Plaintiff Alleges Denial of Unum Disability Claim Violates Federal Law

A California woman has filed a complaint alleging that denial of her Unum disability claim was in violation of federal law governing employee benefits.

On Jan. 14, 2019, Plaintiff Laura D. brought legal action against Defendant Unum Life Insurance Company of America under provisions of the federal Employee Retirement Income Security Act (ERISA) after she was denied disability payments to which she says she was entitled under the terms of her employee benefit plan.

Case Background

According to her complaint, Laura worked for 15 years as a pediatric nurse at the Rady Children’s Hospital in San Diego, Cali. During her tenure at the facility, she participated in a Long Term Disability (LTD) Plan, underwritten by the defendant and subject to the ERISA law.

In 2016, she allegedly developed a condition known as Chronic Inflammatory Response Syndrome, or CIRS. Also known as “biotoxin” or “mold” Illness, this is a complex disorder, resulting in numerous symptoms affecting almost every system in the body. Laura also states that she suffers from a genetic inability to produce specific antibodies and has been diagnosed with Lyme Disease.

Because of her condition, Laura says she experiences chronic fatigue, poor sleep, headaches, joint pain, mental impairment, muscular tension, and neurological symptoms.

After she was no longer able to work, she applied for short-term disability benefits, for which she was approved. However, she says that when she filed the disability claim for long-term benefits, she was denied, despite having provided several hundred pages of documentation of her illness. A subsequent appeal was also denied.

Conflict of Interest?

Laura states that the administrator of an LTD Plan provided by her employer did not give underwriter Unum the “discretionary authority” to determine eligibility nor interpret its terms and provisions. She says that to the best of her knowledge, the plan is regulated under ERISA and established by the hospital at which she was employed. However, she also says that Unum “acted in the capacity of a plan administrator and that in acting in this capacity, created a conflict of interest.

Other Unum Disability Claim Denials

Unum appears to have a history of wrongfully denying legitimate disability claims. The largest underwriter of disability policies in the U.S., Unum has faced thousands of accusations of unfair denial or termination of claims in order to grow its profit margins.

A recent case filed against Unum by a former litigation attorney who was disabled in an auto accident ended in a judgment for the plaintiff. The defendants were ordered to reinstate her benefits and pay retroactive benefits dating from the time they were terminated.

Currently, Unum’s frequent denials of claims have made the company the target of more than 3,000 lawsuits filed by state and federal agencies as well as individual plaintiffs who have had an Unum disability claim denied. Many of these have been successful – but so far, claimants say Unum has shown little inclination to change its behavior.

Laura D.’s Unum Disability Claim Lawsuit is Case No. 3:19-cv-00097-GPC-WVG, U.S. District Court for the Southern District of California.