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SUCCESSFUL PERA DISABILIY APPEAL TO UNUM INSURANCE FOR CLIENT

May 3, 2012

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Our office was recently successful in obtaining Colorado PERA* disability retirement benefits on behalf of a former teacher suffering with Marfan’s syndrome and several other medical conditions. Standard Insurance agreed our client could no longer perform her job as a teacher, and that she was fully disabled for a brief four-month period of time, during which PERA short term disability (STD) benefits were payable. However, it contended she then recovered the ability to perform other jobs, and therefore, terminated her PERA STD benefits.

This claim is one of many this office has handled that has arisen during the transition from Standard Insurance Company to Unum Life Insurance Company of America. Let me provide a quick background. By statute, PERA is required to contract with a disability program administrator (DPA) to evaluate PERA Members’ medical entitlement to PERA disability benefits. PERA had previously contracted with Standard for this purpose. However, that relationship ended as of January 1, 2011, at which time Unum became the designated DPA. When applying for PERA disability benefits, PERA Members are not permitted to opt between disability retirement or STD. Instead, the claim is supposed to be reviewed by the DPA, who evaluates an applicant’s entitlement to either benefit. However, the system has been complicated over the past year due to this change in DPAs. Standard has retained the authority to decide the STD portion of claims that were submitted before January 1, 2011. Then, Members have been required to submit a separate claim to Unum for PERA disability retirement. It is our opinion that this improperly burdens claimants, and has certainly caused much complication and duplicative work during the appeals process.

Returning to our recent case, our client was told in her termination letter that she had the right to pursue disability retirement benefits with Unum, if she thought she was entitled to them. We assisted her with filing that claim and concurrently appealing the PERA STD denial. Ultimately, upon reviewing her claim for the first time, Unum disagreed with Standard’s previous conclusion, determined our client was totally and permanently disabled, and reinstated her benefits.

Navigating the PERA disability process can be quite complicated, particularly during this transition period from Standard to Unum. If you have any questions regarding denial of your PERA disability claim or need assistance with appealing your PERA disability denial, contact us. The disability lawyers at the Law Office of Shawn E. McDermott have many years of experience in handling PERA STD and disability retirement claims, as administered by Standard and Unum.

*”PERA” stands for the Colorado Public Employees Retirement Association.

Categories: Colorado, Disability, PERA Claims

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