Woman Alleges Wrongfully Denied Unum Long Term Disability Coverage

A woman from New York recently filed a claim denial lawsuit alleging she was wrongfully denied Unum long term disability benefits, even though she met all eligibility requirements.

The claim denial lawsuit states that plaintiff Margaret C. was previously fully employed by Irving Place Capital and was supposed to be provided Unum long term disability coverage if needed. This became necessary when Margaret reportedly sustained serious injuries to her left ankle when she fell off a ladder at a company event on Aug. 14, 2015.

Margaret reportedly sustained serious permanent injuries that prevented her from working at her previous occupation and from working in other jobs that would allow her to earn sufficient income.

According to the Unum lawsuit, the lower part of her fibula was severely damaged, with the bone shattering into multiple pieces. The lawsuit further states her ligaments were torn from the lower part of her fibula, which caused her to suffer swelling, pain, stiffness, and limited range of motion in her left ankle. The lawsuit documents state that Margaret eventually had to undergo surgery, but she still experienced trouble walking and significant pain.

In addition to the injuries in her left ankle, Margaret had reportedly been suffering from plantar fasciitis and osteopenia in both ankles, which further compounded her condition. A second surgery was eventually required to remove hardware from her left ankle, but Margaret reportedly continued to suffer significant pain after the surgery.

According to the claim denial lawsuit, Margaret was eventually diagnosed with Complex Regional Pain Syndrome with her doctors also concluding the nerve damage in her left ankle was preventing a full recovery.

Unum Disability Denial

The claim denial lawsuit states that due to the severity of Margaret’s medical conditions, she had to cease working and filed for long term disability benefits on Oct. 15, 2015. Unum initially approved the claim.

However, the claim denial lawsuit states Unum suddenly reversed their decision and stopped providing long term disability coverage on July 14, 2016. Margaret reportedly filed an appeal on Aug. 17, 2016, reiterating the severity of her condition and included additional medical records that proved this.

Even though Margaret says the medical evidence showed that she could not earn a sufficient income by working, Unum upheld its decision and notified Margaret of this decision on Feb. 8, 2017.

At this point in time, like many others denied disability by Unum, Margaret has reportedly exhausted all administrative options and has been forced to resort to filing legal action.

Overview of Unum Disability Coverage Denial

Unum is one of the largest disability insurance providers in the United States. However, it has recently garnered a negative reputation for bad faith disability insurance practices. Some policyholders say the company systematically denies long term disability coverage when policyholders meet all eligibility requirements and need additional financial assistance most in their lives.

Reports of Unum’s claim denial tactics came out when the television documentary show, 60 Minutes, reported on the insurer in 2002.

According to the 60 Minutes program, the disability provider had set up a claim denial quota each month and rewarded claim adjusters who met these goals. Unum allegedly did this to increase their profit margin, by shrinking the amount of money set aside for short term or long term disability coverage.

In comparing disability coverage, short term disability coverage typically replaces 60 to 70 percent of base salary, but only pays out for a few months to one year depending on the policy. In contrast, long term disability coverage replaces 40 to 60 percent of base salary, but the coverage continues until the disability ends, or at retirement if the disability continues.

Margaret is seeking compensation for all missing Unum long term disability payments, along with any other relevant damages. Her Unum lawsuit is Case No. 1:19-cv-00073-TAV-CHS, in the Circuit Court of Hamilton County, Tennessee.