How Disabled Do You Have to Be to Satisfy Unum?

Cincinnati, OHHow disabled does one need to be in order to qualify for long-term disability (LTD) in Unum's eyes? That seems to be the question after a woman from Ohio, suffering from obvious physical challenges, was denied LTD benefits by Unum. The woman has had no choice but to take Unum to court, in an attempt to restore benefits she—and her doctor—feel are deserving of her condition.

The plaintiff, Karen Russell, is a registered nurse who had little choice but to leave her job at Catholic Healthcare Partners due to continuing problems with bilateral knee osteoarthritis, right ankle post-traumatic osteoarthritis anxiety and depression.

The plaintiff's doctor notes that Russell is incapable of standing or sitting more than two hours at a time within an eight-hour period, suffers from complete postural limitations and possesses limited manipulative capacity. The plaintiff also is encumbered with a high risk of falling due to pain and instability in her osteoarthritic, weight-bearing joints.

Further, Russell requires assistive devices to stand and walk, and employs a motorized vehicle to get around at other times. Drugs prescribed to control pain and inflammation have reportedly impaired the plaintiff's kidney and liver functionality.

It is against this backdrop that Unum Insurance, after initially granting LTD benefits to Russell for about two years, abruptly withdrew benefits effective October 2009.

The reason? Unum Group decreed that Russell was no longer disabled, and thus revoked her Unum long-term disability insurance.

Given that Russell's LTD Unum plan is an ERISA-controlled entity, she filed an ERISA appeal with supporting documents from her physician, who verified that Russell suffers from "end stage osteoarthritis of both ankles, osteo-arthritis of her knees, low back pain, bi-lateral carpal tunnel syndrome, diffuse muscle atrophy and osteopenia."

No matter. Unum life insurance upheld its denial of Russell's claims, forcing Russell to launch an action seeking benefits in the US District Court for the Southern District of Ohio Western Division. The lawsuit also names her previous employer as a defendant.

Unum, which has been known previously as Unum Provident and First Unum, is a major provider of insurance products in the US and United Kingdom.

Over the years, it has reeled from accusations that deserving claimants, having maintained their policy premiums faithfully, have been denied benefits without just cause. Allegations that Unum targets claimants randomly in an effort to reduce their exposure continue to dog the company. Linda Nee, a former Unum employee and a vocal critic of the company, notes in her blog May 5 that in its quest to expose wrongdoing on the part of a claimant attempting to obtain benefits fraudulently Unum—via its own field workers or those representing an outsource company—has been known to engage in activities described as "personal trespass" in an attempt to gain incriminating evidence that would support a denial of benefits.