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Posts Tagged ‘Suspension of Benefits’

stop-claimsAs if Unum doesn’t have enough unfair claims practices and strategies, the company seems to be “suspending benefits” in order to compel claimants and insureds to do what they request, when they request it. Ignoring the fact that physicians and others involved in the disability claims process do not work on Unum’s timeline, the company is now sending out letters, suspending benefits until insureds comply, or until the company decides to pay.

Technically, a “claim suspension” or cessation of payment is not a claim denial and therefore the claimant is denied appeal rights during the period of time benefits are not paid. In my opinion according to the policy contract itself, any insurance company is required to pay claims (assuming insureds meet the definition of disability) until such time as there is sufficient proof to deny. Contracts do not stipulate in the policy document that insureds can “suspend” benefits.

There is always a danger with Unum that once benefits are suspended, the company¬†will require a preponderance of proof of claim to its own satisfaction, and deny reinstatement of benefits even when insureds provide whatever it was Unum requested. As many of you know there are times when its unclear whether Unum ever receives enough proof of claim to pay claims. It concerns me that Unum may exercise its own conflict of interest and keep “benefits suspended” forever leaving insureds without recourse at an appeal level.

Another concern is that Unum could “suspend benefits” even when it’s requests are unreasonable, burdensome and impossible to provide. The most recent example is Unum’s request for 10 years of personal and business tax returns when neither the IRS nor insureds are required to keep tax returns that long. Claimants don’t get paid, but Unum leaves the door open to provide the information for possible reinstatement. Of course, insureds can’t provide what doesn’t exist leaving Unum to benefit by its own unreasonable requests.

Insureds with suspended benefits should always provide the information requested by Unum, but if benefits are not immediately restored, insureds should find themselves a good attorney and file an appeal. In my opinion, there is a line that is crossed when suspended benefits are not immediately restored after requested information is provided.

Unum has contractual obligations under the policy to either pay or deny claims. “Suspending” benefits is an out of contract pay status that could leave claimants with unpaid benefits indefinitely at Unum’s discretion.

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