A California resident has filed a disability benefits lawsuit against Unum Life Insurance Company of America, claiming the company improperly denied her benefits to which she was entitled.

Plaintiff Rima H. filed her claim in California federal court against the insurance giant after she became chronically disabled. She brought her claim under ERISA, the Employee Retirement Income Security Act of 1974.

Rima’s Unum insurance policy was maintained as part of her employee benefit plan under her employer at the time, Albermale Bank & Trust. She states that at all relevant times, she was covered under the group disability plan.

Under the plan, Rima believed she was eligible to receive the equivalent of 60% of her previous monthly earnings with Albermale Bank & Trust, following a 90 day waiting period and continuing up through her 65th birthday.

Prior to becoming chronically disabled, Rima says, she worked as a mortgage loan underwriter for her employer. She became disabled as defined by her disability insurance plan in June 2011.

Rima believed her chronic disability was covered under the plan’s definition of disability.

Under that definition, a covered person would be considered disabled if they are limited from performing the material and substantial duties of their regular occupation due to sickness or injury, and they have 20% or more loss in their indexed monthly earnings due to the same sickness or injury.

The applicable definition changes after 24 months of payments. At that point, the claimant is disabled when Unum determines that due to the same sickness or injury, they are unable to perform the duties of any gainful occupation for which they are reasonably fitted by education, training, or experience.

Rima says she became chronically disabled due to her following conditions: “psoriatic arthritis; psoriatic spondyloathropathy; labral tear of the left hip, status post arthropathy and total hip replacement; left hip osteoarthritis; lumbar foraminal stenosis; lumbar facet arthropathy; lumbar degenerative disc disease; lumbar radiculopathy; and mononeuritis.”

Rima stated that her physician, clinical nurse, and physical therapist all agreed that Rima could no longer continue her full time sedentary work in her position as an underwriter.

Following the assessments of her medical team, Rima submitted a claim to Unum for disability benefits and was initially approved.

Unum Denies Plaintiff is Chronically Disabled

Rima says her disability continued to deteriorate, and she kept Unum informed of changes. After phone calls and personal visits, Unum’s consulting physician decided that Rima was not disabled, and a second Unum physician concurred.

Despite continued support from her own medical team indicating that Rima was in fact chronically disabled, Unum continued to deny Rima’s benefits.

Rima appealed to Unum and exhausted all of her administrative appeals without being awarded additional benefits, then took legal action against the insurance company.

Rima alleges that Unum violated the terms of ERISA from July 2014 until the time of her lawsuit filing in January 2017.

She is seeking back payments for her disability claim along with interest, continued disability benefits, continued life insurance benefits, attorney’s fees and costs and any additional relief as deemed just and proper by the Court.

The Unum Lawsuit is Case No. 2:17-cv-00105-FMO-JPR, in the U.S. District Court for the Central District of California.