Q: I am on long-term disability through my employer. The company that manages the benefits is UNUM.
I am trying to understand if UNUM has the power to interpret the terms of the policy freely. Specifically, if a glossary term is defined in the policy, do they have the power to interpret that term how they want to determine eligibility.
The policy certificate states the the benefits are controlled exclusively by the policy and certificate of coverage. The Plan is administered by the Plan Administrator who is listed as my employer. Benefits are administered by the insurer and provided in accordance with the insurance policy issued to the Plan. It is an ERISA Plan. The plan administrator is the fiduciary of the Plan, with authority to delegate its duties.
A: An attorney who has experience with ERISA plans could probably advise you best here, but your question remains open for two weeks. As a general matter in insurance practice, the underwriters and claims departments do have the power to interpret the terms of a policy, as do attorneys who represent policyholders. Interpretation of insurance provisions in policies is a common a source of dispute in a good deal of insurance claim litigation, as well as definitions, which are not always accepted at face value. That's the nature of insurance law. Good luck
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