Question
Is Unum responsible for providing my claim file? How do I move the process along?
Hi there – Unum is reviewing my long term claim. They are certainly dragging their feet – it’s been months now and they continue moving the goal posts. I requested in writing the claim file and all materials associated with the claim. I received the policy itself, but nothing else. The “lead specialist’s” letter included with the policy indicated “we can discuss your request for materials” after the decision has been made. Must not Unum provide my claim file upon request? After all there has already been a short term claim paid. There are specific items I requested in writing regarding short term benefits that I’ve got to review but that were not provided. They claimed there was an over-payment I’d like to contest. What can I do to compel Unum to comply with my info requests? Is it too early in the process for your services to be useful: I believe you normally wait until long term is denied?
Answer
Mr. R, Please feel free to contact our office to discuss how we may be able to assist you. Under ERISA, Unum would have 45 days to render a decision on your claim for benefits, with the possibility of an extension and/or tolling of time while waiting for information to be submitted. With respect to your request for information, an insurance carrier is not obligated to provide a claim file until there has been a denial of benefits, so it is no surprise they are stonewalling you on the request.
