Unum Disability Claims Lawyer
Unum Has Denied Legitimate Disability Claims for Decades. Pillsbury & Coleman Has the Verdict to Prove It.
Unum Denied Your Disability Claim. That Decision Can Be Challenged.
Unum Group is the largest group and individual disability insurer in the United States — and one of the most litigated. The company’s claims-handling practices have been the subject of multi-state regulatory consent orders, a CBS 60 Minutes investigative report, and a $31.7 million jury verdict obtained by Pillsbury & Coleman — the largest disability insurance bad faith verdict in California history.
A Unum disability claims lawyer at Pillsbury & Coleman, LLP has litigated wrongful disability denial cases against Unum, UnumProvident, Provident Life & Accident Insurance Company, and Paul Revere Life Insurance Company since 1991. Our San Francisco-based firm represents policyholders in both ERISA and non-ERISA Unum claims in state and federal courts throughout California and nationally.
If Unum has denied, delayed, or terminated your long-term disability benefits, the firm that obtained the landmark verdict against UnumProvident can evaluate your claim.
Unum Disability Claims Attorney Representing California and National Clients
Unum Group, still sometimes referred to as UnumProvident, is a clear disability insurance market leader with roots extending back to 1848. According to its own corporate website, annual sales are in the $10 billion range and the company has ranked first among U.S. providers of group and individual disability insurance policies since the mid-1970s.
Along the way, the company has expanded through mergers and acquisitions involving companies such as Colonial Life, Paul Revere, General American and Provident. It is a market-leading player in long-term disability, long-term care insurance, life insurance and other forms of coverage. Unum Group has faced sustained regulatory scrutiny, multi-state investigations, and landmark jury verdicts for improperly delaying, terminating, and denying the disability claims of its policyholders.
Unum’s Documented Regulatory and Litigation History
Unum’s claims-handling misconduct is not a matter of allegation — it is documented in public regulatory actions and federal court proceedings.
- Multi-state market conduct examination: In 2004, insurance regulators from California, Maine, Massachusetts, Tennessee, and multiple other states entered into a landmark consent order with UnumProvident following a comprehensive examination of its claims-handling practices. The consent order required UnumProvident to re-evaluate thousands of previously denied claims and implement new claims-handling standards.
- CBS 60 Minutes investigation: National investigative media coverage of UnumProvident’s systematic claim denial practices contributed to public and regulatory pressure that resulted in the multi-state consent order.
- Chapman v. UnumProvident: Pillsbury & Coleman obtained a $31.7 million jury verdict against UnumProvident in San Francisco Superior Court — the largest disability insurance bad faith verdict in California history. Evidence at trial revealed that UnumProvident’s claims department denied benefits to meet internal monthly and quarterly termination goals.
- Womack v. UnumProvident: A federal district court granted summary judgment finding that a reasonable jury could find clear and convincing evidence of malice, fraud, or oppression — the standard for punitive damages under California law.
Case Result — Chapman v. UnumProvident Corporation
$31,700,000 — Jury Verdict | Dr. Randall Chapman v. UnumProvident Corporation
Defendant: UnumProvident Corporation — formed from the 1999 merger of Unum Life Insurance Company and Provident Life & Accident Insurance Company
Claimant: Eye surgeon who practiced in Novato, California for 20 years; purchased disability policies from Provident Life & Accident Insurance Company in 1983 and Paul Revere Life Insurance Company in 1987, including a specialty letter guaranteeing coverage as an eye surgeon
Disabling Condition: Severe anxiety disorder and specific phobia rendering Dr. Chapman unable to safely perform surgery; voluntarily removed himself from the operating schedule and submitted a disability claim
Unum Bad Faith Conduct Proven at Trial: UnumProvident failed to have Dr. Chapman examined by an unbiased physician; falsely claimed his condition could be treated successfully; falsely claimed he was not an eye surgeon; denied his claim to meet internal monthly and quarterly termination goals; claims department intentionally interpreted medical records to produce a denial; held a secret internal meeting at which notes and documents were destroyed pursuant to company policy
Jury Verdict: $1,551,301 in disability benefits for life; $125,000 in emotional distress damages; $30,000,000 in punitive damages
Court: San Francisco Superior Court; three-month jury trial; verdict is the largest disability insurance bad faith verdict in California history
UnumProvident Unfair Claims Handling Practices: The Evidence
Exposing Wrongful Unum Disability Denial Practices
In 2003, Pillsbury & Coleman obtained a $31.7 million jury verdict against UnumProvident Corporation in Dr. Randall Chapman v. UnumProvident — a non-ERISA long-term disability bad faith case litigated in San Francisco Superior Court. This case, together with other prominent litigation and investigative media coverage including a CBS 60 Minutes story, exposed Unum claim denial schemes and practices such as providing bonuses and other incentives to employees for closing large claims.
