Unum Disability Lawsuit Claims Wrongful Denial of Benefits

A recent Unum disability lawsuit claims that the insurance company denied benefits for a doctor who suffered from a spinal injury.

Plaintiff Gene M. reportedly worked as an interventional cardiologist for more than 30 years in Florida. His field is a subspecialty of cardiology that handles treatment of structural heart diseases with catheters.

In April 2005, he allegedly sustained a spinal injury which rendered him unable to perform surgeries as frequently as he had before his injury. He reportedly sought treatment from a chiropractor after he started to experience lower back pain and sciatic-type pain in the legs and buttock.

Gene’s chiropractor allegedly confirmed that he was suffering from acute herniated nucleus pulposus due to the heavy lead gown he was required to wear during surgeries. He recommended some treatments which helped slightly, but Gene says he was forced to cut back at work due to his pain.

By 2009, Gene was allegedly completely disabled, and he was unable to work – prompting him to apply for Unum disability benefits. Unum reportedly requested more information from Gene about his occupation, and later determined that “it does not appear that these restrictions and limitations have had an impact on his ability to perform the duties of his occupation.”

Over the next few years, Unum allegedly continued to deny Gene’s requests for benefits based on his “current procedural terminology” (CPT) codes, which are used by the American Medical Association to document procedures. However, this was allegedly an improper use of CPT codes.

“Dr. Myers did not know at the time of these initial repeated denials of total disability that Unum’s use of CPT codes was improper and was forced to continue working as best he could, exacerbating his injuries,” the Unum disability lawsuit claims.

In 2014, Gene sought help from new legal counsel who reportedly informed him that Unum was misusing CPT codes in determining his disability states. He responded by filing a “Civil Remedy Notice of Insurer Violation” with the Florida Department of Financial Service, giving Unum 60 days to remedy their “improper acts” and approve his claim for total disability.

Unum allegedly failed to respond to this filing, and continued to ask for additional CPT codes to verify his disability. These requests allegedly contrasted with company statements that CPT codes should not be used for the sole determination of disability status.

“Unum internally has recognized that the reason CPT codes should not be used to classify a medical specialist’s occupation is because CPT codes cannot correlate pre- and postoperative office visits with their related surgical procedures and CPT codes cannot tell specific amounts of time that are spent on a particular duty,” Gene claims.

In 2015, Unum reportedly told Gene that he was completely disabled under a separate overhead policy and paid him in full under this policy. However, the insurance company allegedly continued to deny total disability to Gene.

Gene’s counsel reportedly objected repeatedly to Unum’s continued denial of his claims and inability to reach a final conclusion. Through pressure from Gene’s attorneys and repeated prompting, Unum allegedly reached a decision on his claim but determined that he was not eligible for the full compensation.

The company allegedly cited numerous technicalities to deny Gene his owed benefits, including classifying his disability as a “sickness” rather than an “injury”. Gene claims that Unum repeatedly engaged in deceptive actions to deny him benefits and seeks full payment of his long term disability policy.

The Unum Disability Lawsuit is Case No. 8:19-cv-00724-CEH-CPT in the U.S. District Court for the Middle District of Florida.