FAQs About The UnumProvident Settlement
These FAQs were approved by the Lead Regulator States to aid the public in understanding the settlement. If you have any questions regarding the information provided in the FAQs, please contact 1.866.278.4641.
What is the UnumProvident Settlement about?
The insurance regulators of all fifty states, the District of Columbia, and American Samoa participated in an examination of the claims handling practices of Unum Life Insurance Company of America, The Paul Revere Life Insurance Company (“Revere”), and Provident Life and Accident Insurance Company (“Provident”), the three disability insurers owned by UnumProvident Corp. The U.S. Department of Labor conducted a related investigation of UnumProvident’s practices involving employee benefit plans covered by the Employee Retirement Income Security Act. As a result of the examination and the DOL investigation, the three UnumProvident companies mentioned above plus First Unum Life Insurance Company, their New York affiliate, entered into a Settlement Agreement requiring the companies to change their claims practices and to reassess certain long term disability claims going back as far as 1997. The Settlement Agreement was amended in October 2005 to provide claimants with some additional protections.
What is the implementation date?
A number of deadlines in the Settlement Agreement are based upon the "Implementation Date." That date is January 19, 2005.
How can I get a copy of the Settlement Agreement?
The complete Examination Report, the Regulatory Settlement Agreements (“RSAs”), and exhibits and the Amendment To Regulatory Settlement Agreement (the “Amendment”) can be found online at the following Websites:
- Maine Department of Professional & Financial Regulation, Bureau of Insurance
- Massachusetts Division of Insurance (select What's New?)
- Tennessee Department of Commerce & Insurance
How do I know if I can have my claim reassessed?
A long term disability claim can be reassessed if it was denied or closed since January 1, 1997 for reasons other than the following: death of the claimant; withdrawal of the claim; claimant did not satisfy the elimination period; maximum benefits were paid; or, the claim was resolved through litigation or settlement.
However, if you have a reasonable basis for asserting that the Company improperly denied or closed your claim for any of the reasons listed above, you may also have your claim reassessed. (If this applies to you, for purposes of these FAQs, you are an “Other Claimant”).
In addition, if you have pending litigation against the Company challenging the denial or termination of your claim, and your lawsuit was filed after you received notice of the Claim Reassessment Process (“CRP”), or your lawsuit was filed before you received notice of the CRP but there has been a verdict or judgment on the merits before the completion of the reassessment of the claim, you may not have that claim reassessed as part of the CRP.
Will I be getting a notice?
If you are eligible to have your claim reassessed and your claim was denied or your benefits were terminated since January 1, 2000, you should have already received a notice from UnumProvident, and you should follow the instructions in that notice.
If your claim was denied or your benefits terminated between January 1, 1997 and December 31, 1999, the RSA provides that you will not receive a notice of your eligibility for the CRP from UnumProvident. However, if your claim was denied or your benefits terminated between January 1, 1997 and December 31, 1999, and your disability insurance policy was written by Provident or Revere, the Amendment provides that UnumProvident will mail you a notice of your eligibility for the CRP no later than March 1, 2006. (If this applies to you, for purposes of these FAQs, you are a “New Notice Claimant.” You should also note that different rules apply for residents of California, which has a separate agreement with the Companies.) In addition, if you are an “Other Claimant”, you will not receive a notice of your eligibility for the CRP from UnumProvident, according to the RSA. However, if you were covered by a group policy through your employee benefit plan, you may receive notice from the administrator of that plan. In any event, if you wish to have your claim reassessed, you must contact UnumProvident by calling: 1.877.477.0964 or by visiting their Website and submitting an online election to participate. You will need to provide your name and either your claim number or social security number in order to begin the process.
If you have questions about the CRP, you may call 1.866.278.4641. If you experience difficulty with the UnumProvident claim handling process, you may call the Claimant Hotline at 1.866.865.9015 for assistance.
What should I do if I don’t get a notice?
If you believe that you may be eligible to participate in the CRP and you have not received a notice from UnumProvident or from your plan administrator, you should contact UnumProvident immediately.
If you are a New Notice Claimant, UnumProvident will mail you a notice of your eligibility for the CRP no later than March 1, 2006. If you believe that you may be eligible to participate in the CRP and you do not receive this notice from UnumProvident, you should contact UnumProvident no later than June 30, 2006.
