Unum Life Insurance Company of America is facing a new claim denial lawsuit from a Florida woman alleging the insurance company had wrongfully denied her fibromyalgia disability benefits. The woman had previously worked at Starbucks and became eligible for long-term disability coverage, but was still denied fibromyalgia disability benefits.

Plaintiff Heather S. says she had been working full time for Starbucks Corp. and eventually became eligible for long-term disability coverage after working there for the time required under the plan. However, Heather became disabled on May 1, 2014 due to the complications of back pain, knee pain, osteoarthritis, and fibromyalgia.

At this time, Heather filed a claim for long-term fibromyalgia disability benefits and had submitted all relevant medical documentation detailing her condition while following administrative procedure. According to her claim for long-term fibromyalgia disability benefits, she is unable to stay in her current job because she is unable to perform her occupational duties.

In addition, the lawsuit states she is unable to work in a similar industry or sustain sufficient income, with her physician providing testimony detailing the severity of her condition.

Overview of Claim Denial Lawsuit

With these circumstances, Heather met all eligibility requirements under her disability plan and was initially approved for long-term fibromyalgia disability benefits. It is important to note that Unum investigated the validity of Heather’s claim, and concluded she did meet eligibility requirements.

However, Unum recently reversed their decision on May 18, 2017, denying Heather’s coverage for long-term fibromyalgia disability benefits beginning just the next day. Heather appealed this decision in a timely manner on Oct. 24, 2017, reiterating her need for the long-term fibromyalgia disability benefits.

During the appeal filing, Heather says she submitted all relevant documentation and additional medical documentation detailing the severity of her condition. Even with this diligence, Unum upheld their decision to deny Heather’s long-term fibromyalgia disability benefits on Dec. 13, 2017.

It is important to note that Heather is still contending with her medical condition and has not had any payment coverage since May 2017. Due to her extensive medical bills and inability to work, Heather says she has developed mental anguish and stress over the cost of medical care.

Heather has since exhausted all administrative remedies and has resorted to legal action. Heather alleges Unum wrongfully denied her long-term fibromyalgia disability benefits, stating the disability company ignored relevant medical evidence and ultimately dismissed her claim.

Heather’s allegations of wrongful claim denial tactics are similar to those raised by other policyholders who have allegedly experienced similar treatment from Unum. The insurance company is one of the oldest and largest providers of disability coverage in the United States, with millions of customers.

However, Unum has become increasingly associated with wrongful claim denials, with the insurance company at the center of controversy in a 60 Minutes documentary and other wrongful claim denial lawsuits. The insurance company allegedly developed several significant claim denial tactics, to find any excuse to dismiss or lower the policyholder’s claim including:

• Refusing to acknowledge the disability (especially common in fibromyalgia cases)
• Misreading medical records (often by third-party medical examiners)
• Improperly investigating claims and getting opinions from unqualified parties

Heather is seeking all missing fibromyalgia disability benefits payments, along with other relevant damages.

This Claim Denial Lawsuit is Case No. 3:17-cv-00970-MCR-CJK, in the U.S. District Court for the Northern District of Florida, Pensacola Division.

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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