You did everything right. You paid your premiums. You followed the doctor’s orders. You filed your claim with Unum because your injury or illness knocked you out of work. Then a letter shows up in the mail with that cold, sharp word: denied. Your stomach drops. All people need to fulfill their financial duties because the rent for Oakwood Place remains unpaid.
Stop and take a moment to yourself if this situation applies to you. You have rights. Learning to exercise your rights before starting a lawsuit will help you avoid unnecessary expenses and stress and time loss.
Why Getting A Lawyer Helps (And Won’t Break The Bank)
The paperwork alone can wear you down. The rules are fussy. The timelines are tight. Good Unum lawsuit attorneys do three big things:
- Translates doctor notes into claim-proof language
- Spots policy traps and missed deadlines before they bite
- Pushes back on weak “independent” exams or slanted file reviews
Many work on a “no win, no fee” basis. That means they get paid only if you win or settle. Ask about costs up front. No surprises.
A quick story: my neighbor Carlos (you’ve seen him walking his dog past the corner deli) messed up his back installing HVAC units. Unum said he could work “light duty.” Problem is, there’s no “light duty” when you’re lugging metal on ladders in January. His lawyer had his doctor spell out exact lifting limits and got a vocational expert to explain why the “light duty” wasn’t real in our area. That turned the tide.
What’s Unum, And Why Do They Deny Claims?
Unum stands as a top disability insurance provider which operates throughout the entire United States. Their job, in theory, is simple: if you can’t work because of a covered illness or injury, they help replace part of your income. But they’re also a business. Fewer payouts result in increased profits. The conflicting requirements between hospital staff and insurance providers produce administrative obstacles which cause postponed claims along with excessive documentation and ultimately results in claim denials.
Common reasons they say no:
- Not enough medical “proof” in the file
- The doctor’s note is too vague (“light duty” with no details)
- Surveillance or social media posts that seem to conflict with your limits
- The policy’s definition of “disabled” got stricter (more on that in a second)
Here’s a sneaky detail many people miss: lots of policies switch from “own occupation” to “any occupation” after 24 months. That means at first you’re disabled if you can’t do your specific job (say, construction on Main Street). Later, you’re only disabled if you can’t do any job you’re reasonably qualified for. That switch trips up tons of folks.
Read Your Policy Like A Map (Even If It’s Boring)
I know—insurance pages make your eyes glaze over. Still, spend an evening with a highlighter and a cup of tea. Key things to find:
- The definition of “disability” (does it change after a certain time?)
- The elimination period (how long you must be out before benefits start)
- Pre-existing condition rules (often look back 3–12 months before coverage)
- Limits for mental health claims (commonly capped at 24 months)
- Offsets (Social Security Disability or workers’ comp might reduce the check)
Why this matters: Unum will use every line in that policy. You should, too.
Your First Move After A Denial: Appeal The Decision
Before you even think lawsuit, you usually need to appeal. You typically have 180 days from the date on the denial letter to send your appeal. Miss that window and, well, doors slam shut. Set a reminder on your phone. Stick a note on the fridge. This deadline is not flexible.
Here’s the part most people don’t realize: under employer policies (the kind tied to your job), your appeal is your last, best chance to add evidence. If you later end up in federal court, the judge mostly looks at what’s already in your claim file. New records? New letters? Often too late. So build the file now.
What to add in your appeal:
- Detailed letter from your doctor with your exact limits (how far you can walk, lift, sit, stand; how often you need breaks)
- Your job description and why your limits don’t fit those duties
- Supportive notes from specialists (pain management, neurology, cardiology)
- Imaging and test results (MRIs, EMGs, labs)
- A personal statement describing a typical day—what hurts, what helps, and for how long
- Statements from people who see you struggle (a spouse, coworker, or even your barber if you’ve cancelled three times)
Use plain language. Dates help. So do specifics. “I can’t sit for more than 20 minutes” is stronger than “sitting is hard.”
What If Your Appeal Is Denied?
Now the road forks.
- Employer policy? Your case likely falls under a federal law called ERISA. That means you’ll file in federal court. Deadlines can be short—often one year from the final denial. The judge usually reviews the paper record (no jury, no new evidence in most cases).
- Individual policy (you bought it yourself)? You may not have to appeal first, and you might have a longer deadline—often up to three years from denial. Many states also allow “bad faith” claims for unfair handling, which can raise the stakes. Rules vary a lot by state, so it’s smart to ask a lawyer early.
I wish it were simpler. It’s not. But you’re not out of options.
What A Lawsuit Against Unum Actually Looks Like
Let’s keep it real. A lawsuit isn’t a TV courtroom brawl.
- Your lawyer files a complaint that explains why Unum got it wrong.
- Unum responds. Everyone trades documents.
- In ERISA cases, the judge reviews the claim file and the legal briefs. There may be no live testimony. Think of it like a very serious book report.
- In non-ERISA cases, there can be depositions, experts, and sometimes a jury.
- Many cases settle before a final decision. Why? Risk. Time. Cost. Pressure.
What can you win? Back benefits, interest, and sometimes attorney’s fees. In individual policies, possibly more, depending on your state. Keep expectations steady—no windfalls, just fairness.
Real-Life Snapshots: What Could This Look Like?
The Oakwood back injury: You slipped a disc. You can’t stand longer than 15 minutes. Unum points to a clip of you carrying a grocery bag. Your appeal includes your MRI, a note that the bag held paper towels, and a statement about pain flares after errands. You win your appeal.
The Main Street migraine case: You’re a bookkeeper staring at screens all day. You get 12 migraines a month. Unum says there’s “no objective evidence.” Your neurologist writes a detailed note about aura, visual issues, and failed medications. You submit a headache diary and a letter from your boss about missed days. Appeal gets denied anyway. A federal judge later rules the file shows a clear pattern and orders benefits.
The mental health limit: You’ve been out with major depression. You hit the 24-month cap in your policy. Benefits stop, not because you’re better, but because the policy says so. A lawyer checks whether your physical problems also qualify, and whether the policy’s limit was applied fairly. Sometimes a narrow door is still a door.
What About Money While You Wait?
It’s okay to ask about other support. Social Security Disability may help. Some folks look at short-term disability, state benefits, or part-time work within doctor limits. Careful, though: working can affect your claim. Get guidance before you clock in.
How Long Will This Take?
Appeals can run a few months. Lawsuits can go 6–18 months, sometimes more. That’s a long road, especially when your back hurts and the rent’s due. But many cases settle earlier, once Unum sees you’re organized and serious.
When Should You Call A Lawyer?
- Right after a denial (best)
- Before sending your appeal (great)
- After an appeal denial (still helpful, but the record is set)
Bring your policy, denial letters, medical records, and your journal. The more you bring, the faster they can help.
The Bottom Line
You’re not powerless. You have rights, timelines, and tools. Unum may be big, but facts, deadlines, and a clean paper trail are bigger. Keep notes. Keep calm. Keep going.
One last nudge: tonight, set two reminders—one for your appeal deadline and one to update your claim journal every Sunday. Small steps beat big fears. If you need backup, call a disability lawyer who speaks fluent Unum and plain English. Sometimes just showing you’re ready to fight is enough to bring a fair deal to the table.
Your health comes first. Your peace of mind is worth protecting. And yes—you do have a real chance.
