A New Way for Unum Lawsuit Plaintiffs to Fight Biased Medical Review

. By Anne Wallace

New DOL rules effective on April 1 may aid Unum lawsuit plaintiffs in disputes about unfair medical review.

Unum lawsuits frequently claim the insurance behemoth relies on unfair, inadequate or biased medical review to deny long term disability benefits. If and when the case goes to trial, courts tend to defer to whatever the plan administrator decided. A plaintiff could get depressed.

New DOL rules may change that, however, because they affirmatively require an impartial and independent review process.

What changes?

As set out in the Federal Register, the new rule has seven major provisions. Many of them are fairly procedural and seem to restate existing rules about specific descriptions of the reason for claim denial, timing and access to appeals. One provision, however, jumps out:

"Claims and appeals must be adjudicated in a manner designed to ensure independence and impartiality of the persons involved in making the benefit determination."

Two questions come to mind: (1) does this shift the burden of proof to the plan to prove that its review process is impartial (rather than forcing a disability claimant to prove that the review was unfair); and (2) what kind of evidence can be used to show reviewer bias.

What the changes mean and how important they may be, will not really be clear until some litigation happens. In the meantime, however, the armies of lawyers and consultants who represent large benefit plans like Unum have been racking up the hours producing helpful client memos full of defensive strategies.

That idea works both ways.

Action items for Unum plaintiffs (and their lawyers)

Here is a smattering of offensive strategies for Unum lawsuit plaintiffs:

The new DOL rules may, at long last, be good news for plaintiffs in long term disability denial cases. Whether that turns out to be true may depend on proactive efforts by attorneys and plaintiffs at the outset, when the rules are still taking shape through litigation.

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