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Unum and Its Internal Appeals Process

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Dallas, TXLydia was diagnosed with fibromyalgia and applied for long-term disability benefits through Unum, or Unum Provident, her health insurance provider. She received benefits for a year before Unum abruptly cut her off, without warning.

“My Unum representative told me that, according to Unum’s policy, they only cover one year for a mental disability, claiming fibromyalgia is all in my head,” says Lydia. “How can they say that when they have my doctor’s report that says this is manifested in muscle pain and chronic fatigue?”

Lydia is correct about the symptoms but the insurance giant has found a gray area: the Mayo Clinic says that researchers believe fibromyalgia amplifies painful sensations by affecting the way your brain processes pain signals and that it could be brought on by significant psychological stress, physical trauma, surgery or infection. Lydia cannot connect her condition to anything physical, hence Unum says it is a mental condition.

Lydia paid her premiums to Unum for more than 20 years. When she was denied further benefits, Lydia tried to go back to work - she was a university administrator for more than 20 years - but she had so much fatigue due to her illness that she only lasted a few months.

“I phoned my Unum rep again and again, and he said that fibromyalgia is not a physical disability,” says Lydia. “I asked him if he needed more documentation from my doctor and rheumatologist to prove that I have a serious physical disease that prevents me from working. He just said, ‘we are done here’ and hung up on me. Talk about frustrating”

Upon the advice of her former employer, Lydia applied for Social Security benefits. Interestingly, Social Security recognizes fibromyalgia as a disorder: why can’t Unum?

The Unum rep didn’t tell Lydia that she can appeal its decision so she thought it was an open-and-shut case, until she went online and discovered others with fibromyalgia who have filed bad faith lawsuits against Unum.

Lydia filed a claim with an experienced insurance attorney and she is in the process of gathering all her medical records. Meanwhile, she is collecting a pension from work but it is hard to make ends meet.

Last month a Colorado woman filed a bad faith lawsuit against Unum, after she was denied a disability insurance claim, similar to Lydia’s denial. Almost two years ago Cindy Arellano developed disabling medical conditions, namely fibromyalgia, and was unable to continue working as a registered nurse.

Her Unum insurance policy stated that she would be paid 60 percent of her pre-disability earnings per month. Like Lydia, Cindy was initially approved for long-term disability (LTD) benefits but Unum terminated her benefits just two years later. Cindy appealed, but through its internal appeals process, Unum upheld its denial.

Cindy pursued a claim against Unum. Her lawsuit alleges that Unum wrongfully denied her benefits, that she is disabled according to the definition in the insurance policy, and entitled to further disability insurance benefits.


Meanwhile, Lydia is going to determine whether she too has exhausted all of Unum’s internal appeals process. The Unum lawsuit is Cindy Arellano v. Unum Life Insurance Company of America, Civil Action No. 1:14-cv-01111-KMT, in the U.S. District Court for the District of Colorado.

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