Unum Disability Lawyer: Ortiz Law Firm Fights For Your Rights

Have you paid into your long-term disability (LTD) plan, only to have Unum deny your claim when you need it most? You’re not alone—policyholders across the country face the same frustrating situation. At Ortiz Law Firm, we understand how critical your disability benefits are to your health, your family, and your financial future.

Why Choose Ortiz Law Firm?

• National Representation: We assist clients across the United States and handle both ERISA-governed group policies and individual disability insurance claims.
• Proven Results: Our case outcomes and client experiences reflect our focused disability practice and commitment to challenging unfair insurer tactics.
• No Upfront Cost: Your initial consultation is always free, and you pay nothing unless we recover benefits for you.

Don’t wait—Unum enforces strict deadlines for filing appeals, and missing one can permanently jeopardize your claim. Taking action early gives you the best chance of protecting your rights and securing the benefits you paid for.

Ready to Fight Back?

Call us at (888) 321-8131 for a free case review with an experienced Unum disability attorney, or request a free case evaluation online. If you’re unsure where to start, we also offer free educational resources to help you understand the disability claims process and your next steps.

Understanding Unum Disability Denials

Top Reasons Why Unum Denies Long-Term Disability Claims

At the end of the day, an insurance company is a business, and the goal of any business is to make a profit. It is in the company’s best interest to deny claims, and the insurer uses various tactics to do so.

Is Unum Difficult to Deal With?

If your Unum disability claim was been denied, you are not alone. The insurer has a long history of denying disability insurance claims in bad faith. Unum encourages the denial of legitimate disability insurance claims, and leaving claimants scrambling to figure out how to pay for their food, shelter, medical treatment, and other monthly expenses.

Below is a clip from the investigative news program 60 Minutes, which did a piece on Unum disability claims, featuring interviews with former employees who revealed details of a quota system and bonuses for denying claims.

Why Do Claimants Feel That Unum Pays Everyone Except the Person in Need?

Many claimants express frustration with the feeling that disability insurers, like Unum, seem to prioritize everyone except the actual policyholder in need. This perception often arises when, after years of faithfully paying premiums, policyholders experience unexpected denials or abrupt termination of benefits.

Despite reassurances throughout the life of the policy, claimants frequently describe a sudden reversal, with benefits cut off with limited or unclear explanation. This can be especially distressing for those who have dedicated decades to their careers and only filed a claim when truly unable to continue working.

The root of this frustration lies in the sense that the entire insurance apparatus—claims adjusters, medical reviewers, vocational consultants—continues to be compensated through company operations, while the disabled individual who paid for peace of mind is left scrambling for financial survival. The claims process can feel skewed, with repeated requests for documentation and shifting explanations for denial, all while legal representation remains out of reach for many due to mounting financial pressure.

Essentially, when insurers deny valid claims, it often gives the impression that the premiums support a system that pays everyone—agents, consultants, and company staff—except for the person facing hardship. This dynamic leads many policyholders to perceive the claims process as stacked against them, particularly when their livelihoods and well-being are on the line.

Unum Policyholder Ratings and Common Complaints

Unum receives consistently low marks from its policyholders. Overall, reviews tend to rate Unum at around 1.5 out of 5 stars, with very few customers saying they would recommend the company. This pattern shows up across multiple independent consumer review sites, not just legal forums.

The most frequent complaints from policyholders include:

• Claim Denials: Many individuals report having claims denied unexpectedly, even after being initially approved or after submitting extensive medical documentation.
• Delayed and Low Payments: Customers note that payments are either delayed, smaller than expected, or suddenly stopped without warning.
• Poor Customer Service: Difficulty reaching knowledgeable representatives and inconsistent communication are recurring issues.
• Feeling Misled or Given the Runaround: Several policyholders describe a frustrating process full of unclear requirements, shifting deadlines, and unanswered questions.
• Dependability Concerns: There are numerous stories of policies being abruptly terminated or ongoing claims being closed without adequate explanation, sometimes after years of coverage.

In summary, Unum’s policyholder ratings reflect widespread dissatisfaction, particularly with the denial and handling of disability claims, delayed payments, and an overall lack of dependable service.

What Are the Recent Trends in Disability Benefit Denials?

Over the past few years, claimants have reported a number of evolving tactics used by insurers when it comes to denying long-term disability benefits. If you’re currently navigating a claim, it’s important to be aware of these patterns so you can better anticipate and address potential roadblocks.

Some of the most common trends include:

• Increased Reliance on Paper Reviews: Insurers are more frequently denying claims based solely on reviewing medical records, without ever requesting an in-person exam or speaking directly with your treating providers.
• Use of In-House Medical Consultants: Many companies assign their own “independent” medical consultants to review files. These consultants almost always side with the insurer—even when your own doctors provide supporting documentation.
• Vocational Opinion Manipulation: Disability insurers are partnering with vocational experts to reinterpret job descriptions, often downplaying the actual demands of your profession to justify a denial.
• Surveillance and Social Media Monitoring: Insurers might comb through your social media or even hire private investigators to observe your daily activities in an attempt to discredit your claim.
• Volume of Blanket Denials: There has been an uptick in seemingly “template” denial letters that repeat generic language and fail to specifically address the unique details of your medical impairments or job duties.

If you notice any of these tactics in your own claim, or receive a denial letter that seems vague or formulaic, don’t be discouraged. These practices are, unfortunately, widespread—and recognizing the pattern is the first step toward building a strong appeal.

What Language Does Unum Use When It Denies a Claim?

• When deciding on an appeal of a denial, Unum may respond: “We determined the decision on the claim is correct.”
• They may hire a vocational expert/consultant: “On appeal, we had our vocational rehabilitation consultant (VRC) review the demands of your client’s regular occupation as it is performed in the national economy based on the concerns you brought up on appeal.”
• Unum may have the file go through a “medical review”: “On appeal, [your client]’s claim was reviewed by a clinical consultant and a physician board certified in PM&R (physical medicine and rehabilitation).”
• Unum is likely to conclude: “Based on our review, the decision to deny benefits is appropriate. The available file information supports that she has the functional capacity to perform her regular occupation.”

Common Reasons for Denial or Termination

Medical and Documentation Issues

You Did Not Submit Sufficient Medical Evidence

Insurers often deny claims because there is not enough evidence to support the claim. For example, if there is an x-ray to support a claim for back pain, an MRI or a CT scan may be better evidence. In a mental illness claim, if there are cognitive deficits or difficulty thinking and processing information, neuropsychological testing may be good evidence. This is the type of evidence an insurance company looks for when evaluating a case.

Medical Evidence Needed to Support a Disability Claim

For any disabling medical condition, the quality and consistency of your medical evidence can make or break your claim—especially if your case reaches the appeal stage or ends up in court. Insurance companies like Unum look for far more than a diagnosis alone. They want clear, well-documented proof showing how your medical condition prevents you from performing your job.

So, what type of evidence strengthens a disability claim?

