Unum Long Term Disability Claims, Denials, and Appeals
Updated: Oct 26, 2022
If you filed a disability claim with Unum and it was denied, or if Unum terminated benefits it had already been paying, The Maddox Firm can help you appeal that decision the right way. If you have already appealed and received a final denial, we can handle your litigation.
Unum is the largest disability insurer in the United States, and it is also the carrier claimants ask us about most often. Part of that is size. Part of it is that Unum's claim-handling practices have drawn more regulatory attention than any other disability insurer in the country.
In this article, we'll discuss which companies issue disability coverage under the Unum umbrella, how Unum defines disability, the regulatory settlement that reshaped its claims process, the reasons Unum most often denies claims, and what you should put in front of Unum on appeal.
The Maddox Firm has extensive experience with Unum claims, including policies issued under the Provident, Paul Revere, and First Unum names. We have obtained approvals for clients at the initial claim stage and on appeal, in matters involving a wide range of medical conditions.
Who Is Unum, and What Companies Issue Its Disability Policies?
Unum Group is a Chattanooga-based insurance holding company and the largest provider of disability insurance in the United States. The name on your policy may not say "Unum," which causes a great deal of confusion at claim time.
Disability coverage in the Unum family is issued by several entities:
Unum Life Insurance Company of America, the primary group long term disability issuer
First Unum Life Insurance Company, the New York-licensed entity, so most New York group policies are issued here
Provident Life and Accident Insurance Company, a major issuer of individual disability policies, particularly to physicians, dentists, and attorneys
The Paul Revere Life Insurance Company, another individual disability issuer, heavily marketed to professionals in the 1980s and 1990s
Colonial Life & Accident Insurance Company, supplemental and voluntary benefits
Provident and Paul Revere merged into what was then UnumProvident in the late 1990s. If you bought an individual disability policy from Provident or Paul Revere decades ago, your claim is administered by Unum today.
Individual policies issued by Provident or Paul Revere are usually not governed by the Employee Retirement Income Security Act ("ERISA"), while group coverage through your employer usually is. That single fact changes your deadlines, your evidence, and whether a court ever hears live testimony. Our article on how disability policies define disability explains the terms that control either kind of claim.
Has Unum Been Investigated Over Its Disability Claim Handling?
Yes. Unum's claim practices were the subject of one of the largest regulatory actions ever taken against a disability insurer.
On November 18, 2004, UnumProvident entered a multistate regulatory settlement agreement with insurance regulators in Maine, Massachusetts, and Tennessee, the United States Department of Labor, and the New York Attorney General's Office. The company paid a $15 million fine, agreed to contingent penalties of $100,000 per day for missed implementation deadlines, and accepted exposure of up to $145 million if it failed performance standards in later examinations.
The settlement required Unum to reopen its own past decisions. The reassessment program covered individual and group long term disability claims denied or closed since January 1, 2000, roughly 215,000 claims in all. Claimants whose claims were closed between January 1, 1997 and December 31, 1999 could request reassessment as well.
Unum was also required to change how it decided claims going forward, including:
Putting more experienced claims professionals in decision-making roles
Requiring higher-level management approval before an adverse decision
Revising its policies on medical information and independent medical evaluations
Assigning field case managers to certain claims
Creating a quality compliance consultant role to assess claim decisions
Establishing a regulatory compliance unit reporting to the board's compliance committee
A separate settlement followed with the California Department of Insurance in October 2005.
This is history rather than a description of how Unum handles claims today. The settlement is more than twenty years old and the reassessment program closed long ago. It is still useful to know about, because the practices regulators identified in 2004 are recognizably the same categories of problem claimants raise now: over-reliance on in-house medical reviewers, discounting treating physician opinions, and using surveillance selectively.
Sources: UnumProvident settlement announcement, November 18, 2004; California Department of Insurance settlement, October 2005.
Has a Court Ever Ordered Unum to Pay Benefits It Denied?
Yes. One of the clearer examples comes from the federal appeals court covering New York.
In Locher v. Unum Life Insurance Co. of America, 389 F.3d 288, the United States Court of Appeals for the Second Circuit affirmed a judgment awarding long term disability benefits to a claimant whose chronic fatigue syndrome claim Unum had denied. The denial was reviewed without deference, in part because Unum had no written claim and appeal procedures beyond the plan terms themselves. On the merits, the court found that the Unum physician who rejected the evaluating doctors' conclusions had never examined the claimant, had not followed up with the evaluators whose findings he was dismissing, and had rested his opinion substantially on general assumptions about how people behave rather than on analysis of her medical evidence.
The remedy matters as much as the finding. The court did not send the claim back to Unum for a fresh decision. It awarded benefits through the date of judgment, along with attorney's fees.
That distinction comes up in every one of these cases. A court that finds an insurer got it wrong can either return the claim to the insurer to decide again, which is the more common outcome, or award the benefits outright where the record already establishes entitlement. Which one you get depends heavily on how complete the record is, which is one more reason the appeal is where the case is actually built.
How Does Unum Define Disability?
Most Unum group long term disability policies use a two-stage definition.
