Disability Insurance thru Employer

[JulianaP]

What is the name of your state? Ohio
I'm at my wits end! I have been extremely ill for nearly 2 years. My Long-term Disability Co., Unum Provident, gave me benefits from 8/01 through 1/02 then they closed my claim. I appealed and then was denied again! Every item in their denial letter I have more than covered with medical testing, doctors, etc... I do not see how they are able to deny me. My question is, does anyone know where I could look to find out the regulations that cover the insurance co? I need to get a jump start on all of this due to the money not coming in!

Thanks!

 

[CIAA]

JulianaP,

Your coverage would be an ERISA plan and is regulated and enforced by the U.S. Department of Labor. You should be able to find the regs. on their website.

In a nutshell, ERISA plans are generally exempt from state laws and fall under "Administrative Law". What this means is that to overturn the denial you will have to prove that the denial is without any reasonable basis. This can be very difficult to do and how you handle your appeal is crucial because, if you decide to take the case to litigation the evidence is generally limited only to what is in the administrative records. You will need to find an attorney who specializes in ERISA or Labor law, and this may be difficult to do for many reasons. In the meantime get an insurance expert to help you, as it is important not to let any appeals deadlines pass.

Currently, Unum is being sued by one of their medical directors who is alleging that they encouraged improper claims and appeals reviews.

Please feel free to contact us if you wish to discuss your situation further.

Hope this helps.