A Pennsylvania man filed a wrongful claim denial lawsuit against Unum Life Insurance Company of America for allegedly denying him disability benefits after he was injured in a serious accident.

Plaintiff James Casiano was employed by the Children’s Hospital of Pennsylvania through which he was provided  long- and short-term disability insurance. While Casiano had been a full-time employee at this hospital for a number of years, his career abruptly ended on Nov. 16, 2012, when he was hit by a car and sustained severe and debilitating injuries, according to his Unum lawsuit.

Initially, Unum approved Casiano to receive long-term benefits after he applied on May 17, 2013. The plaintiff submitted all relevant paperwork and medical testimony in a timely fashion, and met the appropriate deadline, his Unum lawsuit said. Unum kept paying the long-term benefit payments on a monthly schedule until Oct. 24, 2013. Unum claimed that while Casiano did qualify as being sick or injured under the policy, he was ineligible for the benefits because he was not under the care of a physician.

Casiano disagreed, stating that he had been under the care of two physicians at the time he submitted his claim, qualifying him for these long-term benefits, according to the bad faith claim denial lawsuit. Even after filing an appeal of the claim, which also included extensive medical evidence of his condition, Unum did not move in its decision. At this point, Casiano has reported exhausted all administrative remedies to fix this situation, and had to filed the lawsuit.

The plaintiff accused Unum of wrongfully denying him his benefits, and for allegedly practicing bad faith insurance tactics. Casiano is seeking compensation for all missing disability payments since Oct. 24, 2013, plus interest.

This Unum Lawsuit is James M. Casiano v. Unum Life Insurance Company of America, Case No. 2:14-cv-04404-MSG, in the U.S. District Court for the Eastern District of Pennsylvania.

Overview of Unum Claim Denial Tactics

Unum is America’s oldest disability insurance company, and is the largest disability insurance provider in the world. Unum has been the subject of numerous lawsuits from policyholders who had filed claims to request long-term or short-term benefits due to an injury or illness. Through the years, legal experts have accused the company of practicing unethical claim denial tactics. Tactics mentioned in a lawsuits mentioned in lawsuits include:

• Changing policies after claims are filed (and without the authorization or knowledge of policy holders)
• Improperly investigating the claim and obtaining opinions from unqualified witnesses
• Misreading medical records, often by their own medical examiners
• Demanding repeated requests for independent medical examinations or denying a claim without any medical examination
• Refusing to acknowledge a disability, especially mental disorders, fibromyalgia, and chronic fatigue syndrome
• Arguing that the claim is a pre-existing condition
• Denying a claim with the intent to wear the claimant down to a lower settlement
• Partially paying a claim for total disability
• Use of detectives, friends, co-workers and neighbors in an attempt to discredit the disability