• Comprehensive Medical Records: Courts and insurance companies expect to see ongoing treatment records from your treating providers, not isolated or sporadic visits. Regular progress notes documenting symptoms, functional limitations, and how your condition evolves over time are critical. Diagnostic imaging or other objective studies that confirm your condition and track its progression can carry significant weight.
• Objective Test Results: Lab work, imaging studies, physical exams, and other objective testing help support your claim. When applicable, documentation of physical, cognitive, or neurological limitations—such as mobility evaluations, strength testing, or cognitive assessments—can be especially persuasive.
• Detailed Physician Statements: Statements from your treating doctors are most effective when they go beyond listing diagnoses. Strong medical opinions explain your functional restrictions and clearly describe how those limitations interfere with your ability to perform work-related tasks.
• Documentation of Treatment Efforts: Insurers and courts look for evidence that you are following prescribed treatment plans, including medications, therapy, or other recommended care. Even when treatment does not restore your ability to work, showing consistent compliance helps counter arguments that your condition could improve with further treatment.
• Job-Specific Evidence: Your medical records should connect your limitations directly to your occupational duties. Claims are strongest when a physician compares your restrictions to the actual demands of your job, explaining why those duties can no longer be performed reliably or safely.

When your medical evidence consistently tells the full story—linking diagnosis, symptoms, treatment, and work limitations—you are in a far stronger position, whether you are filing an initial claim, appealing a denial, or pursuing benefits in court.

You Did Not Meet Your Elimination Period

Most disability insurance policies require you to be continuously disabled for a period of time before you can receive benefits. This is called the elimination period. Here is an example from a real Unum long-term disability insurance policy:

“HOW LONG MUST YOU BE DISABLED BEFORE YOU ARE ELIGIBLE TO RECEIVE BENEFITS?

You must be continuously disabled through your elimination period. Unum will treat your disability as continuous if your disability stops for 30 days or less during the elimination period. The days that you are not disabled will not count toward your elimination period.

Your elimination period is the later of:

– 180 days; or
– the date your insured Short Term Disability payments end, if applicable.

You are not required to have a 20% or more loss in your indexed monthly earnings
due to the same injury or sickness to be considered disabled during the elimination
period.

You are not required to have a 20% or more loss in your indexed monthly earnings due to the same injury or sickness to be considered disabled during the elimination period.”

You Don’t Meet the “Any Occupation” Definition of Disability

Most long-term disability policies have a definition of disability that changes from “own occupation” to “any occupation” after a certain number of months. This usually occurs after 24 months of benefits. The differences between the two can be technical and confusing, and the insurance company will do everything it can to muddy the waters and make your long-term disability claim harder to avoid payouts.

The following is an excerpt from a real policy:

“HOW DOES UNUM DEFINE DISABILITY?

You are disabled when Unum determines that:

– you are limited from performing the material and substantial duties of your regular occupation due to your sickness or injury; and
– you have a 20% or more loss in your indexed monthly earnings due to the same sickness or injury.

After 24 months of payments, you are disabled when Unum determines that due to the same sickness or injury, you are unable to perform the duties of any gainful occupation for which you are reasonably fitted by education, training or experience.

You must be under the regular care of a physician in order to be considered disabled.

The loss of a professional or occupational license or certification does not, in itself, constitute disability.

We may require you to be examined by a physician, other medical practitioner and/or vocational expert of our choice. Unum will pay for this examination. We can require an examination as often as it is reasonable to do so. We may also require you to be interviewed by an authorized Unum Representative.”

Mental Health Claims Have a Limited Benefit Period

Most disability insurance companies will only pay mental health claims for a limited time (usually 12-24 months), but your benefits should continue if you also have physical conditions that prevent you from working. Unum will try to say that your physical conditions are not disabling in order to justify denying your claim.

“WHAT DISABILITIES HAVE A LIMITED PAY PERIOD UNDER YOUR PLAN?

The lifetime cumulative maximum benefit period for all disabilities due to mental
illness is 12 months. Only 12 months of benefits will be paid even if the disabilities:

– are not continuous; and/or
– are not related.

Unum will continue to send you payments beyond the 12 month period if you meet one or both of these conditions:

1. If you are confined to a hospital or institution at the end of the 12 month period, Unum will continue to send you payments during your confinement. If you are still disabled when you are discharged, Unum will send you payments for a recovery period of up to 90 days. If you become reconfined at any time during the recovery period and remain confined for at least 14 days in a row, Unum will send payments during that additional confinement and for one additional recovery period up to 90 more
days.

2. In addition to Item 1, if, after the 12 month period for which you have received payments, you continue to be disabled and subsequently become confined to a hospital or institution for at least 14 days in a row, Unum will send payments during the length of the reconfinement. Unum will not pay beyond the limited pay period as indicated above, or the maximum period of payment, whichever occurs first.

Unum will not apply the mental illness limitation to dementia if it is a result of:

– stroke;
– trauma;
– viral infection;
– Alzheimer’s disease; or
– other conditions not listed which are not usually treated by a mental health provider or other qualified provider using psychotherapy, psychotropic drugs, or other similar methods of treatment.”

RELATED POST: Does a Mental Health Limitation Apply to My LTD Claim?

The above policy excerpts above are from a real Unum group long-term disability insurance policy. If Unum has denied your long-term disability insurance claim, regardless of the specific reason for the denial, it is strongly recommended that you do not proceed through the appeals process without first requesting a free case evaluation by an experienced disability attorney.

Can Unum Deny Your Disability Claim Due to a Pre-Existing Condition?

Yes, Unum can deny your long-term disability claim if it determines your condition is considered “pre-existing” under the terms of your policy. Most disability insurance plans have specific rules that limit or completely exclude coverage for disabilities related to medical conditions you were treated for or diagnosed with before your coverage began. This is commonly referred to as a “pre-existing condition exclusion.”

Here’s how it typically works:

• Look-Back Period: Policies often contain a “look-back period,” usually lasting 3 to 12 months before your coverage started. If you received medical advice, treatment, or consultation for your condition during this window, it may be classified as pre-existing.
• Exclusionary Period: If your disability arises from a pre-existing condition, insurers like Unum can deny your claim for a set period—often the first 12 months of your policy—or exclude coverage for that condition entirely.

It’s crucial to review your policy’s definition of a pre-existing condition and the duration of any exclusion period if you have concerns. If your claim was denied on this basis but you believe the exclusion was wrongly applied, an experienced disability attorney can help review the details and determine your options.

What to Do If Your Claim Is Denied for a Pre-Existing Condition Limitation

If Unum has denied your disability claim based on a pre-existing condition limitation, don’t panic—this is a common tactic, and you still have options. Here’s how you can respond:

• Review Your Policy Carefully: Every disability insurance policy defines “pre-existing condition” differently, and the specifics matter. Check the look-back period (often 3, 6, or 12 months before your coverage started) and what treatments or symptoms would qualify as pre-existing under your plan.
• Gather Medical Evidence: Work with your doctors to clearly document when your symptoms began and what conditions were diagnosed. If your disabling condition truly developed after your coverage started, medical records will be key in challenging the denial.
• Build a Timeline: Create a clear timeline showing when you first experienced symptoms, sought treatment, and received your diagnosis. This can help demonstrate that your disability wasn’t related to a pre-existing issue.
• Prepare a Strong Appeal: You can appeal the denial, and many succeed with a well-prepared case. Include all relevant medical records, physician letters, and statements that support your position. Consider requesting a letter from your treating physician specifically addressing the timing and cause of your disability.
• Consult an Expert: This is where disability insurance lawyers can make a big difference. An attorney can review your policy, gather evidence, and craft a compelling appeal. Even if you’re handling the process yourself, a free consultation can help clarify your next steps.
• Don’t Miss Deadlines: Appeals are time-sensitive, so check your denial letter for the deadline to respond—typically 180 days.

