Colorado PERA Second Level Appeal

In a prior blog post, I reported that the PERA Disability Program Administrator, Unum Life Insurance Company of America (Unum Group), was rendering claim decisions in disregard of the terms of the policy that has been issued to Colorado PERA with regard to Short Term Disability benefits.  In a deposition of the Director of PERA’s Benefits Services at Unum a few weeks ago, we learned that PERA itself is very concerned over the way in which Unum has handled claims for disability benefits since January 1, 2011.  This PERA Director agreed that Unum handled our client’s disability claim and the internal appeal process in a way which violated the terms of the Short Term Disability Policy.  More particularly, Unum Insurance is required to inform denied PERA members of the member’s right to request a second level of review.  This second level of review is to be conducted by a “panel of independent experts.”  It is our belief that Unum was not aware of its own policy requirement until we conducted depositions in our client’s case.  As a result, it is plainly obvious that Unum has now altered the way in which it is handling PERA claims.  We have since received follow up letters on behalf of other clients wherein they have now been informed of their right to request a second level of review. 

It remains to be seen how Unum handles such second level of reviews in the future.  These reviews are to be conducted by “independent” experts.  Well, we will see how independent they truly are.  Our suspicion is that Unum will simply send the medical records of the denied PERA members to physicians of their choosing for additional medical records reviews only.  In our past experience, these so-called independent experts are not so independent, have worked with Unum quite frequently, and of course are compensated by Unum to conduct such reviews and render opinions concerning a person’s ability to work or not. 

What we do know is that Unum has clearly changed its policies with regard to the handling of PERA claims as a result of litigation we are pursuing on behalf of a disabled client whose benefits were wrongfully denied.  Whether wrongfully denied or even unreasonably delayed, you may wish to have your claim reviewed by attorneys who specialize in this area of the law.