Unum Disability Claim Denied? How to Appeal Your Unum LTD Decision

Unum Group is the largest group disability insurer in the United States, covering tens of millions of workers through employer-sponsored long-term disability (LTD) and short-term disability (STD) plans. If Unum denied your claim, you are not alone — and you have meaningful legal rights to fight back.

Most Unum LTD plans are governed by ERISA (the Employee Retirement Income Security Act), which creates a specific appeal process you must follow before you can sue in federal court.

Why Unum Denies LTD Claims

Understanding why Unum denied your claim is the first step to overturning it. Common denial reasons include:

• Insufficient medical evidence: Unum claims your treating physician's records don't document functional limitations severe enough to prevent work
• "You can perform sedentary work": Unum's in-house vocational reviewers determine you can do some type of work, even if not your own job
• Pre-existing condition exclusion: Unum argues your disabling condition existed before your coverage effective date
• Surveillance-based denial: Unum conducts video or social media surveillance and uses it to contradict your claimed limitations
• Own occupation vs. any occupation standard switch: One of the most aggressive Unum tactics

The "Any Occupation" Cliff: Know Your Policy

Many Unum LTD plans use a two-tier disability definition. For the first 24 months, the standard is "own occupation" — you must be unable to perform the material duties of your specific job. After 24 months, the standard shifts to "any occupation" — you must be unable to perform any job for which you are reasonably qualified by education, training, or experience.

Unum aggressively terminates benefits at this 24-month transition point. Read your Summary Plan Description carefully. If you are approaching 24 months on claim, start building your "any occupation" evidence now — before Unum acts.

Your ERISA Appeal Rights

ERISA gives you specific procedural protections:

• Right to the complete claim file: Request every document Unum used in its decision — medical reviews, surveillance reports, FCE (functional capacity evaluation) results, vocational assessments, and all internal communications
• 180 days to appeal: From the date of Unum's denial letter, you have 180 days to submit your internal appeal
• Right to submit additional evidence: You can add medical records, expert opinions, and vocational analysis to the record during your appeal
• External Independent Review: Complete Guide" class="auto-link">External review: Under ACA requirements, ERISA plans must provide access to external review by independent physicians

Critical ERISA rule: The administrative record is locked after exhaustion. Everything the court can consider must be submitted during your internal appeal. Do not hold back evidence hoping to use it later in litigation — that strategy will fail.

Building a Winning Unum Appeal

Get a Detailed RFC From Your Treating Physician

A Residual Functional Capacity (RFC) assessment from your treating doctor is the cornerstone of any strong LTD appeal. The RFC must specify, in concrete terms: how long you can sit, stand, walk; how much weight you can lift; whether you have cognitive or concentration limitations; and how often you need breaks or would be absent from work. Generic letters stating "my patient is disabled" are not sufficient.

Challenge Unum's IME and FCE Doctors

Unum routinely retains independent medical examiners (IMEs) and functional capacity evaluators (FCEs) who are paid by the insurer. Request the credentials and prior testimony history of any physician who reviewed your file. In your appeal, address their findings point by point — don't let an opinion from a doctor who never examined you go unchallenged.

Add Vocational Expert Evidence

If Unum terminated your benefits under the "any occupation" standard, hire a vocational expert to analyze whether jobs Unum identified actually exist in significant numbers in the national economy and whether your specific limitations would prevent you from performing them.

Request a Peer-to-Peer Call

Have your treating physician contact Unum's medical director directly. This call creates a contemporaneous record and sometimes results in benefit reinstatement without a formal appeal.

Leverage Social Security Disability

If the Social Security Administration approved your SSDI claim (which Unum may have required you to file), include that determination in your appeal. While not binding on Unum, an SSDI award carries weight as an independent medical finding.

Documentation Checklist

• Unum denial letter (all pages)
• Complete claim file requested from Unum (including all medical reviews and surveillance)
• Treating physician's RFC assessment with specific functional limitations
• Updated medical records from all treating providers
• Specialist opinion letters addressing Unum's stated denial reasons
• Vocational expert report (for "any occupation" denials)
• Neuropsychological testing (for cognitive or psychiatric claims)
• Social Security disability award letter (if applicable)
• Peer-to-peer call summary from treating physician
• Independent medical examination (if IME was used by Unum)

Should You Hire an ERISA Attorney?

For high-value Unum LTD claims — particularly cases approaching the "any occupation" transition or involving large monthly benefits — consulting an ERISA disability attorney is strongly advisable. Many ERISA disability attorneys work on contingency (no upfront fee), meaning they only collect if you win. The administrative record you build now determines your odds if the case ever reaches federal court.

Fight Back With ClaimBack

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Related Reading

• How to Write an Insurance Appeal Letter
• Internal vs. External Insurance Appeal: Which Should You File?
• Common Reasons Insurance Claims Are Denied