The Origins of Unum’s Claim Denial Scheme
In the 1980s, disability insurers such as Provident (later UnumProvident and now Unum) aggressively marketed “preferred professional” policies, which insured certain occupational specialists, like lawyers, doctors, and executives against disabilities. These policies commanded higher premiums, which could then be invested to earn substantial returns in an era of high interest rates.
In the 1990s, however, interest rates dropped and some of those insured professionals began to make disability claims. Provident suffered heavy losses. Looking back, Provident’s Senior Vice President of Risk Management, Tom Heys, explained in a confidential memo that the problem was that Provident sold policies without regard to the claims it would ultimately need to pay.
While many policies sold during this period were poorly underwritten and underpriced, Provident was in a worse predicament than some other firms. Provident had the largest share of business in certain high-growth states, such as California, and it had been slow to recognize and take action on this deteriorating area of business. Many of the poor-risk cases went to Provident.
According to evidence submitted in court, beginning in 1994, a number of insurance companies (including Unum and Provident) made a concerted effort to reverse their financial losses by denying more long-term disability claims.
Ralph Mohney and the Architecture of Denial
Documents revealed that the primary architect of the claim denial scheme was Provident’s Senior Vice President of Claims, Ralph Mohney, a man with essentially no knowledge of how to process a disability insurance claim. He enacted new, aggressive claim handling procedures designed to deny and terminate a much larger number of claims.
The new procedures were so successful in achieving a high rate of denied claims that by 1998, Provident had reversed its huge losses. In 1999, Provident merged with Unum Life Insurance Company to become UnumProvident, by far the largest disability insurer in the country.
The claims initiatives developed by Mohney included:
- Increased use of surreptitious surveillance of insureds
- Increased use of supposed “independent medical examinations”
- The development of a “network” of IME (independent medical examiner) physicians who specialized in “forensics” instead of physicians who had an actual clinical practice
- Increased scrutiny of psychiatric claims which is considered “subjective” and the direct targeting of psychiatric claims for termination
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The “go-to” firm for bad faith insurance coverage issues
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How Claims Staff Were Trained to Manufacture Denials
Special units were created to handle specific claims. Supposedly the members of each of these units would specialize in the specific types of injuries and sicknesses presented. Yet, all too often the claims adjusters had no special training, education or experience at all. Many times the claims staff failed to understand appropriate claims handling procedures and were not trained to evaluate and understand the medical records which often are the backbone of the disability claim.
Claims adjustors were instructed how to document the file with information that allegedly undermined a claimant’s treating physician’s certification that his patient is disabled. If they agreed with the treating physician’s conclusion that an insured was disabled, they were not allowed to write that conclusion in the file.
Instead, they were instructed to focus on gathering information which suggested that the claimant could return to work. Consultants and in-house medical staff were hired to manage and supervise these claims and their performance was evaluated upon the number of claims terminated or denied.
In fact, many of the in-house medical doctors actually had stock options and other benefits tied to the profitability of the insurance company, giving them an incentive to look for ways to deny claims.
Dr. Patrick McSharry — Testimony From Inside Unum’s Claims Machine
Dr. Patrick McSharry, an in-house medical consultant with UnumProvident, reviewed claim files from throughout the country. In a deposition, Dr. McSharry explained that the role of an in-house medical consultant was to write reports in such a way that the claims personnel could deny the claim.
Dr. McSharry testified that his superiors at UnumProvident repeatedly criticized him for expressing his actual medical opinion rather than the opinion preferred by the claims department which could support a denial or termination.
This testimony — from an insider employed by Unum — is among the most damning documented evidence of systematic bad faith claims handling in the history of American disability insurance litigation. It is part of the public record established in Chapman v. UnumProvident.
