A Unum disability claim denial lawsuit was filed by a physician who alleges the insurer unfairly rejected a legitimate claim.

Plaintiff Dr. Samuel Mathew, a licensed medical physician since 1982, has long term disability insurance under the Intra-Hearts Service Corporation policy provided by Unum Life Insurance Company of America, and individual disability insurance through Provident Life and Accident Insurance Company. He alleges a bad faith insurance claim denial by Unum.

Unum is a Fortune 500 company based in Tennessee that is the top disability insurer in the country, with annual revenues of over $10 billion and close to 15 million subscribers. The company was known as Unum Provident until a name change in 2007. Over the past two decades, Unum and its subsidiaries have been the subject of many lawsuits alleging the systematic denial of thousands of policyholders’ disability insurance claims.

According to his disability insurance lawsuit, Mathew was “regularly performing invasive cardiology procedures at various hospitals” until 2008, when he stopped due to disabling medical conditions. Sometime thereafter, he “allowed his hospital privileges to lapse and limited his cardiology duties to clinical cardiology functions only.” This diminished his workload, new patient referrals and, in turn, his income.

Three years later, on July 7, 2011, Dr. Mathew submitted a claim for disability under both of his policies, listing March 1, 2011 as his official disability date. The medical conditions he claimed included diabetes, neuropathy, cervical radiculopathy, spinal stenosis and a host of other issues. The pain and discomfort limited his ability to perform the actions required of his occupation. Moreover, his disability allegedly forced him to reduce his hours to part time and stopped him for performing invasive procedures.

On Oct. 1, 2011, due to his inability to perform invasive procedures, Unum reportedly converted the disability claims from partial disability to total disability and paid Mathew accordingly, even though he was still working on a part-time basis.

Both policies paid residual disability benefits from October 2011 through 2013, when all payments came to a stop. According to the disability insurance lawsuit, “In its letter dated January 31, 2013, Unum closed both of Dr. Mathew’s benefits claims and terminated payments to Dr. Mathew inaccurately claiming that Dr. Mathew failed to timely provide previously requested documents.” Then, on March 6, Unum formally denied both policies.

Now Mathew seeks the fulfillment of his individual and group disability benefits he is entitled to under the terms of his plan. While both of his insurance policies define total disability differently, he alleges the relevant part, “not able to perform the substantial and material duties of Your Occupation,” still stands.

His claim calls on the Employee Retirement Income Security Act of 1974 (ERISA), a federal law that sets minimum standards for most voluntarily established health and pension plans in private industry, and alleges breach of contract and bad faith and unreasonable and vexatious conduct by Unum and Provident.

The Unum Disability Insurance Lawsuit is Samuel P. Mathew M.D. v. Unum Life Insurance Company and Provident Life and Accident Insurance Co., Case No. 1:14-cv-08000, in the U.S. District Court for the Northern District of Illinois, Eastern Division.