An Unum claim denial has prompted a Rhode Island man to file a lawsuit against the insurance company, alleging that his claim should have been approved.

The Unum claim denial led that man to file a lawsuit in an effort to recover the disability benefits he believes he was owed from the outset.

Plaintiff John Doe reportedly purchased a variety of long term disability policies between 1988 and 2001 from providers including Unum Life, Revere, and Provident Philadelphia. According to his complaint, John has been licensed to practice medicine in Rhode Island since before 1988.

In April 2016, John’s physician allegedly diagnosed him with mitral valve prolapse and likely ruptured chordae tendinea, two serious cardiac conditions. John also claims he was found to have a systolic heart murmur and mild dyspnea associated with strenuous activity. Due to his conditions, John’s doctor reportedly recommended for him to have mitral valve repair surgery.

According to the Unum claim denial lawsuit, John underwent surgery in May 2016 and became completely disabled at that point. In late May 2016, John’s cardiologist reportedly noted that he was recovering successfully but was still experiencing fatigue with moderate activities. He was allegedly instructed to start rehab for his cardiac health and return to the doctor in two months. At this time, John claims his doctor wrote a note requiring him to stay out of work through August 2016.

In August 2016, John’s condition was reportedly re-evaluated, and his doctor determined that he was still experiencing some issues but was allowed to return to work , with low to moderate levels of exercise.

At Unum’s request, John says he was evaluated again in September and November of 2016 and January 2017. According to the Unum lawsuit, John was noted to be restricted in his work due to his condition after both evaluations.

In February 2017, John says he sought a second opinion for his condition and was diagnosed with heart failure. His new doctor allegedly told him to continue with his medication and work half what he was working, which was already reduced.

In July 2017, despite repeated follow-ups with John’s doctor, John allegedly received an Unum claim denial letter informing him that they would no longer treat him as totally disabled and pay him total disability benefits. Instead, he was told he would begin receiving partial disability benefits, the complaint says.

John argues that his condition slowly worsened, and his workload was reduced further. Despite this, he allegedly received another Unum claim denial in January 2018 informing him that his payments would be terminated after the insurance company determined him able to perform the duties of his occupation.

John says he saw his doctor for further evaluation, and his doctor noted that he was “[c]learly he is disabled from work at present, but have advised him to continue to engage in regular walking activity.” John says another evaluation led his cardiac surgeon to note that “I do think his symptoms are somewhat disabling and perhaps there is some increased medical therapy that may help him out. I do think he wants to try and work more but is having difficulty at his current halftime workload.”

Despite further evaluations, John claims that the Unum claim denial held. John then filed a lawsuit after repeatedly attempting to appeal, aiming to have his Unum claim denial reversed and his past and future claim benefits restored.

The Unum Claim Denial Lawsuit is Case No. 1:18-cv-00615-JJM-PAS in the Superior Court for the State of Rhode Island.

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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