Thursday, May 15, 2014

Unum Field Visit

I represent an owner of a landscaping business who had purchased a disability insurance policy from New York Life, which was subsequently taken over by Unum. I filed a claim under the policy because the claimant’s diabetes prevented him from working.

During the claim process, Unum made several demands that were outside the terms of the policy. Unum requested tax records, but there was no provision entitling Unum to do so. However, that request was moot as no tax returns were filed during the requested period. 

Unum also wanted the claimant to meet with one of its Field Representatives to understand his occupation and duties.  I explained that there was no need for a meeting because any questions could be asked in writing, and that since a Field Representative is not a vocational expert the request was illogical. More importantly, I pointed out that the policy does not permit Unum to use a Field Representative to question the claimant, and wrote Unum that it they believed I was wrong, then they should identify the section of the policy that they claimed empowered Unum to do so. Unum never responded. 

Unum also asked if the claimant had applied for Social Security Disability (“SSD”) benefits, and for an authorization to obtain his SSD file. I told Unum that the claimant would not comply because there was no offset in the policy for SSD benefits, which rendered the request irrelevant. 

I suggested that Unum could make the request relevant by providing a notarized letter stating that Unum would accept the decision of the Social Security Administration as to whether the claimant was disabled under the policy. Once again, Unum never responded. I was advised today that Unum is approving the claim.

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