical condition, inappropriate burden placed on claimants to justify their eligibility for benefits.
How will Unum's reassessment be different from the prior review?
In reassessing claims, Unum is required to consider the combined effect of each of the claimant’s impairments, and must afford appropriate weight to all diagnoses and medical information. Unum is also required to have substantial evidence to contradict a favorable finding of disability by the Social Security Administration, and to have all of the evidence reviewed by each of its reviewing doctors and vocational consultants with the appropriate expertise. It is critical to have an attorney with substantial experience in obtaining Social Security disability benefits, like Mr. Delott, handle your Unum reassessment.
What is the effect of the Unum settlement on pending litigation?
You do not have to request reassessment, and can continue to litigate your disability claim without the procedural advantages of the reassessment.
We can represent you in connection with the reassessment. The settlement agreement is no guarantee that your claim will now be approved. You can request a copy of the settlement agreement from your state insurance regulator. Our experience in dealing with Unum and the Social Security Administration will significantly improve your chances of successfully obtaining benefits through the reassessment.
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