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More Denied Disability Lawsuits against Unum

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New York, NYIt isn’t surprising that long-term disability (LTD) coverage has seen a six percent decline from 2009 to 2013, given that Unum, or Unum Provident, the top disability insurer in the US., is still wrongfully denying long-term disability benefits, according to its policyholders.

Last week an Unum lawsuit was filed by a New York policyholder, claiming that the giant insurance company wrongfully terminated his short-term disability benefits and denied his claim for LTD. Steven Krol made a disability claim on his Unum policy when he was diagnosed with vascular dementia - a condition similar to Alzheimer’s disease but typically with a more immediate impairment. Unum made good on short-term disability for one year, but for reasons not yet publicly known, denied Krol his LTD. Krol, who worked for an insurance company, claims that he is still disabled and therefore entitled to disability insurance until he is 65 years old, in 2023.

It is mind-boggling that Unum can deny a policyholder with vascular dementia. There is no cure for this disease and the FDA has not approved any drugs to treat the symptoms. To top it off, Krol may not see his 65th birthday because vascular dementia shortens lifespan, according to the Alzheimer’s Association. Furthermore, vascular dementia is the second most common cause of dementia after Alzheimer’s disease. Surely Unum recognizes these facts.

Unum terminated LTD benefits in August of 2014 to a partner in a global accounting firm who earned $85,572.67 per month. (Plaintiff John) Doe had been under doctors’ care for almost two years in an attempt to treat “unremitting fatigue and fecal incontinence.” The man’s condition may in part have been caused by a “stressful” job, but Unum didn’t take the stress factor into consideration.

Unum surveillance

Unum hired investigators who conducted five days of surveillance on Doe. They reported that Doe left his home just three short times. For the rest of the time, he was housebound. The plan administrator determined that the surveillance footage supported the plaintiff’s claim and that Unum:

(1) failed to consider, despite consistent documentation from Doe’s treating physicians, the effect of Doe’s fatigue and fecal incontinence on his ability to work;

(2) failed to analyze Doe’s ability to do the specific tasks his job requires;

3) did not acknowledge the extent to which the surveillance footage supported Doe’s self-reported symptoms; and

(4) conflated Doe’s occasional travel with his ability to work a demanding job.

In other words, Unum chose to ignore information that was favorable to Doe’s case while emphasizing facts unfavorable to his case. The plan administrator ruled that Unum’s decision to deny benefits was “arbitrary and capricious” and it was not the product of reasonable decision-making.

According to an employer survey conducted by the Council for Disability Awareness, the number of US workers with LTD coverage decreased from 34 million to 32.1 million from 2009 to 2013.

One insurance provider (Disability RMS) has suggested that a possible reason for lack of participation is the bad press disability insurance has gotten over the years. But perhaps it is because insurance companies like Unum have been practicing bad faith by denying disability insurance for more than a decade: they continue to deny policyholders their rightful benefits. It just happens that some of those policyholders have received media coverage.

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READER COMMENTS

Posted by

on
People have the perception that just because they carry a long term disability policy they automatically are entitled to benefits. this is not the case. if policyholders took the time to read their policy they would clearly see that they must meet eligibility requirements it is the same for Social Security. just because you pay into Social Security does not guarantee you receive disability benefits. The only reason why ambulance chasing attorneys don't pursue Social Security is because they are limited from attorneys fees since they are paid only based on a retro active benefit for the claimant. As for the gentleman in the story he most likely could do some form of employment but made the decision to remove himself from all types of work. Sadly it is the mindset of most Americans that they can receive or retire on disability without seeking employment within their restrictions and limitations

Posted by

on
Where were the lawsuit people almost 20 years ago when I needed help , I had finally started getting monthly payment and then all at once they started calling and threatening to take me to court for my claim then finally got approved for Social Security Disablity so I could get these nut balls off my back and they had even cancelled my life insurance policy I had some how

Posted by

on
I was a victim of UNUM's policy of dening benefits after 4 yrs. my disease didn't go away. The Doctor refused to discuss it with me and dropped me as a patient. I asked you to look into it but your response was "not enough money to be made". I wanted to sue UNUM and the Doctor but you first said it was an Erisa case. I beg to differ. I'm poor now, facing foreclosure. Still sick with MDS and I've been intimidated by the Oncologist who took over because he is friends with the prior Doctor. His plan of care was "call me when you start to bleed". Finally he has been forced to retire early, I have a new Hemotologist I see next month. I know this disease will end my life. I'm not happy that there are no Lawyers who will take my case on unless they can make a profit up front, win or lose. Thanks for your time...

Posted by

on
my LTD that I have had since 2007 from my previous employer (policy still active) was recently denied effective 10/31/14 with telephonic notification. i had a c5-6-7 fusion and lumbar fusion, followed by a fungal infection 2 months later surrounding lumbar fusion causing me to have emergency surgery and months of i.v. treatments at home after a 5 day hospital stay. I also have Arachnoiditis Ocd 322.9 code. my neurosurgeon writes post laminectomy but does not mention Arachnoiditis. Other medical professionals have concluded with MRIs that I in fact have Arachnoiditis which is chronic pain and progressive. Therefore Sun Life Assurance terminated me as my dr didnt mention it in his report. Also i will be 59 this month and Sun Life says i can return to sedentary work as exec asst sommething i have done for over 30 years and i was awarded Full social security at age 52 at 2nd SS hearing and based on CA Labor Codes. Any advice or opinion based on what I have written here?

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