Standing up to a pre-existing condition denial can feel overwhelming, but remember: insurance companies rely on these limitations to reduce payouts, not necessarily to reflect your health reality. With the right strategy and support, you can give your claim the best possible chance at approval.

Unum Internal Reviews

Unum Conducted a Peer Review Evaluation

Your denial letter might say:

“To give your file every consideration, two physicians reviewed the medical documentation in your claim. The review does not find that you have been precluded from your occupational demands on a full-time basis.”

This means that Unum sent your medical records to one of their doctors, and that doctor gave an opinion about what you can and can’t do, even though that doctor never saw or examined you.

Unum Ordered a Vocational Analysis of Your Claim

A vocational analysis means that the disability insurance company sent your file to a vocational expert who reviewed it and determined that you can return to work in some capacity. Your denial letter may say:

“We had your file reviewed by our Vocational Specialist to assess the occupation duties of your own occupation.”

External Behavior and Surveillance

What Happens If My Disability Claim Is Denied Because I Traveled or Performed Certain Activities?

If your disability claim with Unum was denied based on your ability to travel or engage in certain activities, you’re not alone. Insurance companies often look for evidence—like trips you may have taken or physical tasks you’re able to do—to argue that you may be capable of working.

This doesn’t necessarily mean you’re not disabled according to your policy; however, insurers frequently use these activities as grounds to deny claims.

For example, traveling (even for medical reasons or family emergencies) might be interpreted by Unum as proof that you can handle work-related responsibilities or maintain a regular schedule. Similarly, being seen running errands, attending social events, or participating in community activities can be taken out of context and used to challenge your claim.

If you’ve received a denial for this reason:

• Carefully review the insurance company’s explanation for the denial.
• Gather documentation detailing why your travel or activities do not contradict your disability, such as doctor’s notes or travel details that clarify accommodations you needed.
• Understand that insurers often conduct surveillance or monitor your social media to support their decisions, so always be mindful of what you share.

It’s important to remember that a denial does not mean your claim is invalid or that you should give up. If you find yourself in this situation, consult with a qualified disability attorney before appealing, as they can help you build a strong case and present evidence that the ability to perform occasional activities does not equate to an ability to return to work.

What to Do If Unum Is Giving You the Runaround

It’s not uncommon for policyholders to feel frustrated when dealing with Unum, especially if you sense that you’re caught in a never-ending loop of requests for paperwork, shifting explanations, or long periods of silence. This type of “runaround” can be exhausting and discouraging, but there are proactive steps you can take to protect yourself and your claim.

Steps to Take If You’re Facing Delays or Confusion:

• Keep Detailed Records: Document every phone call, letter, and email. Jot down dates, names, and the content of conversations. Organized records make it much easier to show a pattern of delays or inconsistent communication if you need to escalate your case.
• Respond Promptly and Thoroughly: Send requested documents and medical information as soon as possible, using certified mail or another trackable method. Always retain copies for your records.
• Request Written Explanations: If Unum’s instructions or denial explanations appear vague or contradictory, ask for specific details in writing. This holds them accountable and provides a clear trail.
• Know Your Rights: Disability insurance claims are governed by strict timelines under federal law (ERISA), state regulations, and your specific policy. If deadlines are being missed by the insurer, you may have grounds for a complaint.
• Consider Seeking Legal Guidance: If you continue to face obstacles, consult an experienced disability attorney. Ortiz Law Firm offers free evaluations and can help you cut through red tape, communicate effectively with Unum, and ensure your rights are protected. An attorney’s involvement often leads to more timely and detailed responses from the insurer.

Feeling stonewalled by Unum is unfortunately a familiar tale for many policyholders. Gathering everything above in one place isn’t just helpful for you—it could make all the difference in the eyes of a judge or claims reviewer if your case needs to be appealed or litigated.

Employment and Coverage Termination

Sudden Termination of Benefits: What Could Cause It?

Facing an unexpected termination of your disability benefits can be incredibly distressing, especially when you’ve taken all the steps to protect yourself—like purchasing coverage through your employer and maintaining thorough medical documentation. Yet, many beneficiaries find themselves blindsided by a sudden denial or termination, with little or no warning from the insurance company.

Some common reasons why benefits might be discontinued without prior notice include:

• Administrative Oversights: Sometimes, changes in employment status—such as layoffs, resignations, or even administrative errors by your employer—can inadvertently lead to your coverage ending.
• Eligibility Issues: If the insurer reviews your file and determines you no longer meet their specific definition of “disabled,” your benefits could be halted, regardless of your ongoing medical issues.
• Policy Terms and Conditions: Many policies have strict requirements regarding documentation, deadlines, and ongoing proof of disability. Missing a form, not providing recent medical updates, or simply not meeting the requirements for continued coverage can all be grounds for termination.
• Attendance or Conduct Issues at Work: Employers sometimes terminate employees for attendance or other reasons, which can trigger a loss of insurance eligibility—even if your absences are related to your medical condition.

The unfortunate reality is that, despite your best efforts and clear medical history, the insurance company may still cut off your benefits without forewarning, leaving you to navigate a complex and frustrating appeals process.

If your claim has been denied or terminated abruptly, we recommend reviewing the underlying reasons, gathering all relevant documentation, and seeking legal guidance as soon as possible.

Can Disability Insurance Benefits Be Terminated After Many Years?

You might think that once your disability benefits are approved—especially after years of receiving them—you’re in the clear. Unfortunately, that isn’t always the case. Even for chronic and severe conditions like fibromyalgia, disability insurance companies can revisit your claim years down the line and decide to terminate your payments.

This can happen after a routine review, a new round of claim paperwork, or even a change in the insurer’s internal claims standards. For example, an executive who was awarded long-term disability benefits due to severe fibromyalgia saw his payments discontinued by his insurance company more than 15 years after his initial approval. The insurer asserted that his condition no longer met their definition of disability, despite ongoing symptoms and documented limitations.

So, what does this mean for you?

• Your ongoing eligibility is regularly reviewed, sometimes even decades after your claim began.
• Even “permanent” conditions can be questioned, especially if the insurer believes there is medical improvement, new evidence, or insufficient documentation.
• Termination decisions can be challenged in court, but the appeals process is complex and subject to the insurance policy’s appeal standards.

If you’re concerned about your benefits being cut off—especially for long-standing claims—make sure to keep detailed medical records, attend all necessary evaluations, and consult with a disability attorney if the insurer suggests your claim no longer qualifies. Being proactive may help protect your continued financial security.

What Happens to My Disability Insurance Coverage If My Employment Is Terminated?