For an initial period, typically 24 months, you are disabled if you cannot perform the material and substantial duties of your own occupation. After that period, the standard usually shifts: you must be unable to perform the duties of any gainful occupation for which you are reasonably fitted by education, training, and experience.
That transition is the most dangerous date in a Unum claim. Claims that were paid without difficulty for two years are frequently terminated at the 24-month mark, not because your condition improved but because the standard you must meet changed. If your claim is approaching that date, the evidence you need is different from the evidence that got you approved.
Individual Provident and Paul Revere policies often use a more favorable "own occupation" standard for the life of the claim, and some contain "regular occupation" language that does not transition at all. Read your own policy, because the definition of disability controls everything that follows.
Unum policies also commonly include:
A pre-existing condition provision limiting coverage for conditions treated in the months before coverage began
A 24-month limitation on mental health and self-reported symptom claims, which affects fibromyalgia, chronic fatigue, and chronic pain claims in particular
An offset provision reducing your benefit by Social Security disability, workers' compensation, and other income
Why Does Unum Deny Long Term Disability Claims?
Lack of Objective Evidence
The most common reason. Unum frequently takes the position that your medical records do not contain objective findings supporting the restrictions your doctor describes. This hits hardest in claims for conditions that do not appear on imaging, including fibromyalgia, chronic fatigue syndrome, migraine, long COVID, and many autoimmune and mental health conditions.
Rather than arguing that objective evidence should not be required, supply the objective evidence that does exist, including functional capacity testing, neuropsychological testing, cardiopulmonary exercise testing, and validated symptom inventories, and have your treating physician tie those findings to specific functional limits.
Paper Review by a Doctor Who Never Examined You
Unum makes extensive use of in-house and contracted physicians who review your file without ever meeting you. These reviewers often conclude that your records do not support your reported limitations. A reviewer's report becomes the evidence supporting your denial unless you answer it directly.
Surveillance and Social Media Review
Unum conducts surveillance and reviews social media. A few minutes of video showing you carrying groceries or attending an event can be used to argue that you are more capable than you claim, even where the footage captures nothing about whether you could sustain that activity for a full workday, day after day.
Inconsistent or Sparse Treatment
Gaps in treatment, missed appointments, or a reduction in the frequency of care are read as evidence that your condition improved. Many claimants reduce treatment because it stopped helping or because they cannot afford it. Unum will not assume the benign explanation.
Pre-Existing Condition Provisions
If you were treated for the condition during your policy's look-back period before coverage began, Unum may deny on that basis. Our article on pre-existing condition provisions explains how these clauses work.
The Change in Definition at 24 Months
As above, the "any occupation" transition produces a large share of Unum terminations. Unum will typically obtain a vocational assessment identifying other jobs it says you could perform. Rebutting that assessment requires vocational evidence of your own.
What Should You Submit to Unum With Your Claim or Appeal?
Your appeal is not a letter. It is the evidentiary record of your case, and for an ERISA claim it is usually the last chance you will have to add anything. Depending on your claim, it may need:
Complete medical records from every treating provider, including the notes Unum never requested
A detailed narrative report from your treating physician describing specific restrictions and limitations, not just your diagnosis
Objective testing where available: imaging, laboratory findings, neuropsychological testing, cardiopulmonary testing
A functional capacity evaluation documenting what you can sustain across a full workday
A vocational assessment addressing your own occupation, or, after the transition, the "any occupation" standard
A point-by-point response to Unum's reviewing physician, identifying records they never received and findings they mischaracterized
Statements from family, friends, and coworkers describing the decline they have observed
Your Social Security disability award, if you have one
Documentation of medication side effects affecting stamina, concentration, and reliability
For a fuller explanation of why the appeal stage carries so much weight, see our article on why your appeal is your only chance to build the record.
How Long Do You Have to Appeal a Unum Denial?
If your policy is governed by ERISA, you generally have at least 180 days from the date of the adverse determination to file your appeal. Your denial letter should state the deadline that applies to your claim, and it controls.
That window closes faster than it sounds. Requesting your claim file, collecting updated records, scheduling functional or vocational testing, and giving your physician time to write a substantive report all take weeks. Missing the deadline usually costs you the right to sue at all. Our guide on how to draft an effective appeal letter walks through the sequence.
If your policy is an individual Provident or Paul Revere policy not governed by ERISA, different rules and deadlines apply, and your contract and state law control.
Frequently Asked Questions About Unum Disability Claims
Does Unum deny a lot of long term disability claims?
Unum denies and terminates a significant number of claims, though it does not publish denial rates. What is documented is that in 2004 Unum agreed to reassess approximately 215,000 previously denied or closed long term disability claims as part of a multistate regulatory settlement, one of the largest claim reassessment programs in the industry's history.
Why did Unum stop paying my disability benefits after two years?
Most Unum group policies change the definition of disability after 24 months. For the first two years you need only be unable to perform your own occupation. After that, you generally must be unable to perform any gainful occupation you are reasonably suited for. Many terminations happen at this transition, not because of medical improvement.
