Court Sides with Plaintiff in Unum Claim Denial Lawsuit

Court Sides with Plaintiff in Unum Claim Denial Lawsuit

By Mike Holter

Unum Insurance has a long history of improper claim denials against policyholders that file legitimate disability insurance claims. Luckily, the court system is siding with victims suing Unum and its subsidiaries to get the benefits they deserve. The latest example comes from an Arizona Plaintiff who sued First Unum Life Insurance Company and her Morgan Stanley Long Term Disability Plan for improperly terminating her long-term disability benefits.

Plaintiff Leah A. Bilyeu was employed by Discover Financial Services from 1987 through April 2004 before being forced to quit due to several medical conditions that prevented her from performing the duties of any occupation, her Unum lawsuit alleges. These conditions included Behcet’s disease — a rare condition that causes chronic inflammation of the body’s blood vessels — fatigue and anxiety. Bilyeu filed a long-term disability claim through her Morgan Stanley Long Term Disability Plan in April 2004. Unum is the Plan’s claim administrator, and also the insurer and payor of Plan benefits. According to her Unum claim denial lawsuit, Unum approved the claim in October 2004, but limited it to 24 months — the standard limitation applied to disabilities arising out of mental illness. Bilyeu disputed the limitation, and had her treating physician send an expert medical opinion to Unum explaining that Bilyeu’s inability to work due to fatigue was caused by her Behcet’s disease, not her anxiety. Unum refused to listen to the expert medical opinion, replying that its own in-house doctor reviewed her case and came to the conclusion that “Bilyeu’s fatigue in large part arises from her anxiety and depression, since her Behcet’s is not very active.” Unum’s doctor further concluded that Bilyeu “should have full-time sedentary work capacity,” the Unum claim denial lawsuit says.