If your employment with your company ends, it’s crucial to know how this might impact your disability insurance coverage through Unum or any of its affiliated companies. Generally, most group disability insurance policies are tied directly to your employment status. This means your coverage often ends on your last day of work unless:

• You are already out on an approved disability claim prior to your termination, in which case your benefits may continue as long as you remain eligible under the policy terms.
• Your policy has a “conversion” or “portability” option, which sometimes allows you to keep coverage by paying premiums directly after leaving your employer. Not all group policies offer this, so it’s important to check your individual policy documents or contact Unum directly.

Key Points to Remember:

• If you haven’t filed a claim before your employment ended, you typically can’t claim benefits after your termination unless you were already disabled and eligible while still actively employed.
• Always review your policy for specific provisions about eligibility following termination, as rules can vary depending on your employer’s plan.
• When in doubt, reach out to your human resources department or a knowledgeable disability attorney for guidance on your next steps regarding continued coverage or filing a claim.

Understanding these guidelines can help you protect your rights and take proper action if you are facing job loss and ongoing health concerns.

Special Policy Issues

How Social Security Offsets Impact Your Disability Benefits

If you’re receiving both private disability benefits and Social Security Disability Insurance (SSDI), you should be aware of how “offsets” work. Most private disability policies—including those from major insurers like Unum—contain provisions that allow the insurance company to reduce (or “offset”) the amount they pay you by any amount you receive from other sources, such as SSDI.

Put simply, you won’t receive the full amount from both sources at the same time. Here’s how this usually plays out:

• Overlap Periods: If you’re approved for SSDI benefits and those benefits cover the same months you’re receiving private disability payments, your insurance company will typically subtract your monthly SSDI benefit from what they owe you.
• Retroactive SSDI Approvals: If Social Security grants you benefits for months you were previously paid by your disability insurer, you may be required to pay back the “overpayment” to the insurance company. This can happen if your SSDI application takes several months or even years to be approved.
• Family Benefits: Some policies also offset benefits you or your dependents receive from Social Security, further reducing the amount paid by the insurer.

Offsets can be confusing and sometimes lead to disputes over how much you’re owed. Our firm can help you calculate the correct benefit and ensure that your insurance company isn’t taking more than they’re entitled to deduct.

If you have questions about your policy’s offset guidelines or believe your payments were improperly reduced, don’t hesitate to reach out for guidance.

Should You Accept a Lump Sum Payout from Unum?

Choosing whether to accept a lump sum payout from Unum is a significant financial decision, and there are several factors to consider before making your choice.

If you are currently receiving monthly disability benefits from Unum and you are offered a lump sum settlement—perhaps as part of a buyout or as an option for your pension—it’s important to understand how this could impact your overall benefits. Most Unum policies include provisions for “offsets.” An offset means that if you receive other income, such as Social Security Disability benefits or a lump sum pension, Unum may reduce your monthly disability check by all or a portion of that amount.

Here’s what to keep in mind:

• Policy Language Matters: Every disability insurance policy is unique, so you’ll need to check the specific language in your Unum policy. Some policies treat pension lump sums as income, which could reduce or eliminate your Unum payments.
• Coordinating Benefits: If you are already receiving Social Security Disability Insurance (SSDI), continuing monthly disability benefits from Unum, and are now eligible to receive a pension lump sum or monthly payout, these streams of income may interact. Accepting a pension lump sum or selecting a higher monthly pension may decrease your Unum benefits, depending on how your policy treats these payments.
• Tax Implications: Lump sum payments can have different tax consequences compared to monthly income, so it’s wise to consult with a tax advisor before making a decision.
• Your Financial Needs: Take stock of your short- and long-term needs. While a lump sum can provide immediate funds for large expenses, monthly payments may offer more long-term security.

Before you accept a lump sum, review your policy carefully and consider speaking with a disability attorney or financial advisor. This can help ensure you understand the full implications for your disability benefits and avoid unexpected reductions.

If you have specific questions about your policy or your best course of action, we are here to help with a free consultation.

RELATED POST: Should You Accept a Buyout Offer from Unum?

Can I Negotiate a Lump Sum Settlement If I’m Still Receiving Payments from Unum?

Yes, it is sometimes possible to negotiate a lump sum settlement, also known as a buyout, while you are still “on claim” and actively receiving monthly disability payments from Unum. In fact, some claimants prefer to explore this option if they no longer wish to deal with the ongoing claims process or want to secure a one-time payment in lieu of future monthly benefits.

Here’s what you should know:

• Eligibility: Generally, Unum will only consider a buyout when you are already receiving benefits—not if your claim is still pending or has recently been denied.
• Process: If you are interested in a lump sum, it’s important to approach Unum strategically. Sometimes Unum initiates these offers, but in other situations, you or your attorney can begin the discussion.
• Considerations: There are several things to think about before moving forward with a buyout:
  • You must be comfortable ending your monthly payments in exchange for a one-time amount.
  • The settlement amount is usually less than the total you might receive if monthly benefits continued for the full duration—Unum factors in the present value, your life expectancy, policy terms, and the likelihood of continued disability.
  • There could be significant tax or financial planning implications.

If you’re considering requesting a lump sum or have received an offer from Unum, we can review your situation, help you evaluate the pros and cons, and handle negotiations for you. This can help ensure you’re protected and receive a fair and well-structured settlement.

Can I Negotiate a Lump-Sum Settlement or Buyout for My Disability Insurance Claim?

In certain situations, you may have the option to pursue a lump-sum settlement—often referred to as a “buyout”—for your disability insurance claim. This means you would receive a one-time payment from your insurer in exchange for releasing them from any future payment obligations under your policy.

Not every insurer offers lump-sum settlements, and even those that do are not required to provide this option in every case. Some key factors that come into play when evaluating the possibility of a buyout include:

• The Insurance Company’s Policies: Major insurers like Unum, The Hartford, MetLife, and Prudential occasionally present buyout opportunities, but availability depends on their internal guidelines.
• Your Stage in the Claim Process: Insurers are more likely to discuss buyouts after your claim has been approved and paid for a period of time, although some may consider offers during ongoing appeals or litigation.
• The Strength of Your Claim: Strong supporting medical evidence and a clear proof of disability may increase the chances of obtaining a favorable settlement.
• Your Needs and Preferences: A lump-sum payout can offer immediate financial certainty, freedom from ongoing claims paperwork, and settlement of any disputes. However, it may result in a lower overall payout compared to what you might collect over time.

Before accepting or negotiating any settlement, it’s wise to consult with a disability insurance attorney or financial advisor. They can help you assess whether a buyout is in your best interest based on your health, the value of your policy, and your long-term financial goals.

What If I Move or Travel Abroad?

One question we hear often is whether you can move or travel abroad and still receive your disability insurance benefits. The answer depends largely on the specific terms in your Unum policy.

Some disability policies—especially group policies—include a “foreign residency limitation.” This type of clause may restrict or even eliminate benefit payments if you choose to reside outside the United States for an extended period. Others might allow travel but require you to return periodically for medical review, while certain policies, typically individual ones, offer more flexibility and permit international residency with little to no restriction.

