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The Terms

Required Changes In UnumProvident DI Practices In California

? Discretionary authority: The company can no longer use “discretionary clauses” that appear to give it unlimited discretion to interpret policy language.

? Mental and nervous conditions: The company cannot apply a 24-month limit on benefits for mental and nervous conditions to a claimant who has mental health problems but also continues to suffer from serious physical health problems.

? Self-reported conditions: The company must stop using “self-reported condition” provisions for conditions such as pain and weakness to limit benefits payments.

? Definition of “total disability”: Early on, during the “usual occupation period,” the company must define “total disability” to mean “a disability that renders one unable to perform with reasonable continuity the substantial and material acts necessary to pursue his or her usual occupation in the usual and customary way.”

? Pre-existing conditions: The company must stop enforcing clauses excluding coverage for new conditions “contributed [to] by” pre-existing conditions, and the company must eliminate such clauses from new policies.

? Rehabilitation: The company must stop including contract provisions requiring claimants to participate in mandatory rehabilitation programs.

? Social Security disability income benefits: When coordinating disability benefits with SS disability benefits, the company can include only the SS payments claimants actually have received.

Source: UnumProvident California settlement agreement


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