Pre-existing situation clauses and limitations are comparatively uncommon in short-term incapacity insurance coverage insurance policies. Nonetheless, you must by no means assume that UNUM didn’t sneak exclusions and exceptions into the high-quality print of your incapacity insurance coverage coverage.
UNUM is the most important incapacity insurance coverage firm in america, 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 situations usually tend to want to gather incapacity than others. So, they generally write insurance policies that make it simpler for them to disclaim these claims.
At Bryant Authorized Group, we now 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 could decide your declare’s success, ways UNUM makes use of to disclaim claims, the distinction between brief and long-term incapacity claims, and the way a incapacity lawyer may help you struggle again.
Quick-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. While you or your employer buy a short-term incapacity coverage, you’re agreeing to its particular phrases and situations. Typically, insurers embrace limitations and exclusions for pre-existing situations.
Most individuals have certainly one of two sorts of short-term incapacity protection:
- ERISA: you might have short-term incapacity protection by an employer-sponsored plan. A federal legislation, ERISA (Worker Retirement Revenue Safety Act of 1974) applies to your declare.
- Particular person: you bought your individual short-term incapacity coverage from a dealer. State legal guidelines will apply to your declare.
Regardless, in the event you file a declare for short-term or long-term incapacity, your coverage’s phrases and situations will assist decide whether or not you’re eligible for advantages. Ensure you evaluation your coverage or plan paperwork earlier than you file a declare.
Insurance coverage corporations like UNUM are eager on avoiding payout on such claims, typically going to nice lengths to show your declare is invalid. Some short-term incapacity plans embrace a pre-existing situation clause. If it applies to your incapacity declare, you would possibly face a prolonged ready interval earlier than you’ll be able to file a declare—otherwise you is perhaps fully ineligible for month-to-month profit funds.
Need assistance deciphering the high-quality print in your coverage? Schedule a consultation with certainly one of our incapacity insurance coverage attorneys.
What to Look Out for if You Have an ERISA Plan
Most employer-sponsored short-term incapacity insurance policies don’t embrace a pre-existing situation exclusion or “look-back interval,” however some do. Ensure you fastidiously evaluation your Abstract Plan Description (SPD) or different plan paperwork—and seek the advice of with a incapacity insurance coverage lawyer in the event you need assistance deciphering their language.
If there’s a pre-existing situation clause, it would make you ineligible for advantages for a time period. For instance, in the event you obtained 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 may help you perceive the exact phrases and situations that apply to your declare.
What to Look Out for if You Have a Personal Incapacity Insurance coverage Coverage
When you have a non-public short-term incapacity coverage, you might have much more management over its phrases and situations. While you bought the coverage, you picked from a wide range of choices, which could have included pre-existing situation exclusions or limitations.
Nonetheless, you may not have totally understood the implications of those choices on the time. When you’re 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 sudden occurs, you’re left with longer ready durations, extra crimson tape, and even lack of protection.
Our workforce may 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 could attempt to deny your declare by skewing your medical data. Insurance coverage adjusters will look by your medical remedy historical past, together with checks, physician’s visits, and medicine 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 remedy, and your issues resolved themselves.
Though you recognize you pulled a muscle doing garden work, UNUM would possibly 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 need to deny claims like yours, so you will need to have assist all through the method. Consulting with an skilled short-term incapacity lawyer, even earlier than submitting your declare, may help the general success and ease of your case. Having an legal professional accessible to you’ll be able to aid you perceive the trade jargon and keep away from potential pitfalls that might stop you from getting the compensation you deserve.
Our workforce 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 information to construct a authorized technique that can get you justice. Having an skilled workforce in your facet can stop 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 evaluation all of your medical data, seek the advice of together 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 Quick-Time period Incapacity
In case you undergo from a persistent well being situation, you will need to look fastidiously over the phrases and situations of your incapacity insurance policies, each brief and long-term. Even when your short-term incapacity coverage doesn’t embrace exclusions in your pre-existing situation, your long-term incapacity coverage would possibly. Even insurance policies provided by the identical employer could have totally different situations.
This distinction in coverage phrases isn’t unusual and prevents claimants from getting the assistance they want if their situations worsen. Make sure to fastidiously evaluate your insurance policies to make sure you can obtain incapacity protection no matter severity. If you’re 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 Quick-Time period Incapacity Pre-Present Situation Instances
In case you or a beloved one is battling a UNUM short-term incapacity insurance coverage declare, you have to communicate with a incapacity lawyer who understands the insurance coverage firm’s ways. Bryant Authorized Group is among the premier incapacity legislation corporations in Illinois, and we now 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.
