The U.S. Department of Labor will require Portland-based insurance company Unum to change how it determines proof of good health after a settlement revealed the company wrongly denied life insurance benefits to customers in job-based insurance plans.
In a settlement announced Friday, the department said it found that Unum’s life insurance wing often accepted payments without verifying that customers were insurable, leaving them to believe they had coverage. When plan participants died, investigators found that Unum often denied benefits claims, saying that the company had never received proof of insurability.
Investigators also found that Unum provided coverage to dependents in certain policies without proof of good health. If the dependent died within two years, the department said, Unum would review their medical records and often deny them if they were disabled at the time of their enrollment, citing a “delayed effective date of coverage.”
The settlement prohibits Unum from denying benefits claims because of a lack of evidence of insurability when a policyholder has paid premiums for 90 days or more. It also requires the company to make its delayed effective date of coverage provision more clear to customers.
“The U.S. Department of Labor will take appropriate action against any insurance company that collects regular premium payments from plan participants and later tries to wrongfully deny benefits based on technicalities like ‘insurability’ after the participant passes away,” said Boston Regional Solicitor Maia Fisher in a statement.
Unum is voluntarily re-processing claim denials based on lack of insurability going back to 2018 and denials based on delayed effective date back to 2016.
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