• Is Unum Denying More Disability Benefit Claims Than Usual?
  • Unum / Provident / Paul Revere Long & Short Term Disability Claims (Ep. 13)
  • Unum Disability Denial & Appeal Tips
  • Deposition of Insurance Co. Employee in a Disability Insurance Benefits Denial Lawsuit (Ep. 19)
  • Did Disability Insurance Claims Examiner Understand A Physician's Job Duties? (Ep. 22)
  • What relationship does UNUM have with hired doctors in disability insurance claims?
  • UNUM Lump Sum Settlement / Disability Lump Sum Buyout
  • 24 Month Self Reported Symptoms Limitation in Unum Disability Policy Case Study
  • Tips About a Unum Medical Examination in a Disability Benefit Claim

Unum Disability Claim Dismissed For Failure To File a Timely Claim

In Wilson v. Provident Life and Accident Insurance Company, Woodrow K. Wilson, a shareholder of the Woodrow Wilson Construction Company, Inc., purchased an individual disability insurance policy from Provident in 1993. On April 18, 2013, for the first time, Wilson filed a claim for disability stating he had been unable to work since October 13, 2008, due to osteoarthritis pain in his shoulder, left knee and low back. Provident denied his claim finding that, based on the information it had available, the plaintiff was not disabled on that date. Provident noted the tardiness of the claim made it difficult to evaluate and impossible to have an independent medical exam. After exhausting his administrative appeals, the plaintiff filed this lawsuit.

Provident moved to have the lawsuit dismissed on the grounds that:

  1. Wilson failed to provide timely proof of loss which was required to be filed within 90 days of his alleged disability date; and,
  2. he failed to file the lawsuit within the three-year time frame established by the contractual terms of the policy. The court agreed with Provident and found that its contractual terms establishing time limits was “in conformance with law.” The court determined there was no exception to the 90-day filing requirement that would excuse Wilson’s tardy claim. The court also determined Wilson’s lawsuit was filed beyond the three-year statute of limitations and accordingly dismissed the lawsuit.

Wilson’s Claim for Benefits Was Untimely

Wilson admitted that October 13, 2008, was the date upon which he claimed he became disabled. He failed to file proof of his disability until April 18, 2013. The contract allowed for a late claim to be filed beyond the 90 day deadline if plaintiff could submit proof that it was legally impossible to file a claim within the time limit or at least not reasonably possible to file one. The only reason Wilson gave for his late filing was that he “hoped” he would get better. The court found that “Wilson’s explanation does not demonstrate that it was not reasonably possible for him to file his notice and proof of loss timely.”

Wilson’s Lawsuit Was Also Untimely

The clear language of the policy allowed a lawsuit to be filed three years from the time proof of loss was required, not from the time the claim was denied. In this case, considering all time frames in the light most favorable to the plaintiff, the very latest he was required to file proof of loss was May 13, 2010. Three years from that date would be May 13, 2013. He did not file his lawsuit until August 11, 2014. Since this was beyond the filing date required by the statute of limitations, the court dismissed his lawsuit as untimely.

This case was not handled by our office, but it may provide claimants guidance in the importance of filing a timely claim for disability benefits and in complying with the applicable statute of limitations for filing a lawsuit. If you need assistance with a similar matter, or for any other question concerning your claim for disability benefits, please contact any of our lawyers for a free consultation.

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Questions About Hiring Us

Do you help Provident claimants nationwide?

We represent Provident 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 Provident disability insurance policy?

Our disability insurance lawyers help policy holders seeking short or long term disability insurance benefits from Provident. 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 Provident.

How do you help Provident claimants?

Our lawyers help individuals that have either purchased a Provident 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 Provident:

  • 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.

How can I contact you?

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.

Dell & Schaefer Client Reviews   *****

EH, M.D.

I am a physician with a long medical history including cancer, arthritis, peripheral vascular disease, and Complex Regional Pain Syndrome (formerly RSD). I expected to retire early. However, my health and work deteriorated rather rapidly. Suddenly I was no longer working and needed help negotiating my benefits. The first two attorneys I met were personally recommended. I soon learned that they had either limited or no experience with private LTD policies. I searched the internet for more information about Long Term Disability claims. The Dell & Schaefer website kept popping up with the answers to my questions. I liked both the text explanations and the videos. With nothing to lose, I requested a free consultation.

From the beginning, Attorney Steven Dell and legal assistant Merlin Bryan have been consistently honest, professional and patient. During my initial phone conversation with Steven Dell, it was clear that he understood both my medical conditions and my work situation. He had already read my LTD policies and was familiar with both the Unum and the Hartford insurance companies. Steven Dell is an excellent, thorough attorney. What does that mean? First, he knows what information is needed to submit a claim. Early on, he gave me a checklist of items he needed. At times, it felt like a part-time job, finding all of the financial, employment, and medical records he needed. Yet Steven Dell and Merlin Bryan were very patient whenever I had a health setback. They actually understood that folks with health problems have problems filling out paperwork. Second, he picked up the phone and contacted lawyers, human resources, personnel and insurance agents to keep the paperwork moving. Third, he is relentlessly thorough. I submitted hundreds of pages of paperwork. He actually seems to have read them! He double checked that dates, numbers and statements were accurate. He would not submit any paperwork until any discrepancies were discussed and resolved. At this time, two LTD claims have been approved and I have received my first benefits. I have nothing but respect and gratitude for this law firm. Thank you!

***** 5 stars based on 202 reviews

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