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.

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, CRC Jan 14, 2016  #1

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Questions About Hiring Us

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.

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.

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I was referred to Dell & Schaefer, and specifically attorney Stephen Jessup, by a local lawyer in my home state of Vermont. I was advised that Dell & Schaefer would be better suited to handle my appeal for LTD with Unum insurance company. I was a little hesitant about using an out of state law firm, but I am certainly glad that I did. There was less than 60 days left for me to appeal Unum’s original denial but Steve and his aide Vanessa got to work right away on it. I was given a detailed list of items to accomplish, things I and even my doctors had not thought of.

I believe that Steve and Vanessa worked hard and fast to set up appointments for me and to amass an appeal that Unum ultimately could not deny. One very nice caveat of having Steve and Vanessa working for me was I no longer had to have any more frustrating, time consuming and energy draining dealings with Unum myself. They handled everything. I used to be upset for days after speaking to a Unum rep. As far as the not local aspect of a law firm, my worries were unfounded. I was kept up to date immediately via email and telephone and I never had the feeling that I was being ignored or that my questions were going unanswered. As busy as I’m sure my team was, in many ways I felt like I was their most important client by how good the communication was. They understood that this very long process weighed heavily on me and were optimistic and diligent on my behalf when I no longer could be.

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