Misrepresentation By Claimant Results in Unum Disability Claim Denial

Unum disability claimants need to be aware that when filling out an application for disability insurance benefits it is necessary to disclose your medical history accurately and to make sure your insurance agent is doing the same. Should the insurance company discover a material misrepresentation, the policy could be rescinded, and the claimant could be required to pay back any and all benefits previously paid and then be subject to a fraud investigation. The disability carrier must be able to prove that a misrepresentation was fraudulent. Let’s take a look at recent court decision from Michigan in which a Unum disability claim denial was upheld due to a misrepresentation while applying for a UNUM disability policy.

Plaintiff applied for disability insurance with help from his insurance agent. Plaintiff initially left unanswered the medical portion of the application. Subsequently, the application was filled out by the agent answering all questions “no” except for one which asked “have you ever been diagnosed or treated for disorders of the spine.” Unum’s representative called the Plaintiff and asked him what the answer was to that question and he stated the answer was “no”. Based on that info, Unum issued the policy to the Plaintiff. The policy contained an “incontestability clause” which prevented Unum from denying benefits because of a misstatement or omission on the application 2 years after the policy effective date, with an exception for fraudulent misstatements or omissions. Plaintiff filed a claim 2 years and 3 weeks after effective date for a disease of the spine. The APS from his physician revealed that he saw the Plaintiff nearly a year before he applied for the policy. Unum’s investigations revealed that the claimant had sought treatment back in 2008. Unum denied disability benefits and rescinded his policy.

Plaintiff hired a Michigan disability attorney (not Dell & Schaefer) and sued Unum for his benefits and the agent for malpractice. The District Court granted summary judgment to Unum agreeing that there was material misrepresentation as well as to the agent (Correa) as the suit was filed beyond Michigan’s statute of limitation. The Michigan Court of Appeals affirmed the lower court’s decision stating that Unum would not have issued the policy had it known about the Plaintiff’s medical history as Unum suffered an injury when it relied on Plaintiff’s misstated medical history.

Our firm handles Unum disability claim denials on a daily basis and we always offer a free consultation to discuss your claim options.

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There are 2 comments

  • Willette,

    Pre-existing condition is a very common reason for a disability insurance company to deny benefits. You must file your appeal within 180 days and that deadline appears to be approaching quickly. Please contact us immediately and we will take a look at your denial letter to see if we can help you.

    Gregory DellDec 11, 2012  #2

  • I took out a short/long term disability policy 11/2011 (during my employment and early enrollment) and was not required by the insurance company to provide my medical history/background at the time. Premiums were deducted from my payroll beginning 01/2012 through 05/2012. However, I became disabled in 05/2012 (with emphysema) and could no longer work; prior to that I was working full time with the company but was unaware that I had emphysema until I began experiencing breathing problems and sought medical treatment for my symptoms which ultimately led to my resigning from my job because of the emphysema. I filed my disability claim with the insurance company in August 2012 but was denied because the company felt my condition was pre-existing. Am I entitled to those disability benefits or a refund for all funds deducted from my payroll while I was employed? I have 180 days to appeal the decision which I anticipate doing. It has now been 120 days. Your response is greatly appreciated.

    Willette GrahamDec 10, 2012  #1

FAQ

Do you help Unum claimants nationwide?

We represent Unum clients nationwide and we encourage you to contact us for a FREE immediate phone consultation with one of our experienced disability insurance attorneys.

Can you help with a Unum disability insurance policy?

Our disability insurance lawyers help policy holders seeking short or long term disability insurance benefits from Unum. We have helped thousands of disability insurance claimants nationwide with monthly disability benefits. With more than 40 years of disability insurance experience we have helped individuals in almost every occupation and we are familiar with the disability income policies offered by Unum.

How do you help Unum claimants?

Our lawyers help individuals that have either purchased a Unum long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer.

Our experienced lawyers can assist with Unum:

  • ERISA and Non-ERISA Appeals of Disability Benefit Denials
  • ERISA and Non-ERISA Disability Benefit Lawsuits
  • Applying For Short or Long Term Disability Benefits
  • Daily Handling & Management of Your Disability Claim
  • Disability Insurance Lump-Sum Buyout or Settlement Negotiations

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

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When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

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Sol S. (California)

I can’t find the right words to describe how grateful I am for the wonderful job you have to get my long term disability claims approved. I did file claims on my own at first but both got denied. It was heartbroken because I did pay monthly premiums for ten years.

When I got sick and not able to work, the insurance company said that I don’t qualify for any benefits. Atty. Alex and his angels were heaven-sent to me. Thank you for taking both of my cases. I was at my very last breath and just don’t know what else to do and had no where else to turn to until I got hold of you, wonderful people. You are definitely a blessing and a breath of much needed fresh air. I may not be the most profitable client of yours but I would like to tell you that I am one of your most grateful client. Thank you so much for helping me get what I deserved from the greedy insurance companies. Without you, I wouldn’t think the insurance companies won’t pay me anything. They will keep finding ways to deny my claims. Again, thank you for a job well done.

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