A consumer recently filed a lawsuit alleging that his Unum disability claim for medical issues was wrongfully denied.

Plaintiff Elton H. recently filed a lawsuit against Unum Life Insurance Company of America, claiming that his Unum disability claim was wrongfully denied. Elton filed his disability request due to persistent health issues.

Unum is a life insurance and disability benefits company which provide benefits programs through employers. Unum is currently the largest disability insurance company in the country. An estimated 40 percent of disability insurance policies in the United States are handled by Unum or UnumProvident, providing coverage to over 17 million Americans.

Unum Claim Denials

Over the past few years, Unum has been repeatedly accused of wrongfully denying or terminating legitimate insurance claims to boost the company’s profits.

The alleged systematic denial of legitimate claims is a corporate strategy that dates back years. According to Unum employees interviewed by 60 Minutes in 2002, Unum sets a claim-denial quota each month. The system rewards claim adjusters who deny enough people the benefits they paid for. The alleged misconduct has prompted over 3,000 lawsuits filed by the government, regulators, and policyholders.

According to Elton, Unum defines disability as “you are limited from performing the material and substantial duties of your regular occupation due to your sickness or injury; and you have a 20% or more loss in your indexed monthly earnings due to the same sickness or injury.” Unum also states “[a]fter 60 months of payments, you are disabled when Unum determines that due to the same sickness or injury, you are unable to perform the duties of any gainful occupation for which you are reasonably fitted by education, training or experience.”

Elton suffers from a variety of health issues including lumbar and cervical degeneration with radiculopathy, ulnar neuropathy, excessive daytime sleepiness, sleep apnea, and related chronic pain, fatigue, cognitive impairment, and arthritis. Radiculopathy is a condition involving a compressed nerve in the spine. The condition can involve numbness, tingling, and weakness along the course of the nerve.

Due to his persistent health problems, Elton filed an Unum disability claim through his previous employer UMD, for which Unum is a claims administrator. Elton was previously an Assistant Director at UMD before becoming disabled and filing an Unum disability claim in April 2017. In June 2017, his Unum disability claim was denied.

Denial Appeal

As in many Unum lawsuits, after the denial, Elton obtained counsel and filed an appeal. He says his appeal included medical evidence, functional capacity evidence, vocational evidence, and more.

However, his Unum disability claim appeal was denied in December 2017, with new information that Elton feels he should have gotten before filing his appeal. He filed a response in January 2018; Unum maintained its denial.

“Prior to appealing the claim denial, Plaintiff’s counsel set a request for claims file documentation to Defendants which required production of the all summary plan documents, governing claims manual provisions or handling instructions under which this claim was reviewed,” the lawsuit states.

Elton seeks review of his Unum disability claim, and a ruling that he is entitled to benefits, penalty payments, court cost, and attorneys’ fees.

The Unum Disability Claim Lawsuit is Case No. 1:18-cv-01309-GLR in the United States District Court for the District of Maryland.

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.

Learn More