Unum Denies Disability Insurance Claim, Winds Up In Court

Unum Denies Disability Insurance Claim, Winds Up In Court

By Robert J. Boumis

Jeffery Avena of Louisiana has filed a lawsuit against the insurance company Unum Life Insurance, alleging that the insurance giant has wrongfully denied his disability insurance claim.

According to the Unum lawsuit, Avena had a long-term disability insurance plan through his employer, Hollywood Casino/Penn National Gaming Incorporated. The insurance policy was underwritten by the Unum Group, the largest provider of disability insurance in the United States. 

In October 2011, Avena was involved in a serious car accident. According to the text of the Unum lawsuit, the accident cause severe damage to his head, back, shoulders and neck. He also allegedly suffered nerve damage to his foot, as well as pain and muscle spasms throughout his back and neck. Initially, Avena’s doctors restricted him from walking and discouraged him from returning to work for three months. 

Per the Unum lawsuit, Avena returned to work from January through March of 2012, but found that his injuries were too serious to continue working. The damage allegedly impaired his ability to function in the job in that he was unable to sit or stand for long periods of time, and the pain prevented him from focusing, in a job that required “a high level of cognitive functioning.” Per the text of the Unum lawsuit, the duties of his job exacerbated his injuries and Avena was ultimately unable to continue working. The complaint points out that Avena had worked continuously for more than three decades until his accident.

Unum denied Avena’s initial disability insurance claim. Avena appealed through Unum’s internal appeals process, but was ultimately denied the benefits of the insurance policy. The Employee Retirement Income Security Act (ERISA), which governs pensions and disability insurance, requires that policyholders exhaust internal appeals processes before seeking relief from a court of law. 

Avena’s lawsuit characterizes Unum’s denial of his disability insurance benefits as “arbitrary and capricious” and “an abuse of discretion.” The lawsuit contends that Unum has denied Avena’s claim in bad faith – a legal term meaning that the claim was wrongfully denied so that Unum would not have to pay out on a legitimate claim. The Unum lawsuit seeks the instatement of disability insurance benefits per the terms of the original policy, as well as back-owed benefits back to the original claim. 

The Unum lawsuit is formally titled Jeffery V. Avena v. Unum Life Insurance Company of America, Case No. 2:13-cv-5947, in the U.S. District Court for the Eastern District of Louisiana. 

If you believe your legitimate disability claim was denied, it’s normal to feel overwhelmed. Large insurance companies like Unum can seem ironclad and intractable against your appeals. But you need to remember that you have rights, and the legal system is designed to protect those who have been wrongfully harmed. You can start to explore your options by visiting the Unum/UnumProvident Disability Insurance Claim Denial Class Action Lawsuit Investigation. Here, you can enter information about your situation for a legal review by a trained expert with a background in this type of litigation. The initial consultation is completely free of charge, and from here you can receive additional guidance on the best steps to take in your exact situation.