You must contact UnumProvident by calling 1.877.477.0964 or by visiting its Website and submitting an online election to participate. You will need to provide your name and either your claim number or social security number in order to begin the process. If you have any questions regarding your election to participate in the CRP, you may call 1.866.278.4641. If you have further difficulty regarding your election, you may also call the Claimant Hotline at 1.866.865.9015.
What do I have to do to have my claim reassessed?
If you receive a notice from UnumProvident, you should follow the instructions provided in the notice.
If you have not received a notice and you wish to have your claim reassessed, you should contact UnumProvident as soon as possible.
You must contact UnumProvident by calling 1.877.477.0964 or by visiting their Website and submitting an online election to participate. You will need to provide your name and either your claim number or social security number in order to begin the process.
If you have any questions regarding your participation in the CRP, you may call 1.866.278.4641. If you have further difficulty regarding the claims process, you may also call the Claimant Hotline at 1.866.865.9015.
Why should I expect the decision this time to be different from the previous denial?
There is no guarantee that the decision will be different. However, under the RSA, the Company is required to put into place many new guidelines and procedures which are intended to ensure a fair and balanced decision. As only one of many examples, under the RSA, UnumProvident has committed to considering and affording appropriate weight to all diagnoses and impairments and their combined effect on the whole person, when evaluating medical information in a claim file. In addition, the state insurance regulators will continue to monitor implementation of these new guidelines and procedures, and the DOL will work with the regulators as to claimants who are or were covered under an ERISA benefit plan.
What if UnumProvident denies my claim again?
If, following the CRP your entire claim is denied again and you receive no additional benefits, you will still have any litigation rights that you would have had if you had not participated in the CRP.
If, following the CRP any part of your claim is still denied, you retain the right to initiate or continue litigation regarding that portion of the original denial that has not been reversed or changed by the CRP. If however, any portion of your claim is granted, you will not have the right to seek additional remedies regarding that portion of the claim that has been granted.
Do I need a lawyer?
There is no requirement that you retain a lawyer to represent you in the CRP. You do have the right to hire a lawyer if you wish.
My claim was denied years ago and I have lost all the paperwork. What should I do?
At the outset you should contact UnumProvident (see contact information) and provide them with your name and social security number or claim number if available. You should make every effort to obtain any information which will be helpful in assessing your claim. All claimants will be asked to provide medical, employment and other income information since the date the claim closed. You may also call UnumProvident and request assistance with your claim. The Company has committed to making a good faith effort to obtain all the information necessary to make an informed claim decision, and to analyze and weigh the information in a fair and balanced manner.
When will the reassessment process be completed?
Pursuant to the RSA, the Company is committed to using its best efforts to complete all reassessments by December 31, 2006.
Pursuant to the Amendment, the Company is committed to using its best efforts to complete all reassessments for New Notice Claimants by June 30, 2007.
Once you have opted for reassessment, the Company will acknowledge your decision to participate. UnumProvident will contact you again at a time closer to when your claim will actually be reviewed. After you receive that notice, and the Company has obtained all the information it needs for the review, it estimates that reassessment of your claim could take from four to twelve weeks, depending on the complexity of your particular situation.
Will I need to sign any papers waiving my rights?
In order to participate in the CRP, you will be required to sign a Conditional Waiver and Release. According to this release, if a portion of your claim is granted, you will only waive any right you may have to begin or continue litigation regarding that portion of your claim that has been granted. You will not waive any rights with respect to any portion of your claim that has not been granted.
What if I have a pending lawsuit against UnumProvident challenging the denial of my disability claim?
You should consult with your attorney as to what course of action is most appropriate for you.
What if I returned to work or I am no longer disabled?
Even if you are working and/or are not disabled now, if your claim was denied for any period since January 1, 1997 during which you believe you were disabled, you may be eligible to have your claim reassessed.
Is there someone I can talk to about my claim?
If you have any questions about your claim or the CRP, you should feel free to call UnumProvident at 1.866.278.4641. If you experience difficulty with any aspect of the claims handling process, you can obtain assistance by contacting the Claimant Hotline at 1.866.865.9015.
If you are an employee benefit plan participant and believe that UnumProvident has treated your claim improperly, you may also contact your plan administrator, and/or your nearest EBSA office.