Here are a few key points to consider:

• Check Your Policy: Read through your policy’s fine print to see if there’s any language that limits benefits when you live or travel overseas.
• Notify Your Insurer: Even if your policy allows international residency, you may be required to keep your insurer updated about your location and participate in periodic medical evaluations.
• Plan Ahead: If you’re considering relocating, let your doctor and claims administrator know in advance. This helps avoid interruptions in your benefits or other unwelcome surprises.

If you have questions about your Unum policy’s stance on foreign residency, or if you’re planning a move abroad and want to avoid jeopardizing your benefits, we recommend reaching out for a personalized policy review.

How Pregnancy-Related Health Issues Affect Disability Claims

Pregnancy itself isn’t typically considered a disability, but complications arising from pregnancy can absolutely qualify you for short-term or even long-term disability benefits under most policies. Common examples might include severe gestational diabetes, preeclampsia, or a complicated delivery that results in extended recovery.

If you are dealing with pregnancy-related health issues, here’s how it generally impacts your claim:

• Short-Term Disability (STD): Most STD policies explicitly cover pregnancy and related complications, offering benefits for the time your doctor certifies you’re unable to work. This often includes both the typical six to eight week postpartum recovery period, plus additional time if your recovery is more complex.
• Long-Term Disability (LTD): If your pregnancy results in long-lasting complications—perhaps a serious condition like postpartum cardiomyopathy—you may be eligible for long-term benefits. However, LTD carriers often scrutinize these claims, so strong medical documentation is key.

Be aware:

• The claims process for pregnancy-related issues will require detailed statements from your physician about your specific restrictions, recovery timelines, and ongoing symptoms.
• Many insurers have waiting or elimination periods built into their policies. Make sure to check your specific waiting period after your last day of work before benefits kick in.
• Always submit thorough medical records and ongoing updates from your care team to support any extension of leave or transition from short-term to long-term disability.

If you’re unsure about how your situation fits under your coverage, reviewing your policy terms and consulting with an experienced disability attorney can help ensure you’re approaching your claim in a way that maximizes your chances of approval.

Legal Remedies and Strategies

How Do You Fight Unum Disability Insurance Claim Denials?

Receiving a Unum disability insurance claim denial does not mean that all hope is lost. If your Unum disability claim is denied or terminated, you have the right to file an appeal. Many claimants choose to hire a disability law firm to help them fight their claim denials, and most disability attorneys offer a free case evaluation.

However, you are not required to hire an attorney to represent you, even if you take advantage of a free case evaluation. If you are interested in filing an appeal on your own, we recommend that you first review our free Disability Insurance Appeal Guide first. It will help you to understand the steps disability insurance lawyers follow when preparing an appeal.

If you prefer to work with a disability expert, we hope you will consider our law firm. Having handled Unum disability claims nationwide since 2005, Nick Ortiz has the insight and skills to help you get the long-term disability benefits you deserve.

What Steps Should You Take to Win a Lawsuit or Appeal Against a Disability Insurance Company?

Successfully appealing or litigating a denied disability insurance claim requires strategy, patience, and thorough preparation. Here are some steps to help you build the strongest possible case:

• Request Your Claim File: Start by requesting the complete claim file from your insurance company. This file should include all documents, notes, reports, and communications related to your claim and its denial. Reviewing this information will help you identify any weaknesses or gaps.
• Collect Strong Medical Evidence: Gather comprehensive and up-to-date medical records, including detailed physician notes, test results, and reports from specialists. Ask your doctors to provide statements that specifically address how your condition limits your ability to perform your job duties.
• Obtain Expert Opinions: Consider supporting your case with expert opinions, such as a vocational expert who can explain how your medical limitations prevent you from working in your occupation or any occupation based on your education and experience.
• Carefully Review Your Policy: Read through your disability insurance policy to understand the definitions, exclusions, and requirements. Policies may differ greatly—even among the same insurer—so be sure you know exactly what benefits you are entitled to and what obligations you must meet.
• Meet All Deadlines: Pay attention to deadlines—whether for submitting appeals, additional documentation, or litigation. Missing a deadline can harm your chances of success.
• Consider Legal Representation: While it’s possible to appeal on your own, working with a disability attorney can vastly improve your odds. Attorneys have experience identifying insurance company tactics and know how to present claims in a way that addresses the insurer’s frequent reasons for denial.
• Keep Records of All Communications: Maintain copies of all correspondence with your insurer, including emails, letters, and notes from phone calls. Organized documentation can be a powerful tool if your case goes to court.

Above all, persistence is key. Insurance companies often hope you will give up after an initial denial. By methodically building your case and seeking assistance when needed, you can maximize your chances of obtaining the disability benefits you deserve.

What Legal Strategies Are Effective for Challenging Disability Benefit Denials?

Successfully overturning a disability benefit denial requires a thorough and strategic approach. While every case is unique, there are several tried-and-true methods that can strengthen your appeal or lawsuit against a major insurer like Unum:

• Comprehensive Documentation: Your file should include detailed medical reports, statements from your treating physicians, and any relevant diagnostic test results. All evidence should specifically address how your condition limits your ability to perform your occupation.
• Expert Opinions: Consider obtaining opinions from independent medical experts or vocational consultants. These professionals can provide objective assessments of your functional limitations and your capacity (or lack thereof) to work.
• Policy Review: Carefully examine your disability policy to clarify the definitions and requirements, such as “own occupation” versus “any occupation.” Knowing precisely what your policy covers helps you target your arguments more effectively.
• Timely Responses: Meet all deadlines for appeals and provide prompt, well-organized responses to any requests for additional information. Missing a deadline can jeopardize your entire claim.
• Challenge Insurer’s Evidence: If the insurer’s denial is based on a file review or an in-house expert’s opinion, you should address and rebut their findings directly. Highlight inconsistencies or incomplete analyses and support your counterpoints with solid evidence.
• Attorney Involvement: While not required, working with an experienced disability attorney can add significant value. Attorneys can ensure that your appeal or lawsuit meets procedural requirements and stands on the strongest legal footing, especially for complex ERISA claims.

Strategically combining these elements positions you to challenge a disability insurance denial with confidence and clarity. This comprehensive approach targets both the medical and legal weaknesses in the insurer’s case, increasing your odds of a successful outcome.

