We have recently discovered a major failing in the way Unum Insurance is administering and deciding Colorado PERA disability claims. If you are reading this blog, you are likely aware that Unum Insurance is the Disability Program Administrator for the Colorado Public Employee Retirement Association (Colorado PERA) Disability Program. This is a two-tiered disability program which entitles disabled PERA members to either short term disability payments or disability retirement. Unum took over the role as the DPA from the prior administrator, Standard Insurance Company, on January 1, 2011. This office has a couple of PERA member clients whose disability claims have been denied by Unum and whose right to a complete review of their claim was not provided in accordance with the law. The Colorado PERA statutes, the PERA Rules, and the PERA short term disability policy issued by Unum to PERA guarantees the right to a second level of appeal review of a denied claim which is to be completed by a “panel of independent experts.” This final level of review is to be a “medical review.” This office has reviewed a few situations recently where the claim for disability was denied by Unum, the appeal of the denial which was submitted by the member to Unum was also denied, but the final appeal decision letter (which Unum refers to as an “uphold” letter) did not contain the required statement that the PERA member may request a second level of review. This final level of review was never offered to these clients. In our opinion, the failure to offer a review that is mandated by the policy and Colorado Law constitutes improper claims handling and results in both an unreasonable delay and unreasonable denial of the PERA member’s disability claim. If deemed unreasonable, the denial can result in a doubling of the contract benefit owed along with an award of attorney’s fees in favor of the denied PERA member.
If you have experienced a similar situation, or feel that your denied PERA disability claim should be reviewed by an attorney, feel free to contact our office for an free initial consultation.