First Unum Life Insurance Company is facing a new claim denial lawsuit from a woman alleging her claim for disability benefits was wrongfully denied. This woman reportedly met all eligibility requirements and followed all administrative procedure, but was still denied benefits she believes she is entitled to.

Missouri plaintiff Karen F. had been previously fully employed by Pearson Inc., working as the company’s Head of Assessment Quality Assurance. According to the claim denial lawsuit, Karen’s occupational duties include a wide range of tasks requiring full range of motion and cognitive function.

Through Karen’s occupation, she should have been able to file a claim for disability benefits on a short or long term basis without any issue. With this in mind, Karen filed a claim for short term disability benefits on Dec. 2, 2015 for an upcoming surgery.

Before undergoing the surgery, Karen had only managed to work one final time before losing her ability to work due to the effects of the surgery.

Overview of Claim Denial Lawsuit

The surgery was conducted on Dec. 15, 2015 in her left shoulder to repair her rotator cuff, and to address other medical problems that developed in the area too. However, soon after her surgery, Karen reportedly became disabled due to the effects of fibrosis, scarring, adhesive capsulitis, shoulder pain, tissue damage, and other post surgical complications.

As soon as she could, Karen filed a claim for disability benefits on a long term basis citing that she had been unable to work since her surgery. She filed her claim for disability benefits on June 28, 2016, filing all relevant medical documentation showing her medical treatments and physical therapy she had been going through.

Even with all this medical testimony submitted, Unum opted to deny her claim for disability benefits and sent the first claim denial letter on Oct. 21, 2016. In this claim denial letter, Unum stated Karen was capable of performing her occupational duties and cited treatment notes from her medical documentation that indicated improvement during the summer of 2016.

Karen says that the claim denial letter did not account for recent medical evidence, which showed Karen’s condition would not improve.

Unum also tried to argue that her doctor failed to provide medical testimony when the insurance company requested itduring the claim filing process.

However, Karen says her doctor submitted the requested information on Oct. 24, 2016, which cited her limitations and impairments. Soon after receiving the claim denial letter, Karen filed an appeal on April 26, 2017.

During the appeal filing process, Karen says she submitted all required documentation and relevant medical testimony including her physician’s option statements and independent physician statement. Karen’s appeal also contained a vocational report, which identified several errors in Unum’s decision to deny her claim for disability benefits.

However, Unum still denied Karen’s claim for disability benefits on July 28, 2017, while Karen has been forced to contend with her worsening condition and extensive medical bills. At this point in time, Karen has exhausted all administrative remedies and has been forced to file legal action.

This Unum Claim Denail Lawsuit is Case No. 5:17-cv-06148, in the U.S. District Court  for the Western District of Missouri.

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