Real-Life Examples of Successful Disability Claim Appeals

If you’re wondering whether it’s possible to overturn a denied disability insurance claim, there are plenty of examples that show it can be done. Here are just a few stories of individuals who fought back after their claims were denied—and won the benefits they deserved:

• Manager with a Traumatic Brain Injury: After working for years in transportation management, one claimant suffered a brain injury that left her unable to perform her high-level job duties. Even though the insurer had already approved her claim and acknowledged her disability for several months, her benefits were later terminated without evidence of improvement. By challenging this decision and providing thorough medical documentation, she successfully reinstated her benefits on appeal.
• State Director Facing Chronic Pain: A regional director diagnosed with severe spine and nerve conditions—including chronic neck and back pain—had her long-term disability claim denied, even after undergoing surgery. Persistent legal advocacy and updated medical records eventually led to a successful appeal, although the insurer challenged her benefits again in the future. It’s a reminder that persistence and prompt action can make a difference in complex cases.
• Billing Manager Dealing with Chronic Back Disorder: Years of managing accounts took a toll on another claimant, whose chronic knee and back pain left her unable to work. Despite the insurer’s skepticism and initial denial, her detailed appeal—supplemented by additional medical opinions—ultimately resulted in her claim being approved.
• Mental Health and Neurological Challenges: Some policies restrict coverage for mental health conditions, but one client’s situation stood out. Initially, her claim was limited by a two-year cap for mental health, even though she also experienced epileptic seizures. By demonstrating that her disabling condition was neurological in nature, her legal team helped her receive the full benefits she was entitled to.
• Registered Nurse with Ongoing Physical Limitations: After developing severe, chronic physical conditions, a longtime nurse’s claim was denied following a brief period of short-term disability. A thorough appeal, which included updated medical evaluations and testimony regarding her occupational duties, led to the insurer reversing its decision and awarding her long-term benefits.
• Account Manager with Gastrointestinal Illness: In another case, a manager battling a debilitating digestive disorder faced initial denial of her claim. Her appeal, which leveraged newly obtained laboratory results and physicians’ reports, succeeded in demonstrating her inability to return to work—resulting in the approval of her disability benefits.

These real-world outcomes show that appealing a denied disability insurance claim can yield positive results, especially when you back up your appeal with strong medical evidence, a clear record of your occupational duties, and, sometimes, the guidance of an experienced attorney.

Can I Sue Unum Over a Disability Denial?

In some cases, we are successful in getting Unum to put you “on claim,” meaning that the claim was approved and benefits were paid during the internal appeals process with Unum’s claims department, without resorting to a lawsuit against the insurance carrier. In other cases, however, Unum may uphold the decision to deny or cancel your claim. If this happens, you may be able to sue Unum over the disability denial.

Do I Have to File an Appeal Before I Can File a Lawsuit?

Whether you must file an appeal before filing a lawsuit depends on how you purchased your Unum disability insurance policy. Unum is an insurance company that offers both group and individual disability insurance policies. Your legal rights under a group policy are very different from those under an individual policy.

If your policy is part of a group benefit plan through a private employer, employee organization, or union, then it is likely governed by ERISA, and you must file at least one appeal before you can sue the insurance company. If the internal appeals process fails, you have the right to file an ERISA lawsuit to have your case reviewed by a federal judge. Under ERISA, the disability insurance company is not liable for bad faith damages and therefore has no real incentive to pay the claim.

You are almost always better off with an individual policy. If you have an individual policy, or if a church or a government employer provides your policy, then your claim is likely not governed by ERISA, and you may not have to make any appeals before filing a lawsuit. Bad faith damages also come into play, as bad faith laws only apply when ERISA does not apply.

If your Unum claim was denied and you’ve exhausted your appeals, or if you’re trying to determine if you need to file an appeal, our Unum insurance lawyers are here to help.

What Standard of Review Applies to Disability Benefit Lawsuits?

When you challenge an insurance company’s decision to terminate your long-term disability benefits in court, the standard of review can make a significant difference in the outcome of your case.

For most group disability insurance policies—like those provided by private employers and governed by ERISA—the court typically applies what’s known as the “abuse of discretion” standard (sometimes called “arbitrary and capricious”). This means the judge will not simply re-decide your claim from scratch. Instead, the judge will consider whether the insurance company’s decision was reasonable and supported by the evidence. If the insurer had a reasonable basis—even if the court might disagree with the ultimate outcome—the denial may be upheld.

However, if your group policy doesn’t grant Unum or the insurer explicit discretion to interpret the terms and facts, or if you have an individual or government-provided policy not governed by ERISA, the court may use a “de novo” standard instead. Under “de novo” review, the court takes a fresh look at your claim and is not bound by the insurance company’s findings.

Understanding which standard of review applies in your case is crucial—it often shapes both your legal strategy and your chances for success on appeal.

How Have Courts Ruled in Past Unum Long-Term Disability Lawsuits?

Many people wonder what happens when a claim with Unum is denied and ends up in court. Over the years, Unum has been the subject of thousands of long-term disability lawsuits across the United States. While every case is unique, several patterns have emerged in how courts address these disputes.

For example:

• Policy Interpretation: Courts have closely scrutinized how Unum interprets its policy language, especially when claimants have complex or hard-to-define medical conditions. In some cases, judges have found that Unum’s decisions did not align with the actual terms of the policy or failed to consider medical evidence properly.
• Claim Investigation Practices: Some lawsuits have involved claimants who pursued legal action after Unum relied on limited or generic medical forms, much like the standard Attending Physician’s Statement. In these cases, courts have considered whether Unum made a reasonable effort to evaluate the claimant’s actual restrictions and limitations.
• Settlements and Jury Trials: There are instances where claimants have succeeded at trial, particularly when they were able to present compelling medical and vocational evidence. For example, medical professionals suffering from conditions like carpal tunnel syndrome or chronic back pain have, at times, successfully demonstrated that they could not perform the key duties of their occupations. In some situations, the court has ruled that disability benefits must be paid even if the claimant can technically perform some work, so long as it is not their prior, specialized role.

Ultimately, past results show that while Unum vigorously defends its decisions, courts have not hesitated to overturn claim denials when the evidence supports the policyholder’s position. The specifics of your policy and your medical situation will play a large role in any court’s decision.

What If You Prove Eligibility for LTD Benefits by a Preponderance of the Evidence?

If you have gathered enough evidence to show you are eligible for long-term disability (LTD) benefits—meaning the proof is more likely than not in your favor—how does Unum respond? In theory, meeting this burden of proof should result in your claim being approved. Evidence might include:

• Detailed reports from your treating physicians about your symptoms and limitations
• Objective diagnostic tests (like MRIs, X-rays, or lab results)
• Attending physician statements tailored to your condition
• Statements from family, coworkers, or others who can attest to your daily challenges

Despite this, Unum—and other major insurers—sometimes deny LTD benefits even when the claimant’s evidence clearly supports disability. Why does this happen? Insurance companies may use their own medical consultants who never meet you, disagree with your doctors, or interpret policy language narrowly.

If Unum doesn’t accept your evidence and upholds the denial, your next step often depends on the type of policy you hold. For ERISA-governed group policies, the courts review whether Unum’s denial was “reasonable” based on the record—so thorough documentation and compelling evidence remain essential. For individual policies, you may have more leverage, especially if bad faith or unfair claims handling is at play.

If you find yourself in this situation—having strong evidence yet still facing a denial—don’t get discouraged. Our team is here to step in, review your record, and help present your case so the true weight of your medical evidence gets the attention it deserves.

Is Remand Necessary If Disability Is Proven by a Preponderance of the Evidence?

A common question for claimants disputing a disability denial is whether remand—sending the case back to the plan administrator for further consideration—is required when the court finds that disability has been established by a preponderance of the evidence.

In many cases, courts have found that if the claimant has already proven their disability and entitlement to benefits by a preponderance of the evidence, there is no need for another round of administrative review. Instead, courts may simply order the insurer to pay benefits outright. This approach is particularly common in ERISA cases, where lengthy delays caused by repeated remands can cause additional hardship for claimants who are already dealing with health and financial stress.

