A frequent tactic we are seeing in Unum long term disability claim denials is Unum denying the claim by saying the person was not disabled throughout the elimination period. The elimination period, often referred to as the waiting period, is the span of time between when your long-term disability begins, i.e when you stop working, and when benefits become payable.
Understanding the Elimination Period
First, it's essential to understand the specifics of your long-term disability (“LTD”) insurance policy's elimination period. In group disability insurance, this period is typically 90 or 180 days. During this time, you must be continuously disabled and unable to work to qualify for benefits.
Assuming you also have group short term disability insurance, the LTD elimination period is typically equivalent to the short-term disability period. Common sense would then tell us that if you are paid all the short-term disability benefits then you were disabled throughout that time period and have thus met the elimination period.
Unum’s Contradiction – Disabled During STD but Not the LTD Elimination Period
It is common to see Unum approve and pay benefits the entire short term disability period but then deny long term disability. In these denials, Unum alleges that from the day the claimant stopped working and throughout the elimination period, they are not totally disabled. But this is an inconsistent position Unum takes – finding someone disabled for the short-term disability period but not disabled during the same time frame for long term disability.
Here's what to do if Unum claims you are not disabled during the elimination period:
Gather Comprehensive Medical Evidence
Unum’s decision is often based on the medical evidence you provide. Ensure that your medical documentation is thorough and up-to-date. This includes detailed reports from your healthcare providers, diagnostic test results, treatment plans, and any notes that clearly articulate the extent of your disability. Consistency and clarity in your medical records can significantly impact the review process.
Document Your Symptoms and Limitations
Maintain a detailed record of your symptoms, daily activities, and limitations. Personal journals, logs, or symptom diaries can provide a compelling narrative that supports your medical evidence. Describing how your condition affects your daily life and ability to work can offer a comprehensive view that goes beyond clinical notes.
Hire an Expert to Help You Appeal the Denial
Navigating a disability claim denial can be complex and overwhelming. It can also be frustrating when the denial is based on a hypocritical position like this. Consulting with an attorney who specializes in disability insurance can provide invaluable support.
These attorneys can help you understand your rights, gather additional evidence, and put together a strong legal argument. They can also negotiate with Unum on your behalf and, if necessary, pursue legal action.
Your appeal should address these reasons directly and provide any additional evidence or clarification needed. It's often beneficial to consult with a disability insurance attorney who can guide you through the appeals process and strengthen your case.
Lawyers with Expertise in Disability Insurance Claims
This law firm has always focused only on disability insurance law.
Because we specialize in long term disability, our clients get the benefit of:
- Having an attorney who is an expert in long term disability claims;
- Having an attorney who has experience with every major disability insurance company;
- Being backed by a law firm that has a proventrack record of winning tough disability lawsuits.
Call Dabdoub Law Firm to get experienced disability lawyers on your side.
We can help with:
- Submitting a disability insurance claim;
- Appealing a long-term disability denial;
- Negotiating a lump-sum settlement; and/or
- Filing a lawsuit against your disability insurance company.
