Given that her employer maintains a long term disability benefits policy, the plaintiff was reasonable in expecting disability benefits. Unum, however did not agree…
Atlanta, GAThere is little doubt that wrongly denied disability claims tend to make more noise than claims that are approved and duly paid. Such is the case with a denied disability claim that is the subject of a lawsuit against insurance provider Unum.
According to Court documents the plaintiff in the case is identified as Leslie Onusic, a former employee of AJS Services Inc. located in Fort Gordon, Georgia. The plaintiff alleges she became disabled while working for AJS, and given that the company had long term disability coverage for its employees administered through Unum Life Insurance Company of America, presumed LTD benefits would be available to her.
But that wasn't to be.
Unum denied her claim out of the gate.
Her initial claim with Unum for disability benefits was filed March 15, 2016 according to the plaintiff's bad faith insurance claim. In a response that arrived two months later, dated May 13 of that year, Unum denied her claim.
Onusic duly filed an appeal with Unum October 14 of that year. Unum's answer arrived three weeks later on November 8, indicating it stood by its initial ruling to deny the long term disability coverage.
The plaintiff maintains that her medical records detail an "ongoing, intensely painful physical condition that has been exacerbated by the mental pain and anguish" that she is going through. Medical staff representing the defendant reportedly consulted those medical records - duly provided by the plaintiff - in order to arrive at their recommendation to deny coverage, without a direct examination of the claimant.
Her own doctors say the plaintiff is disabled. But Unum didn't consult them…
A request by the plaintiff to access and examine the professional qualifications and resumes of those experts was denied by Unum.
Onusic's denied disability claim is brought under the Employee Retirement Income Security Act (as amended 1974) due to the plaintiff's contention that Unum is seen as having a conflict of interest under ERISA.
"As the Plan Administrator and the fiduciary, [Unum] failed to maintain 'revenue neutral' compensation, as required by ERISA," the claim states. According to the denied disability lawsuit, Unum employs evaluation methods that result in denied claims in order to satisfy Unum's own financial interests. To that end, the insurer's stated reasons for denying Onusic's claim do not reflect statements and determinations made by the plaintiff's own doctors.
Unum's decision to deny coverage "was arbitrary and capricious as to defy common sense and logic and is a bad faith breach of the terms and conditions" of the Plan, the lawsuit says.
Onusic seeks disability benefits as stipulated in her coverage documents, as well as punitive damages, attorney's fees and interest on the unpaid disability benefits.
The lawsuit is Onusic v. Unum, Case No. 1:17-cv-04414-SCJ in the US District Court for the Northern District of Georgia, Atlanta Division. The lawsuit was filed November 3, 2017.
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