Unum faces a lawsuit by a woman claiming the insurance company denied her claim for long-term disability for fibromyalgia.

Plaintiff Mary D. filed a lawsuit against Unum Life Insurance Company of America, alleging that they wrongfully denied her insurance claim for long-term disability for fibromyalgia.

Unum is a life insurance and disability benefits company which provide benefits programs through employers. Unum is currently the largest disability insurance company in the country. An estimated 40 percent of disability insurance policies in the United States are handled by Unum or UnumProvident, providing coverage to over 17 million Americans.

Over the past few years, Unum has been repeatedly accused of wrongfully denying or terminating legitimate insurance claims to boost the company’s profits. The alleged systematic denial of legitimate claims is a corporate strategy that dates back years.

According to Unum employees interviewed by 60 Minutes in 2002, Unum sets a claim-denial quota each month. The system allegedly rewards claim adjusters who deny enough people the benefits they paid for. The alleged misconduct has prompted over 3,000 Unum lawsuits filed by the government, regulators, and policyholders.

Mary alleges she formerly worked as a project manager and graphic design specialist at TPG Global. In 2012, she says, she started to develop severe fatigue and pain in her joints, specifically in her sacrum, legs, and feet. She was later diagnosed with Lyme disease, fibromyalgia, and chronic fatigue syndrome.

As a result of her fibromyalgia, Mary says she suffers from debilitating fatigue, severe joint pain, widespread pain, sacroiliitis, limited mobility, concentration problems, and IBS.

Fibromyalgia is a musculoskeletal disorder characterized by severe pain, fatigue, sleep issues, memory issues, and mood issues. Although scientists do not fully understand how fibromyalgia affects the body, researchers theorize that the condition amplifies the way the brain processes pain signals. Fibromyalgia often co-exists with other conditions including irritable bowel syndrome, migraines, interstitial cystitis, and temporomandibular joint disorders.

Following her diagnosis, Mary applied for long-term disability for fibromyalgia through Unum. Unum approved her claim but misclassified Mary as suffering from depression and anxiety despite having applied for long-term disability for fibromyalgia.

Mary claims that Unum misclassified her claim because mental and nervous disabilities have a 24-month limit for benefits. Since Unum misclassified her, she alleges, they “stood to save substantial amounts of money that it would otherwise have to pay [Mary] in disability benefits”.

After 24 months of paying benefits on her allegedly misclassified claim, Unum denied her long-term disability for fibromyalgia claim.

“[Mary] timely appealed UNUM’s denial of her long-term disability claim. [Mary] was very clear throughout her claim that her disability was based on physical restrictions and limitations and not due to her mental health conditions,” the complaint states. Mary continued to appeal to Unum and provided numerous letters and records which supported her claim for her physical disability.

According to the lawsuit, Mary submitted “medical records, a Functional Capacity Examination that visibly demonstrated [Mary’s] physical disabilities and inability to work, and numerous letters from her treating physicians supporting her disability and her ongoing physical restrictions and limitations”.

Mary seeks a court order mandating Unum to pay her the benefits for long-term disability for fibromyalgia. Her lawsuit also seeks statutory damages, court costs, and attorneys’ fees.

The Unum Lawsuit is Case No. 3:18-cv-02270-LB in the United States District Court for the Northern District of California.

Do YOU have a legal claim? Fill out the form on this page now for a free, immediate, and confidential case evaluation. The bad faith insurance attorneys who work with Top Class Actions will contact you if you qualify to let you know if an individual lawsuit or Unum class action lawsuit is best for you. [In general, Unum bad faith lawsuits are filed individually by each plaintiff and are not class actions.] Hurry — statutes of limitations may apply.

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