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Unum's Catch-All: the Pre-existing Condition

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Rancho Mirage, CASteve says that Unum Insurance Company denied his claim because he has a pre-existing condition. "I applied for my long term disability benefits, but Unum's reasons for denial were so twisted out of shape, they don't make sense," says Steve, who points out that he was approved for social security benefits within a few weeks of filing his application.

"In 2006 I had several surgeries to treat a back injury," says Steve. "I returned to work as an operating room nurse and everything was fine, until I suffered a rapid onset of pain that caused my foot to drag. I constantly fell down and I was in such severe pain that I couldn't work any longer.

"It's so distasteful, the way they decide not to pay people—especially twisting everything into pre-existing conditions"
"Unum really gave me the run-around. At first they "lost" my claim, so I applied to social security and I was immediately approved. Then Unum sent me a letter stating that since social security approved me, there was no reason to get benefits from Unum.

"All along, Unum concentrated on a neck injury of mine, saying that would not cause foot drop. They ignored all the doctor's tests regarding my back problems, which did cause the drop foot. I have pointed out my back injury to Unum in numerous letters and calls but they won't address the issue.

"Although Unum has talked to my doctors, they managed to summarize my diagnosis inaccurately. They are not asking about my back injuries, only my neck. My doctors have documented my back injury and sent Unum all the reports—ignored again.

"My second appeal has been denied, so now I'm trying to find a lawyer to take my case to court. I figure Unum owes me at least $300,000. If I can't find a lawyer, I will have to take Unum to court myself, but I don't think that will fly too well because of course I'm not legally trained and I'll be up against their team of lawyers.

"Meanwhile, I've gone bankrupt, I've lost my home and I'm saddled with an inaccurate diagnosis from Unum.

"I talked to my insurance agent, who used to work for Unum. He said he quit because it's so distasteful, the way they decide not to pay people—especially twisting everything into pre-existing conditions—and they will devise so many tactics not to pay."

If Steve lived in New York, he'd likely have more success with his appeal. According to Unum's website, the Court of Appeals for the State of New York issued a ruling in 2007 which specifies that all group disability insurers must review certain New York disability claims that were denied on the ground that the insured's disability was due to a pre-existing condition. Policies, the court stated, "must be interpreted as establishing a waiting period, rather than a total exclusion, for coverage of disabilities that are due to a pre-existing condition."

As a result, Unum says it will review the claim of any insured covered under a fully-insured, group disability policy regulated by the state of New York and denied because of a pre-existing condition between June 28, 2004 and June 27, 2007.


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Posted by

My husband has been getting disability benefits from Unum since 2008. He was on the job as a fire fighter attempting to see if there was any way of rescuing a dog that had fallen off a cliff when he fell into a crevasse. He pinged between rock bluffs hitting his head all the way down. Original reports were that he fell 30 ft but it was later determined to be at least twice that.He was knocked unconscious and suffered a TBI. He became eligible for PPI benefits and applied but has been denied. We filed an appeal because of an unfair IME (11 mins to determine whole body). The appeal was sent back to the original doctor for another review with additional information. The same doctor that did the 1st IME was the one to make the final determination. My husband also has a cardiac condition so they are trying to say that he had to quit work because of the cardiac. I really hope that phone conversations with Unum are recorded as there were a few other things that they did that could result in a lawsuit.

Posted by

A specialist from Unum told me I was not eligible for long term disability because my Rheumatoid Arthritis that I have had since 2006 was a pre existing condition. If you have been under treatment for three months prior to request for disability then it was concerned pre existing. Let alone my cervical and lumbar spinal stenosis. I know the point of an insurance company is to make money, not pay it out. If I could get disability from Unum until my social security benefits, I would be content.


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