How Unum Denies Disability Claims Today
Unum’s claims-handling methodology has evolved since the Mohney era — but many of the core tactics documented in the Chapman trial remain in use. Policyholders whose claims have been denied by Unum today frequently encounter the following:
- Paper reviews by in-house or contracted physicians who have never examined the claimant — used to contradict treating physician opinions and justify termination or denial of long-term disability benefits
- Referrals to IME vendors from Unum’s network of forensic-focused physicians — physicians retained specifically for their tendency to produce opinions favorable to claim denial rather than clinical accuracy
- Functional capacity evaluations used to manufacture return-to-work conclusions — often conducted over a single day and used to override years of treating physician records
- Premature application of the any-occupation definition of disability before the own-occupation period under the policy has expired — a practice particularly common in professional and executive disability claims
- Surveillance of claimants in public — footage of driving, walking short distances, or attending routine appointments used to mischaracterize functional capacity
- Psychiatric and mental health claim targeting — Unum policies frequently contain 24-month benefit limitations for mental and nervous conditions; Unum has a documented history of reclassifying physical claims as psychiatric in order to trigger those limitations
- Social Security offset manipulation — Unum routinely requires claimants to apply for SSDI and then applies the award as a dollar-for-dollar offset against LTD benefits
- ERISA exhaustion traps — in employer-sponsored plans, Unum relies on strict administrative appeal deadlines to bar federal court claims when policyholders fail to exhaust remedies within the required window
- Claim file documentation manipulation — as documented in the Chapman trial, claims staff are trained to build a file record that supports denial rather than objectively evaluate the medical evidence
ERISA and Non-ERISA Unum Claims — Why the Distinction Matters
The best approach to your case will depend on many factors, such as whether your policy is governed by the federal law known as ERISA or by state law. Pillsbury & Coleman analyzes the governing law for every Unum claim at the outset of representation — because the distinction determines the full scope of available remedies.
Unum’s policies include those issued under the Unum, UnumProvident, Provident Life & Accident, Paul Revere, and Colonial Life brand names. Each policy must be analyzed individually to determine whether ERISA governs.
- ERISA-governed Unum claims: Employer-sponsored group LTD plans issued by Unum or its predecessor companies. Recovery is generally limited to plan benefits and attorney fees under ERISA § 502(a). The administrative appeal is critical — evidence not submitted during the appeal is generally excluded from federal court review. Pillsbury & Coleman builds Unum ERISA appeals with litigation in mind from day one.
- Non-ERISA Unum claims: Individually purchased disability policies — including the “preferred professional” policies Unum aggressively marketed to physicians, dentists, attorneys, and executives in the 1980s. These claims are governed by California state law and permit recovery of punitive damages, consequential damages, and Brandt attorney fees when Unum’s conduct constitutes bad faith. Chapman v. UnumProvident was a non-ERISA case — which is why a $31.7 million verdict was possible.
Frequently Asked Questions — Unum Disability Claim Denials
How long do I have to appeal or sue Unum after my disability claim is denied?
The deadline depends on whether your Unum policy is governed by ERISA or California state law. For ERISA-governed group LTD plans, Unum is required to give claimants at least 180 days to file an administrative appeal after a denial. Failure to exhaust that appeal within the deadline generally bars any federal court claim. For individually purchased non-ERISA policies, the policy’s suit limitations clause — sometimes as short as one year from denial — may govern. Contact a Unum disability claims attorney immediately after receiving a denial letter; the clock starts running from the date of denial, not the date you retain counsel.
Is my Unum disability policy governed by ERISA or California state law?
Unum issues both employer-sponsored group LTD plans governed by ERISA and individually purchased disability policies governed by California state law. The distinction is critical: ERISA limits recovery to plan benefits and attorney fees, while California state law permits punitive damages, consequential damages, and Brandt attorney fees in bad faith cases. Unum’s individually purchased “preferred professional” policies — marketed heavily to physicians, dentists, and attorneys in the 1980s — are typically governed by state law. Pillsbury & Coleman determines the governing law at no charge as part of every initial case evaluation.
Can I recover punitive damages against Unum for denying my disability claim?
Punitive damages are available against Unum in non-ERISA cases — that is, claims involving individually purchased disability policies governed by California state law. To recover punitive damages, a claimant must prove by clear and convincing evidence that Unum acted with malice, oppression, or fraud. In Chapman v. UnumProvident, a San Francisco jury awarded $30 million in punitive damages after finding that UnumProvident denied Dr. Chapman’s claim to meet internal monthly and quarterly termination goals. In Womack v. UnumProvident, a federal court found sufficient evidence for a jury to find malice, fraud, or oppression.
