A man suffering from multiple and purportedly unrelated disabilities has filed an Unum lawsuit in hopes of getting his disability insurance benefits finally sorted out.

Plaintiff Richard J. says he is a beneficiary of an employer-sponsored disability insurance policy administered through defendant Unum Life Insurance Company of America.

This employer-sponsored benefit plan is governed by the federal Employee Retirement Income Security Act, or ERISA.

Richard says he became disabled in October 2012 because of “foot ulcers and infections complicated by Systemic Lupus Erythematosus.” He says he applied for and received long-term disability insurance benefits, which Unum paid from April 2013 through his recovery and return to work in October 2014.

Later, in January 2015, Richard says he became disabled again – this time due to a fall on a staircase that caused a lumbar fracture, requiring surgical treatment.

Unum then began paying him short-term disability insurance benefits based on that injury and started evaluating his claim for long-term benefits.

The following April, he says, he was also diagnosed with a left foot fracture, which required casting and other treatment through the summer and fall of 2015.

In September 2015, Richard says, Unum denied his claim for long-term disability benefits. He says Unum’s stated reason for the denial was that his disability that began in January 2015 was a recurring disability that occurred within six months of the end of his prior period of entitlement to benefits.

In other words, Richard argues, Unum believed Richard’s fall and spinal fracture was somehow connected to the same cause as the foot ulcers for which he had received prior disability benefits.

Richard says he tried appealing the denial directly to Unum, submitting additional evidence showing his lumbar fracture and foot fracture was not connected to his foot ulcers.

In response, Unum paid Richard an additional 2 months and 23 days’ worth of entitlement, since he had not exhausted the maximum period of 21 months of entitlement. But besides making that payment, Unum stood behind its original denial.

Following that internal appeal, Richard filed his current Unum lawsuit. He argues Unum’s denial was not supported by substantial medical and vocational evidence. On the contrary, he argues, Unum ignored unrefuted medical and vocational evidence in Richard’s favor.

The Unum lawsuit seeks an award of benefits already withheld, plus related benefits such as life, health and dental insurance that he would have received if Unum had not originally denied his claim for disability insurance.

Richard is also asking the court for reimbursement of his attorney’s fees, as provided by ERISA.

Bringing an Unum Lawsuit Under ERISA

Appealing a denial of disability insurance benefits under ERISA can be tricky. While ERISA may have been enacted to protect employees, today attorneys who handle ERISA cases say it tends to favor the insurance company.

ERISA creates many detailed procedural requirements for both the internal appeal and for appealing to a court. It also precludes many claimant-friendly state laws that might otherwise apply, such as availability of punitive damages or a more favorable standard of review.

A knowledgeable ERISA attorney can help claimants know exactly what their claim requires and what their best options may be when considering an Unum lawsuit.

The Unum Lawsuit is Case No.1:16-cv-00223 in the U.S. District Court for the Northern District of Florida, Gainesville Division.