A woman has filed an Unum bad faith denial lawsuit after she was denied long term disability coverage.

Plaintiff Wilma L. says she was employed by Tenet Healthcare Corporation, which was contracted with Unum to provide long term disability benefits and life insurance to its employees.

According to Unum’s policy, a person is disabled when Unum determines that 1) an employee is limited from performing the material and substantial duties of the employee’s regular occupation due to sickness or injury; and 2) an employee has a 20 percent or more loss in the employee’s indexed monthly earnings due to the same illness or injury.

The Unum bad faith denial lawsuit says that Unum’s policy dictates, “After 12 months of payments, you are disabled when Unum determines that due to the same sickness or injury, you are unable to perform the duties of any gainful occupation for which you are reasonably fitted by education, training or experience.”

Unum Bad Faith Denial Lawsuit Says Administrative Appeals Were Exhausted

Wilma was a general duty nurse at Tenet Healthcare, but she stopped working and Unum determined she was disabled. She was paid disability benefits until June 24, 2015.

She received a letter from Unum that her benefits were denied on June 26, 2015.

According to the Unum bad faith denial lawsuit, the letter acknowledged that Wilma “was in a great deal of pain and had received Social Security Disability Income benefits, however, it stated that its definition was different from the Social Security Administration’s definition.”

Wilma appealed the Unum bad faith denial on Nov. 30. 2015 when she included all of her medical records and the results of a two-day Functional Capacity Evaluation that indicted she was unable to perform sedentary work. She also included a questionnaire from her doctor, who said she agreed with the results of the evaluation.

Unum denied the appeal in January 2016, replying that Wilma “could perform an alternate occupation of Triage Nurse given her physical limitations.”

Wilma responded to that denial in June 2016 with “vocational evaluation which found that given her limitations, she did not have the background, education, training or experience to perform any gainful occupation which the policy defines as providing sixty (60%) of her previous earnings.”

The Unum bad faith denial lawsuit went on to say, “Specifically, the vocational expert stated that she did not possess even the basic typing skills required for work as a telephone triage nurse or any other similar job.”

In July 2016, Unum upheld its decision to deny benefits even after reviewing the vocational evaluation.

After exhausting her administrative appeals, Wilma has filed this Unum bad faith denial lawsuit because she is still entitled to long term disability benefits under the policy. She has provided proof in the form of medical documentation and supportive opinions from her treating physician.

If you have become disabled and have been denied disability benefits under a similar policy, you could benefit by speaking with a lawyer regarding your options for compensation.

The Unum Bad Faith Denial Lawsuit is Case No. 1:17-cv-02756-SCJ in the U.S. District Court for the Northern District of Georgia, Atlanta Division.