A Unum bad faith insurance denial lawsuit was filed by a former U.S. Healthworks medical assistant against Unum Life Insurance Company alleging that the company wrongfully denied long-term disability benefits under her employer’s plan.

Long-term disability benefits provide financial benefits to employees when they are unable to work due to a disability regardless of whether that illness or injury is work-related.

Unum Insurance policyholder and plaintiff Teresa R. filed her Unum bad faith insurance lawsuit on Jan. 1. She was a full-time medical assistant who began working for U.S. Healthworks in 1995 and participated in the company’s Employee Benefit Plan which contracted with Unum Insurance to provide long-term disability benefits to full-time employees, the lawsuit says.

According to the Unum claim denial lawsuit, Teresa was unable to continue to work after a work-related injury that occurred in November 1999.  As a result of this injury, Teresa sustained severe injuries to her wrists, right shoulder, back and neck for which she had to undergo rotator cuff and nerve transposition surgery.

Teresa’s physician also recommended spinal surgery in 2003 to repair disc protrusions as a result of the workplace injury, but this was never performed.

Teresa submitted a timely claim to Unum Insurance for payment of her disability benefits, which Unum denied.  Teresa requested that her insurance claim denial be reassessed and eventually in 2007, Unum overturned its denial of Teresa’s disability claim and provided long-term disability benefits to her for nearly 14 years.

However, in January 2014, Unum abruptly terminated Teresa’s LTD benefits without legal justification, even though Teresa’s medical condition had not improved.  According to the Unum lawsuit, Teresa’s medical records were never reviewed by any physician prior to the denial and Unum improperly decided that Teresa was no longer disabled.  In fact, according to the Unum lawsuit, Teresa’s Unum file notes that her medical records were “lost”.

When, as part of her appeal, Teresa submitted updated medical records, including a recent hospital room emergency visit related to her disability, Unum still upheld it denial of Teresa’s disability benefits.

Unum Bad Faith Insurance Tactics

Unum and its subsidiaries have repeatedly been found liable for questionable practices relating to denied disability claims.

Among tactics allegedly used by insurers to unreasonably delay or deny insurance claims is ignoring professional medical diagnosis or using biased experts, changing policies after a claim is filed, and claiming a person is not disabled and can work, despite a medical diagnosis from a professional.

Such tactics fall under bad faith insurance, and if an insurer has committed bad faith insurance, policyholders whose claims have been improperly or unreasonably denied or delayed may be eligible to file a complaint against the insurance company.

Unum Bad Faith Insurance Lawsuits

Unum lawsuits seek compensation for policyholders whose claims have been improperly or unreasonably denied or delayed by Unum Insurance’s alleged bad faith insurance practices.

Teresa is seeking to recover payment of all long-term disability benefits withheld pursuant to section 502(a) of the Employee Retirement Income Security Act of 1974 (ERISA), with interest and continued payment of the benefits, as well as attorney’s fees and cost.

The Unum Bad Faith Insurance Lawsuit is Case No. 5:16-cv-00001-VAP-SP, in the U.S. District Court for the Central District of California.