Many Unum policyholders have consequently filed lawsuits, alleging that the company has falsely denied their benefits. For instance, a recent Unum lawsuit was filed by a disabled health care worker.
Brenda Andrus was a case manager at the Opelousas General Health System Medical Center - a government entity that is exempt from ERISA - until she became disabled due to numerous medical conditions. Andrus claims in her lawsuit that she has been diagnosed with sarcoidosis (an inflammatory disease), hypercrapnic respiratory failure, chronic bronchitis, low back pain, severe fatigue, diabetes, lymphadenopathy and hypertension. She provided Unum with medical documentation detailing her condition.
But Unum disagreed with Andrus’s doctors and denied her benefits. In her appeal, Andrus provided even more documentation, including letters from three doctors who are treating her, saying she can no longer work full-time and that she is disabled under Unum’s policy terms. Andrus claims her doctors also phoned Unum to confirm that she is disabled.
Andrus is now seeking a jury trial. She filed a lawsuit in the U.S. District Court for the Eastern District of Louisiana against Unum alleging illegal denial of long-term disability benefits and waiver of life insurance premiums. She is suing for damages, including past and future disability benefits, interests, for continued life insurance coverage sans premium, for penalties under the Louisiana Insurance Code, damages from physical and emotional injuries, court costs, and attorney fees (U.S. District Court for the Eastern District of Louisiana Case number 2:16-cv-01112).
Ignoring or “overriding” policyholders’ own medical reports is a common tactic of denial by Unum. Sometimes Unum will insist on the claimant being examined by its independent medical examiners; sometimes they determine that the claimant can work in another type of job.
Sarah (not her real name) worked as a bank teller until a back injury left her disabled - she couldn’t stand for more than a few hours at a time. And her workers’ compensation doctor sent medical reports to Unum stating she could no longer work. But Unum denied her claim and told Sarah that she can “work in a sedentary position holding 10 pounds in my lap.”
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Sarah underwent a second back surgery last month. “I am collecting workers’ compensation but just for my medical bills,’ she says. “I haven’t had any income for the past three months and I just applied for food stamps. I don’t have any savings and I’m at my wit’s end. The Unum representative just told me to apply for Social Security - I don’t understand how they can continue to deny, how they can get away with it.”