However, there are instances where remand may still be deemed appropriate. For example, if key medical evidence was not considered or procedural errors occurred during the initial review, a judge may decide that remand is necessary to ensure a fair and thorough process. Ultimately, whether remand is required depends on the specific facts of your case and how well the disability has been documented.

If you find yourself facing this scenario, it is important to discuss your options with an attorney who understands how these decisions are made in federal courts. A lawyer can help evaluate whether sufficient evidence exists to avoid remand and move directly to an award of benefits.

How Successful Are Lawsuits Against Major Disability Insurance Companies?

Many people wonder about their chances of success if they choose to pursue a lawsuit against a large disability insurance company like Unum, Provident, or The Paul Revere Life Insurance Company. The reality is that a significant number of lawsuits brought by disability claimants do result in favorable outcomes—either a reinstatement of benefits or a settlement for a lump-sum payment.

While outcomes naturally depend on the unique facts of each case, experienced disability attorneys have a proven track record of challenging these insurance giants in both state and federal courts across the country. By effectively documenting your disability, gathering strong supporting evidence, and navigating the complex legal landscape, a skilled attorney can substantially improve your likelihood of securing the benefits you deserve.

If you are considering legal action after a denial or termination, we invite you to take advantage of a free review of your claim. This can give you a better understanding of your options and the potential for success based on your circumstances.

What Are Some Examples of Lawsuits Filed Against Unum for Disability Denials?

Across the country, numerous policyholders have taken legal action against Unum following denials of long-term disability benefits. These cases span a wide range of professions and medical conditions, and they highlight both the challenges claimants face and the ways courts scrutinize Unum’s claim practices.

Here are a few examples that illustrate how Unum disability lawsuits unfold:

• Medical Professionals Fighting for Benefits: Physicians and surgeons commonly file lawsuits against Unum after being denied benefits for conditions that impact their ability to practice. For example, an ophthalmologist diagnosed with severe carpal tunnel syndrome successfully resolved a lawsuit after showing that her limitations were not adequately considered in the initial claim review.
• Surgeons Challenging Unum’s Decisions: Unum has faced trial verdicts in favor of general surgeons whose claims were denied, sometimes based on the insurer’s strict interpretation of medical records or a misunderstanding of the occupational demands of surgical practice. In some instances, surgeons have demonstrated at trial that ongoing home exercise and minimal medical visits were appropriate for their condition—ultimately convincing the jury that Unum’s denial was unjustified.
• Highlighting Past Practices: These lawsuits also serve to remind us of Unum’s history, including regulatory actions that required the company to change its claim review processes. Some court cases reference prior regulatory settlements when evaluating whether a particular denial was reasonable.

These examples show that while taking legal action can feel overwhelming, courts often take a close look at whether Unum applied its policy provisions fairly and in good faith. Lawsuits can result in negotiated settlements or court-ordered payment of benefits, depending on the strength of the evidence and the claimant’s persistence.

If you are considering a lawsuit against Unum, know that every case is unique and fact-specific. Reviewing court opinions or speaking with a disability attorney can offer valuable insights into how similar claims have been handled and what steps may be involved in your own case.

How Ortiz Law Firm Helps

Get Help from an Experienced Unum Disability Lawyer

Mr. Ortiz has helped hundreds of disability insurance claimants get the disability benefits they deserve. We understand how frustrating it can be to go through the Unum claims handling process to receive a disability claim denial, and we are here to help you through the process. Our experience helping past clients fight insurance companies like Unum has given us great insight into the best steps to take to improve your chances of winning your claim.

How Can a Disability Insurance Lawyer Help?

Our goal is to document your disability in a way that demonstrates your impairments and your inability to work. We will work with you to gather the appropriate evidence and documentation to meet the requirements of your disability policy. We will also prepare attending physician statements specific to your medical condition.

Unum may provide you with a generic Attending Physician’s Statement form, but this form will not be customized for your situation. Forms from the insurer are designed to apply to any claim, whether the claimant has a heart condition or a broken ankle. Using a customized form that only asks about the limitations and restrictions that apply to you will make it much easier for your doctor to complete the form.

How Disability Lawyers Help Clients Reverse LTD Claim Denials

Many individuals facing a denial from major insurance carriers like New York Life or Lincoln Financial feel overwhelmed by the appeals process. Disability lawyers can make a significant difference at this stage by guiding you through each step and ensuring your claim receives the attention it deserves.

Here’s how an experienced disability attorney can help overturn a long-term disability (LTD) claim denial:

• Immediate Guidance and Advocacy: Lawyers review the denial letter, clarify the insurer’s reasons, and explain your legal options. They take the time to understand your medical situation and the impact on your ability to work.
• Thorough Case Review: Attorneys gather all necessary medical documentation, including records, diagnostic tests, and detailed attending physician statements tailored to your unique disability—not just generic forms provided by the insurer.
• Strategic Communication: Your lawyer acts as your point of contact with the insurance company, responding promptly to questions and submitting supporting evidence to address the insurer’s objections.
• Building a Comprehensive Appeal: Experienced disability lawyers craft persuasive appeal letters that directly counter the insurance company’s arguments, relying on medical opinions, vocational evidence, and policy language.
• Relieving Your Stress: By handling communications and negotiations, your attorney takes the burden off your shoulders, giving you space to focus on your health and recovery.

Many clients have found that, after hiring a disability law firm, insurers such as New York Life or Lincoln Financial are far more likely to reconsider their denial and pay benefits as they should have from the start. If you’re facing a denied LTD claim, consulting an attorney—even before filing an appeal—can make a critical difference in the outcome of your claim.

How Do Disability Lawyers Communicate with Clients?

When you’re facing the stress of a disability insurance claim, clear and consistent communication with your legal team is key. Most experienced disability attorneys take the lead in handling all correspondence with insurers, so you don’t have to play phone tag with adjusters or worry about missing important deadlines.

Here’s what you can typically expect:

• Regular Updates: Good disability lawyers keep clients informed with frequent progress reports—whether that’s monthly updates, emails, or phone calls—to ensure you always know where things stand.
• Prompt Responses: You shouldn’t be left in the dark if you have a question. Your attorney and their staff will make themselves available to answer your concerns and respond quickly, often within a business day or two.
• Professional Guidance: From the start, the legal team will explain the process, outline the documentation needed, and give you straightforward advice about next steps. Their goal is to make the process as smooth and stress-free as possible.
• Hands-Off for You: One of the big benefits is being able to step back from direct dealings with the insurance company. Your lawyer and their team will manage the paperwork, negotiate with the insurer, and keep you looped in—giving you more time to focus on your health and family.

The bottom line: A good disability attorney doesn’t just bring expertise—they make sure you feel supported and informed, every step of the way.

What Past Clients Say About Our Professionalism and Support

Clients consistently share that working with experienced disability attorneys brings not only outstanding legal skill but also genuine compassion and support during a stressful time. Many mention feeling treated like family, with regular updates and open channels of communication—never left in the dark about where their case stands.

