An anesthesiologist says he had his Unum claim denied for long-term disability insurance despite multiple professional medical opinions of treating physicians supporting his case.

Plaintiff Lucien C. M.D., a citizen and resident of Madison County, N.Y., has registered a lawsuit under the Employee Retirement Income Act (ERISA) of 1974 against the Unum Life Insurance Company and CHAG Anesthesia PC after exhausting all administrative recourse he had at his disposal after having his Unum claim denied.

What is ERISA?

According to the U.S. Department of Labor website, ERISA protects the financial interests of people enrolled in employee benefit plans. It also protects the enrollee’s named beneficiaries.

It set up standards of conduct for managers that administer benefit plans and others with fiduciary responsibilities. It protects the investment of workers in the event that a for-profit company goes bankrupt, ensuring that plans remain accessible to those that have paid into a protective policy.

A Doctor’s Unum Claim Denied

According to the lawsuit, Lucien works as an active anesthesiologist at CHAG Anesthesia PC in Syracuse, N.Y. His income has been reduced because he can no longer work the long hours associated with his profession which often involves being on call at night and working weekends, the Unum lawsuit says.

Lucien says he has been in two serious car accidents in which his back has been injured. Approximately two years ago in February 2017, he required surgery on his back in the Lumbar-5 and Sacral-1 area. The laminectomy and decompression surgeries helped but did not cure him of all back pain, he says.

Six months after his surgeries—Aug. 11, 2017, Lucien claims he qualified for long-term disability benefits associated with his plan. He says he had been working in a limited fashion since March after his condition had been reviewed by several physicians. They limited him to work no more than 45 hours on a Monday through Friday basis to reduce strain, he says.

Even though he was working, Lucien says he suffered and continues to suffer a substantial loss to his income by this reduction in hours. He argues this necessary curtailment of hours conforms to one of the two definitions of disability Unum puts in its benefit plan materials according to the factual section of the lawsuit:

You are unable to perform one or more of the material and substantial duties of your regular occupation, and you have 20% or more loss in your indexed monthly earnings while working in your regular occupation or in any occupation.

This section of the lawsuit also claims that he is entitled to 60 percent of his monthly earnings up to a cap of $5,000 which when the Unum claim denied has not been paid. Lucien appealed the denial in August 2018 and it was again denied in September. Unum indicated in that refusal of benefits that the demands of his profession do not increase based on the day of the week or time of the day.

Unum has been accused by the plaintiff of breaching a fiduciary duty to him by denying benefits without consideration of several independent medical professionals who have examined him. He seeks a restoration of benefits as well as all attorney and court fees with this action.

What is Unum?

Unum Life Insurance Co. is a Tennessee-based Fortune 500 insurance company that was derived from a union between the Unum Corporation and The Provident Companies in 1999.

The Unum Claim Denied Lawsuit is Case No. 5:19-cv-00133-MAD-TWD in U.S. District Court for the Northern District of New York

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