A doctor has filed a lawsuit after Unum refused to reinstate long term disability benefits he says he should continue receiving.

The plaintiff says he took out a disability income policy called The Preferred Professional in 1994 from The Paul Revere Life Insurance Company. The policy is obligated to pay benefits “for loss due to injury or sickness.”

In 1997, Provident Life and Accident Insurance Company acquired The Paul Revere Life Insurance Company. In 1999, Unum merged with Provident and became UnumProvident Corporation. In 2007, UnumProvident became Unum Group.

According to the lawsuit, the plaintiff was performing brain surgery on a fellow surgeon in June 2016 when he suddenly experienced a ruptured lumbar disc in his spine. At that moment, the plaintiff says he was holding a surgical drill in his right hand. As he collapsed the floor, he says he twisted his right hand to ensure the drill did not hurt the patient. This twisting action purportedly resulted in a ruptured tendon to his right hand.

Despite having surgery on his right hand in July 2016, the plaintiff says his hand has not returned to full use.

The plaintiff saw an orthopedic surgeon, who recommended he undergo surgery to implant an artificial disc to replace the ruptured disc. Because he has been attempting to ensure his insurance companies pay for the procedure, he has yet to undergo the spine surgery.

In August 2016, the plaintiff submitted a claim to Unum for disability benefits under his Paul Revere insurance policy. In January 2017, Unum declared the plaintiff was totally disabled as of June 30, 2016 and began paying him benefits.

On Dec. 13, 2017, however, Unum sent a letter to the plaintiff notifying him they would no longer continue to pay benefits.

He appealed the decision and asked Unum to reinstate long term disability benefits, but the company denied his request.

Failure to Reinstate Long Term Disability

The plaintiff alleges Unum’s failure to reinstate long term disability benefits for him is linked to the fact his policy is one of the old “Closed Block” segments, a collection of policies no longer offered.

The Closed Block segment includes individual disability, group and individual long-term care, and other insurance products that Unum no longer markets. These Closed Block segment policies were no longer issued after 2004, and Unum allegedly has lost billions of dollars paying for policies in the Closed Block.

“Consequently, the defendants look for reasons to deny benefits and to close these claims, thus reducing their exposure under these policies,” alleges the lawsuit.

Unum is accused of placing the company’s own economic interests ahead of their obligations to the plaintiff under his policy by failing to reinstate long term disability benefits to him.

As a result of their failure to reinstate long term disability insurance benefits, the plaintiff alleges he has incurred and continues to incur economic losses.

The Unum Lawsuit is Case No. 2:18-cv-08337-JAK-KS in the Superior Court of the State of California for the County of Los Angeles.

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