A California resident filed a bad faith insurance lawsuit against Unum Insurance alleging the company wrongfully denied her long-term disability benefits claim.

If a person is denied disability claims, they can either accept that decision or appeal for another review by the insurance company. The insurance company must explain the reason for the claim denial. Appealing that decision requires filing a lawsuit.

Plaintiff Michelle D., an outside sales territory manager for Coast Aluminum & Architectural Inc., was diagnosed with thrombocytopenia, pernicious anemia, peripheral neuropathy, and severe gastrointestinal and hematological problems in 2012.

Her condition caused her to have profound complications with her nutritional status which has contributed to her low weight of only 92 pounds, extreme fatigue, unstable gait, and impaired speech and judgment, rendering her unable to work.

Upon her diagnosis, Michelle submitted a timely claim for payment of disability benefits, as she was covered for under her Unum plan.

According to the bad faith insurance lawsuit, in January 2015, Unum attempted to contact Michelle’s physician but were unsuccessful and instead spoke with an office person who informed the Unum representative that it was Michelle’s doctor’s opinion that due to her weight loss and ongoing condition, she was unable to work in any capacity.

However, another doctor working on behalf of Unum, reviewed Michelle’s file and concluded that there was no evidence that would preclude her from performing full time work activities of her regular occupation.  Unum issued a claim denial on January 29, 2015.

Michelle appealed Unum’s claim denial and provided evidence from her physician that stated that her condition had not improved and that she was unable to sustain functional activities.

Unum upheld its denial of Michelle’s claim in October 2015, forcing her to file a bad faith insurance lawsuit in order to recover payment of all long-term disability benefits withheld pursuant to section 502(a) of the Employee Retirement Income Security Act of 1974 (ERISA) with back interest as well as attorney’s fees and cost.

Unum Bad Faith Insurance Practices

Countless Unum Insurance policyholders like Michelle have allegedly experienced the bad faith insurance practices that Unum uses to deny appeals or deny disability claims altogether.

Unum (formerly known as Unum Provident and First Unum) has been accused of systematically denying disability claims for thousands of policyholders over the past two decades. Unum and its subsidiaries have been subject to numerous bad faith insurance lawsuits.

Some examples of Unum’s alleged insurance claim denial tactics include:

• Changing disability insurance policies after claims are filed (and without the authorization or knowledge of policy holders)
• Improperly investigating the claim and obtaining opinions from unqualified people/supposed experts
• Misreading medical records, often by their independent medical examiners
• Demanding repeated requests for independent medical examinations or denying a claim without any medical examination
• Refusing to acknowledge a patient’s disability, especially mental disorders, fibromyalgia, and chronic fatigue syndrome
• Arguing that the claim is a pre-existing condition
• Denying a claim with the intent to wear the claimant down to a lower settlement
• Partially paying a claim for total disability
• Use of detectives, friends, co-workers and neighbors in an attempt to discredit the disability

The Unum Bad Faith Insurance Lawsuit is Case No. 2:16-cv-00678 in the U.S. District Court for the Central District of California.