When neither the Insurance Company nor the Claimant Can Produce the Original Disability Policy, the Burden is on the Plaintiff to Prove the Terms of His or Her Policy

Be Sure To Maintain a Copy of Your Original Disability Policy

It is extremely important to make sure you maintain a copy of your disability policy once it is initially provided by your insurance company. If your policy is lost, it is possible that your insurance company may be able to provide you with a copy, but they are not obligated to do so, nor are they obligated to maintain one. In order to make sure that your insurance company abides by the terms of your policy, it is pertinent that you keep your policy in a safe place where it can be found several years down the road should you need to file a claim. Claimants often misplace their policy and rely on the insurance company to provide them with a copy. However, more often than not, the insurance company does not retain a copy of the policy. Courts tend to rule that it is the plaintiff’s burden to prove the terms of his or her policy, and if they cannot produce the policy, then the ruling is often in the favor of the insurance company.

In the recent case of Beasley et al v. Unum out of the Eastern District of Michigan, the Plaintiff was insured under an ERISA governed plan with Unum and became disabled in 1979. Unum paid his benefits for several years and then terminated them once the Plaintiff turned 65. The Plaintiff appealed the decision and then brought suit against Unum claiming that the original policy did not contain a provision terminating benefits at age 65, claiming the benefits were to be paid throughout his lifetime. Unum did not have a copy of the original policy, but argued that the specimen policy states benefits terminate at age 65. Unfortunately for the Plaintiff, he also could not produce a copy of the original policy, arguing that it was Unum’s burden to maintain a copy of the policy as well as to establish the terms and conditions of the policy. The Court disagreed, granting summary judgment for the Defendant, Unum, holding that the Plaintiff has the burden to establish entitlement to benefits. Therefore, the plaintiff was not entitled to receive any benefits beyond age 65 from Unum in accordance with the terms of the specimen policy.

The above case demonstrates how important it is to maintain a copy of your original policy and not to rely on your employer or insurance carrier to do so. If you fail to do so you could lose your rights to your disability benefits.

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There is one comment so far

  • Thank You for putting this out there Rachel. In 19 years working as a vocational counselor in LTD and STD claims I was amazed at how few claimants actually had a copy of any form of the plan, be it the summary plan document or the actual policy. As I now seek to establish a service providing assistance to STD and LTD claimants, my first recommendation is always to pursue and obtain a copy of the SPD at the least and, better yet, the policy. At the companies I worked for, we were directed to refer claimants back to the employer for the SPD or policy. There were occasions when the plan was amended for a customer, typically as of a new calendar year, but the updated policy or even SPD was not provided to the claims team by the customer or sales team. The claims team would decide claims based on an outdated plan. Unfortunately, I don’t believe the policy is typically provided to an employee at the initiation of coverage and employees don’t think to request it until it is too late.

    Joseph Atkinson, MS, CRCJan 14, 2016  #1

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