Unum terminated my disability benefits based on an IME — what are my rights?
Unum has a documented history of building and maintaining a network of IME physicians who specialize in producing opinions favorable to claim denial. An IME conducted by a physician retained and paid by Unum creates an inherent financial conflict of interest. Courts have consistently held that Unum cannot terminate long-term disability benefits based solely on a one-time IME opinion that contradicts years of treating physician records without adequate justification. Pillsbury & Coleman identifies Unum’s IME vendor relationships and challenges the methodology and reliability of their opinions in both administrative appeals and litigation.
Unum says my disability is “mental and nervous” and wants to limit my benefits to 24 months — is that valid?
Many Unum policies contain a 24-month benefit limitation for disabilities classified as mental and nervous conditions. Unum has a documented history of reclassifying physical conditions — including chronic pain, fibromyalgia, and neurological disorders — as psychiatric in order to trigger these limitations and terminate benefits. Whether such a reclassification is valid depends on the medical evidence in the claim file and the specific language of your policy. Pillsbury & Coleman regularly challenges improper mental and nervous reclassification decisions in Unum disability cases.
What was the multi-state regulatory action against Unum and does it affect my claim?
In 2004, insurance regulators from California and multiple other states entered into a consent order with UnumProvident following a market conduct examination that documented systematic claims-handling abuses. The consent order required UnumProvident to re-evaluate thousands of previously denied claims under new standards and to implement reformed claims procedures. This regulatory record — combined with evidence from Chapman v. UnumProvident and other litigation — establishes a documented pattern of unreasonable claims handling that is relevant to bad faith claims against Unum today.
Unum is requiring me to apply for Social Security disability — do I have to?
Most Unum LTD policies contain a provision requiring claimants to apply for Social Security Disability Insurance and permitting Unum to offset LTD benefit payments by the amount of any SSDI award. This offset practice is contractually permitted in most policies. However, Unum must credit the offset accurately and cannot use the SSDI process to delay, reduce, or terminate benefits improperly. If Unum is using the SSDI application requirement as a litigation tactic rather than a legitimate offset mechanism, that conduct may constitute unreasonable claims handling.
What documentation should I preserve after Unum denies my disability claim?
Preserve immediately: the denial or termination letter and all written correspondence from Unum; the insurance policy and any specialty letter or certificate of coverage; all medical records, attending physician statements, IME reports, and functional capacity evaluations submitted with or related to your claim; explanation of benefits statements; notes of any oral communications with Unum claims handlers; prior claim approvals and payment records; and any surveillance notifications or records you may have received. In ERISA cases, this documentation forms the administrative record on which federal court review is based.
Unum approved my disability claim for two years and then terminated it — is termination after approval actionable?
Yes. Termination of previously approved disability benefits is one of the most common and most actionable forms of Unum claims misconduct. Courts have held that an insurer’s initial approval of a claim is relevant evidence of the claimant’s disability status and that termination based on a paper review or IME without a meaningful change in the claimant’s condition may constitute a wrongful denial of benefits and breach of the implied covenant of good faith and fair dealing. Pillsbury & Coleman has successfully challenged Unum terminations of previously approved claims in both state and federal court.
Has Unum been held liable for bad faith disability claim denials in California?
Yes — with documented results obtained by Pillsbury & Coleman. In Chapman v. UnumProvident, a San Francisco jury returned a verdict of $31.7 million — including $30 million in punitive damages — after finding that UnumProvident denied Dr. Chapman’s claim to meet internal termination goals, destroyed documents at a secret internal meeting, and intentionally interpreted medical records to produce a denial. In Womack v. UnumProvident, a federal court found sufficient evidence of malice, fraud, or oppression to permit the punitive damages question to go to a jury. These results reflect more than 30 years of Pillsbury & Coleman litigation against Unum and its predecessor companies.
Contact a Unum Disability Claims Lawyer
Policyholders in San Francisco, Los Angeles, San Diego, and throughout California — as well as clients nationally with Unum ERISA and non-ERISA disability claims — can contact Pillsbury & Coleman for a formal case evaluation. Our attorneys assess Unum disability coverage denials and appeals at no charge. There is no attorney fee unless we recover compensation on your behalf. To speak with a Unum disability claims lawyer, call (415) 433-8000 or submit a confidential inquiry through our website.