• Responsiveness and Clear Communication: Clients often highlight quick and thorough responses to questions. Having a dedicated legal team manage communications with major insurers such as Unum, Lincoln Financial, or others means clients avoid unnecessary anxiety and confusion.
• Relief From Stress: Facing an insurance company alone can be daunting. Clients say their stress levels drop dramatically once our team steps in to handle interactions and ensure the process stays on track.
• Diligence and Attention to Detail: Feedback from past clients indicates that our careful and relentless attention to every detail helps cases progress smoothly. From gathering evidence to following up on every step of the process, we work to ensure nothing slips through the cracks.
• Knowledge and Patience: Our team is praised for both in-depth understanding of disability law and the patience to explain complex issues clearly. Clients appreciate never being rushed, and knowing an experienced professional is always available for their concerns.

Above all, clients report that their legal team’s dedication makes a difficult situation much more manageable—often leading to successful outcomes and restored peace of mind.

Request a free case evaluation if your benefits have been wrongly denied or terminated. This is your opportunity to discuss the specific details of your unique situation, and there is no obligation to hire our firm. We also handle Social Security Disability Insurance claims, so if you have a concurrent claim with the Social Security Administration, we can help you with that claim as well.

If you’d like to learn more about how we can help you fight to prove your inability to work and recover the denied disability benefits you deserve, call our office at (888) 321-8131 to schedule your free case evaluation today.

Improving Your Claim

How Can I Improve My Chances of Getting My Disability Insurance Application Approved?

Securing approval for your disability insurance application can often feel like running an obstacle course designed by an insurance company. Every detail in your application really does matter—and unfortunately, most insurers will scrutinize your paperwork, searching for gaps or inconsistencies to justify a denial.

Here are practical steps you can take to put your best foot forward:

• Be Thorough and Accurate: Complete every section of your application honestly and fully. Double-check that your answers are accurate and that you haven’t left any important fields blank.
• Gather Comprehensive Medical Documentation: Collect up-to-date medical records that outline your diagnosis, treatment, and current limitations. Include details from your treating physicians that clearly state how your condition affects your ability to work.
• Customize Physician Statements: Ask your doctor to fill out a statement specific to your situation, highlighting your unique restrictions and limitations, rather than using a generic form provided by the insurance company.
• Document Symptoms and Impact: Keep a daily journal of your symptoms and how they impact your ability to perform work duties and daily living activities. This can be helpful evidence if your case is questioned.
• Watch for Insurer Correspondence: Respond promptly to any requests from the insurance company for forms, interviews, or exams. Stay organized, and keep copies of all communication.

Above all, take the time to review your policy so you understand its terminology and requirements. The better prepared and documented your application, the less room there is for the insurance company to argue against your claim. If you’re unsure about a particular step or want additional peace of mind, consulting with a disability insurance lawyer—even just for guidance—can make a real difference.

The Impact of Knowledge in Disability Claims

Navigating a disability claim with major insurers like Unum, Lincoln Financial, or New York Life can be overwhelming and, frankly, discouraging. Policyholders often encounter confusing requirements, inconsistent communication, or denials—even when they believe they have strong medical support. One of the most common reasons claims fail early on is not understanding how disability insurance companies actually evaluate evidence.

Before you even submit a claim, having the right information can make a meaningful difference.

Why Most Disability Claims Run Into Trouble

Insurance companies do not evaluate claims the way most people expect. They look for specific proof, apply strict policy definitions, and often rely on technical gaps—rather than medical reality—to justify denials. Many claimants unknowingly weaken their own cases by making avoidable mistakes, such as:

• Submitting incomplete or inconsistent medical records
• Failing to tie symptoms to job duties
• Relying on diagnosis alone instead of functional limitations
• Misunderstanding policy definitions like “own occupation” or “any occupation”

These issues often arise long before an appeal is even necessary.

Start With the Right Guidance

Rather than rushing into representation at the application stage, many claimants benefit from first educating themselves on what insurance companies look for—and what mistakes to avoid. Our Top Ten Mistakes That Will Destroy Your Disability Claim book is designed to do exactly that.

The guide walks you through:

• The most common errors claimants make when filing disability claims
• How insurance companies use medical records and paperwork against you
• What evidence matters most—and what often gets ignored
• How seemingly harmless statements can undermine your credibility

Understanding these pitfalls upfront can help you submit a stronger claim and reduce the risk of an early denial.

Unique Challenges Faced by Professionals in Disability Claims

Professionals such as physicians, soldiers, police officers, and pharmacists often encounter unique hurdles when filing disability insurance claims. These individuals might have highly specialized duties, rigorous licensure requirements, or face skepticism from insurance companies about the true extent of their disabilities.

For instance, insurance carriers may question whether a physician could perform a related, but less demanding, medical role—even when their medical restrictions say otherwise. Similarly, professionals in law enforcement or pharmacy might find their claim scrutinized if their job involves both mental and physical demands, and the insurer may underplay the complexity of their duties.

Common obstacles include:

• Overly Generalized Claim Forms: Insurers often provide generic forms that don’t account for the nuanced job functions or specific limitations unique to each profession.
• Demanding Proof and Documentation: High standards of proof are often expected, and the insurance company may not accept medical opinions at face value, even from multiple respected providers.
• Financial and Emotional Stress: In addition to dealing with their health challenges, professionals are often responsible for significant financial obligations, both for their families and their practices or teams.

How Legal Representation Makes a Difference

An experienced disability insurance lawyer can be instrumental in overcoming these challenges. Here’s how attorneys help:

• Tailored Evidence Collection: Lawyers understand the importance of gathering customized documentation—including physician statements tailored to a client’s specific job requirements and medical condition.
• Navigating Policy Language: Attorneys can decode the complexities of disability policies, making sure that the insurer upholds the actual terms of the agreement rather than relying on blanket denials.
• Negotiation and Advocacy: Legal experts are well-versed in communicating directly with disability insurers, ensuring that legitimate claims are properly evaluated, and, when necessary, applying the appropriate external pressure to secure rightful benefits.
• Reducing Stress: By handling communications and appeals, lawyers reduce the emotional and administrative burden on professionals, allowing them to focus on recovery and their families.

Having an advocate who is familiar with both the demands of your profession and the tactics disability insurers use can make the process less daunting—and often leads to more favorable outcomes.

Additional Information

Do I Have a Unum Disability Insurance Policy?

Unum Group is one of the largest disability insurance companies and has purchased and assumed disability insurance policies from several other insurers:

• Unum Life Insurance Company
• Provident Life and Accident
• Unum Provident
• First Unum Life
• Colonial Life & Accident Insurance
• The Paul Revere Life Insurance Company

If your policy is from one of these companies, you have a Unum policy. There may be some similarities between disability insurance policies, but the policyholder can customize them. For this reason, you need to review your disability insurance policy and consult a disability attorney if you have any questions about your coverage.

When Legal Help Becomes Necessary

If a claim is denied, terminated, or delayed despite your best efforts, that is often the point where legal representation becomes critical. At the appeal stage, deadlines tighten and evidence rules become more rigid. Mistakes made during the appeal process are much harder to fix. Having an experienced disability attorney step in at that point can help level the playing field and challenge improper insurer tactics.

If you’d like to learn more about how we can help you fight to prove your inability to work and recover the denied disability benefits you deserve, call our office at (888) 321-8131 to schedule your free case evaluation today.