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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.
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.
A number of deadlines in the Settlement Agreement are based upon the
"Implementation Date." That date is January 19, 2005.
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 Web sites:
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.
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 Web site 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.
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 Web site 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.
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 Web site 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.
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.
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.
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.
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.
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.
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.
You should consult with your attorney as to what course of action is most
appropriate for you.
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.
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.
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