Read and understand the summary plan description or policy for your long term
disability benefits.
If the employer is the sponsor of a long term disability plan, or if the plan is “self-
funded,” you have been given or should receive upon request a “summary plan
description.” 7 If you have purchased private disability insurance, you have been given a
policy and presumably you have worked with someone, an agent or other specialist, to
determine your particular needs for coverage in the event you lose the ability to engage
in your own occupation.
The policy or plan is a contract or agreement between you and the insurer or employer;
it defines the rights and responsibilities of the parties. You are bound by its language
and the company is bound by its language. This document must be read thoroughly and
understood. As lawyers say: “It is the law of the case.” Unlike most agreements that we
make in life, the language of long term disability benefit policies is generally non-
negotiable. The insurer, armed with superior knowledge and experience, has defined
the terms, and designed the procedures, limitations and exclusions in coverage of your
long term disability benefits. Insurers like UNUM are, as one can imagine, very good at
drafting policies whose terms benefit them at the expense of those seeking their long
term disability benefits.
Normally, when a dispute arises concerning ambiguous terms in an insurance policy,
the courts, under state law, use an equitable rule that ambiguities are decided against

7 The term “plan” is often confusing. The word is derived from the ERISA law which describes employee benefits as
“employee welfare benefit plans” and includes pension plans. Disability benefits, however, are usually secured
through the payment of insurance premiums or they are “self-funded” by payment directly from the employer or

an employer group. When insurance is purchased, the “plan” is usually the insurance policy.