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Pre-existing situation clauses and limitations are comparatively uncommon in short-term incapacity insurance coverage insurance policies. Nevertheless, you must by no means assume that UNUM didn’t sneak exclusions and exceptions into the superb print of your incapacity insurance coverage coverage.
UNUM is the biggest incapacity insurance coverage firm in the US, and so they have a historical past of wrongfully denying short-term disability insurance claims. Insurance coverage corporations like UNUM know that policyholders with pre-existing circumstances usually tend to want to gather incapacity than others. So, they often write insurance policies that make it simpler for them to disclaim these claims.
At Bryant Authorized Group, now we have dealt with (and resolved) many instances the place our shoppers have been wrongfully denied their short-term incapacity advantages. On this article, our skilled incapacity attorneys will cowl how your coverage might decide your declare’s success, techniques UNUM makes use of to disclaim claims, the distinction between quick and long-term incapacity claims, and the way a incapacity lawyer will help you combat again.
Brief-Time period Incapacity Insurance coverage Pre-Present Situation Clauses Can Fluctuate
In contrast to Social Safety incapacity, incapacity insurance policy are operated by for-profit insurance coverage corporations. Whenever you or your employer buy a short-term incapacity coverage, you’re agreeing to its particular phrases and circumstances. Generally, insurers embody limitations and exclusions for pre-existing circumstances.
Most individuals have one in every of two sorts of short-term incapacity protection:
- ERISA: you’ve short-term incapacity protection by way of an employer-sponsored plan. A federal legislation, ERISA (Worker Retirement Revenue Safety Act of 1974) applies to your declare.
- Particular person: you bought your personal short-term incapacity coverage from a dealer. State legal guidelines will apply to your declare.
Regardless, should you file a declare for short-term or long-term incapacity, your coverage’s phrases and circumstances will assist decide whether or not you’re eligible for advantages. Be sure to overview your coverage or plan paperwork earlier than you file a declare.
Insurance coverage corporations like UNUM are eager on avoiding payout on such claims, usually going to nice lengths to show your declare is invalid. Some short-term incapacity plans embody a pre-existing situation clause. If it applies to your incapacity declare, you may face a prolonged ready interval earlier than you’ll be able to file a declare—otherwise you could be utterly ineligible for month-to-month profit funds.
Need assistance decoding the superb print in your coverage? Schedule a consultation with one in every of our incapacity insurance coverage legal professionals.
What to Look Out for if You Have an ERISA Plan
Most employer-sponsored short-term incapacity insurance policies don’t embody a pre-existing situation exclusion or “look-back interval,” however some do. Be sure to fastidiously overview your Abstract Plan Description (SPD) or different plan paperwork—and seek the advice of with a incapacity insurance coverage lawyer should you need assistance decoding their language.
If there’s a pre-existing situation clause, it’d make you ineligible for advantages for a time frame. For instance, should you acquired medical remedy for a pre-existing situation inside 90 to 180 days of protection after which file for short-term incapacity advantages inside 12 months, you may not be lined.
Once more, that is comparatively uncommon—and a lawyer will help you perceive the exact phrases and circumstances that apply to your declare.
What to Look Out for if You Have a Personal Incapacity Insurance coverage Coverage
You probably have a non-public short-term incapacity coverage, you’ve much more management over its phrases and circumstances. Whenever you bought the coverage, you picked from quite a lot of choices, which could have included pre-existing situation exclusions or limitations.
Nevertheless, you may not have absolutely understood the implications of those choices on the time. If you find yourself younger and comparatively wholesome, it’s tempting to pick a lower-cost coverage that has extra limitations and a stricter definition of incapacity. Then, when the surprising occurs, you’re left with longer ready intervals, extra pink tape, and even lack of protection.
Our crew will help you perceive your coverage language and put together your short-term incapacity declare.
UNUM Could Misread Medical Data to Deny Your Declare
Even you probably have short-term incapacity insurance coverage protection, insurance coverage corporations like UNUM might attempt to deny your declare by skewing your medical information. Insurance coverage adjusters will look by way of your medical remedy historical past, together with checks, physician’s visits, and drugs logs, on the lookout for proof of a “pre-existing situation.”
For instance, suppose you have been in a automotive accident and suffered a severe again harm. You file for short-term incapacity advantages whereas recovering from backbone surgical procedure. Throughout UNUM’s investigation, the adjuster notices that 12 months earlier than the crash you talked about a minor again ache to your physician. They prescribed you a brief course of ache medicine, and your issues resolved themselves.
Though you understand you pulled a muscle doing garden work, UNUM may argue that these twinges of ache have been indicators of a pre-existing herniated disc—and deny your declare.
What an Skilled Incapacity Lawyer Can Do to Assist Struggle Again
Incapacity insurance coverage corporations wish to deny claims like yours, so it is very important have assist all through the method. Consulting with an skilled short-term incapacity lawyer, even earlier than submitting your declare, will help the general success and ease of your case. Having an lawyer accessible to you’ll be able to assist you perceive the business jargon and keep away from potential pitfalls that would forestall you from getting the compensation you deserve.
Our crew has dealt with 1000’s of incapacity insurance coverage instances identical to yours and is able to assist. Our expertise coping with UNUM provides us the data to construct a authorized technique that may get you justice. Having an skilled crew in your facet can forestall wrongful denials and result in a faster decision for you and your family members.
We take a sensible, evidence-driven method to UNUM incapacity instances. Our attorneys will fastidiously overview all of your medical information, seek the advice of along with your physicians and different medical specialists, and construct a complete technique that helps your declare.
Pre-Present Circumstances and Lengthy-Time period Incapacity Insurance coverage: How It Differs From Brief-Time period Incapacity
When you undergo from a persistent well being situation, it is very important look fastidiously over the phrases and circumstances of your incapacity insurance policies, each quick and long-term. Even when your short-term incapacity coverage doesn’t embody exclusions to your pre-existing situation, your long-term incapacity coverage may. Even insurance policies provided by the identical employer might have completely different circumstances.
This distinction in coverage phrases shouldn’t be unusual and prevents claimants from getting the assistance they want if their circumstances worsen. You should definitely fastidiously evaluate your insurance policies to make sure you can obtain incapacity protection no matter severity. In case you are uncertain in case your insurance policies present the protection you want earlier than submitting a declare, seek the advice of an skilled incapacity insurance coverage lawyer.
Bryant Authorized Group: Chicago’s Premier Agency for UNUM Brief-Time period Incapacity Pre-Present Situation Circumstances
When you or a liked one is combating a UNUM short-term incapacity insurance coverage declare, you could communicate with a incapacity lawyer who understands the insurance coverage firm’s techniques. Bryant Authorized Group is without doubt one of the premier incapacity legislation corporations in Illinois, and now we have efficiently dealt with many UNUM claims.
To request your free session, contact our workplace by calling 312-561-3010 or finishing this brief online form.
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