Can I sue Unum for denying my disability claim?
Yes, but usually only after you exhaust the administrative appeal your policy requires. For ERISA-governed policies, you must complete the internal appeal first, and a court will generally review only the evidence in the administrative record. This is why the appeal, not the lawsuit, is where the case is built.
Is my Provident or Paul Revere policy the same as a Unum policy?
Provident Life and Accident and The Paul Revere Life Insurance Company are part of the Unum group of companies, and Unum administers their claims. However, individual policies issued by these companies are often not governed by ERISA, which changes your deadlines, your remedies, and whether a court hears live testimony.
Does Unum use surveillance on disability claimants?
Yes. Unum conducts surveillance and reviews publicly available social media. Surveillance footage is often used to argue that a claimant is more functional than reported, even when the footage shows only brief activity and says nothing about whether the claimant could sustain work across a full day.
What is the Unum regulatory settlement?
In November 2004, UnumProvident entered a multistate regulatory settlement agreement with regulators in Maine, Massachusetts, and Tennessee, the U.S. Department of Labor, and the New York Attorney General. Unum paid a $15 million fine, agreed to reassess roughly 215,000 claims denied or closed since January 1, 2000, and made required changes to its claim-handling procedures.
Should I appeal a Unum denial myself or hire a lawyer?
You may appeal on your own, but for an ERISA claim the appeal is generally the last opportunity to add evidence to the record a court will review. Evidence not submitted during the appeal is usually excluded from litigation. That makes the appeal the stage where representation matters most.
Does a Social Security disability award mean Unum has to pay?
No. A Social Security award does not bind Unum, which applies your policy's definition rather than the Social Security standard. The award is still valuable evidence, and Unum's own policy likely reduces your benefit by the Social Security amount, which means Unum encouraged you to apply while reserving the right to reach a different conclusion.
What should I do first after Unum denies my claim?
Request your complete claim file in writing. Under the ERISA claims regulation you are entitled to it free of charge, and it will show which records Unum's reviewing physician actually received, whether that reviewer contacted your doctors, and what internal guidelines Unum applied. You cannot rebut a denial you have not read the basis for.
Does Unum have to give me the report of the doctor who reviewed my file?
Yes, for ERISA claims. You are entitled to all documents relevant to your claim free of charge, and if Unum generates new evidence during your appeal it must provide that evidence before issuing a final denial and give you a reasonable opportunity to respond.
How Can The Maddox Firm Help With Your Unum Claim or Appeal?
The Maddox Firm treats your Unum appeal as the most important stage of your case, because in most long term disability claims it is. We prepare every appeal as though it is the last evidence a court will ever see.
We work on Unum claims constantly, and we have obtained approvals for clients at both the claim and appeal stages, in matters involving conditions ranging from orthopedic and neurological impairments to autoimmune disease, cardiac conditions, chronic pain, and mental health conditions.
Here's how The Maddox Firm can help you with your Unum claim:
We Obtain and Review Your Entire Unum Claim File: We request your complete file and review all of it, including internal claim notes, the reports and credentials of the physicians Unum used, vocational analyses, and any surveillance. This shows us what Unum relied on, what it left out, and where its reasoning is vulnerable.
We Determine Whether ERISA Governs Your Policy: Group coverage through your employer usually falls under ERISA. An individual Provident or Paul Revere policy often does not. The answer changes your deadlines, your evidence, and your remedies, and it needs to be settled before anything else.
We Identify What Your Record Is Missing: We compare the evidence in your file against what your specific policy requires you to prove, then determine what medical, functional, and vocational evidence has to be added before your appeal window closes.
We Work With Your Doctors and Retained Experts: We coordinate with your treating physicians to obtain detailed reports addressing your restrictions and limitations, and where appropriate we arrange functional capacity evaluations and vocational assessments.
We Respond Directly to Unum's Reviewers: We answer the paper reviewers and examining physicians Unum relied on, documenting the records they never received, the findings they mischaracterized, and the conclusions their own reports do not support.
We Prepare for the Change in Definition: If your claim is approaching the 24-month "any occupation" transition, we build the vocational and functional record before Unum moves to terminate rather than after.
We Handle Appeals and Litigation: If your appeal is denied, we are prepared to litigate in federal court on the record we built.
A Unum long term disability claim can be a complicated process, and an incomplete record is a problem that usually cannot be fixed later. If you need help during the claims process, with appealing a claim denial, or with litigating a final adverse long term disability decision, The Maddox Firm can help. The experienced team at The Maddox Firm will examine your insurance policy, correspondence from your insurance company, medical records, and any other relevant documentation in order to give you personalized guidance on how we can help you win your long term disability claim. Our New Jersey and New York long term disability attorneys help clients nationwide.
Disclaimer: Prior results do not guarantee a similar outcome. Results depend on the policy language, the medical evidence, and the record in each individual claim. The court decisions described on this page were decided on their own facts and involved other claimants, and they are not a prediction about the outcome of your claim. This page is attorney advertising and provides general information only. It is not legal advice, and reading it does not create an attorney-client relationship.
