A woman whose disability insurance benefits were cut off after more than ten years is suing First Unum Life Insurance Company of America to get them back.

Plaintiff Beverly F. says that as an employee of HSBC Bank, she is subject to that company’s employee disability insurance benefits program administered by defendant Unum.

Plan participants who meet the plan’s definition of “disabled” can expect to collect disability insurance benefits and are also eligible for continuation of life insurance coverage with premiums for that coverage waived, Beverly says.

Beverly says she became disabled according to the plan’s definition in 2004. After she made a claim for disability benefits, Unum granted that claim and began making payments, she says.

The payments continued until September 2015, when she was denied disability benefits, presumably based on the opinions of two of Unum’s medical reviewers.

According to Beverly’s bad faith claim, she and Unum now disagree as to whether she meets the definition of “disabled” under the plan’s terms.

Disability Insurance Benefits Under ERISA

This disability insurance benefits lawsuit falls under a federal law called the Employee Retirement Income Security Act, or ERISA. Originally enacted in 1974 to protect employees’ rights under pension plans, ERISA now also governs the administration of disability benefits in certain employer-sponsored group insurance policies.

In an ERISA lawsuit, the plaintiff may be able to get the court to apply a more beneficial standard of review if they can show that the insurance company operated under a conflict of interest that made a difference in its final decision.

Beverly tries to do that in her own disability lawsuit: she says that Unum both funds the plan and decides who will or will not receive benefits, creating an inherent conflict of interest.

If the plaintiff can’t give the court a reason to apply the more plaintiff-friendly standard, it will likely review the denial under a standard that gives much more deference to the insurance company.

Beverly takes issue with Unum’s denial on several grounds. She says the two medical reviewers based their decision solely on a review of Beverly’s medical records without the benefit of an independently-conducted exam.

She also challenges the two medical reviewer’s qualifications, and she argues their opinions were inherently biased since they were being paid by Unum to do the reviews. The opinions of Beverly’s own treating physicians were ignored or misrepresented in the process, she claims.

She also says that Unum’s denial was not based on substantial evidence in her file and was inconsistent with the overall evidence in the record. Unum cherry-picked medical evidence in its own favor, she claims.

Beverly is asking the court to award damages to cover her unpaid disability insurance benefits through the date of judgment, plus pre- and post-judgment interest, together with any other benefits she may be entitled to such as the continued life insurance with premium waiver.

She is also asking for reimbursement of all premiums she paid since she was denied disability benefits, as well as attorneys’ fees and court costs.

The Unum Denied Disability Insurance Benefits is Case No. 0:16-cv-1333 in the U.S. District Court for the District of Minnesota.