A man has filed suit against Unum Life Insurance Company of America over denied disability income benefits.

Plaintiff Kevin M. worked full-time as a territorial manager for the sales department at Biotest Pharmaceuticals Corporation where employees were covered by group long-term disability coverage under a policy issued by Unum.

On Oct. 28, 2013, Kevin stopped working due to being diagnosed with severe depression and anxiety, which Unum agreed made him disabled at the time. He began collecting disability income benefits.

In 2015, Kevin’s health took a turn for the worse when he also became physically disabled.

He underwent a total disc arthroplasty at C5-6 levels of his spine in April 2015. This procedure was a result of degenerative cervical disc disease with cervical herniated discs and the worsening of a previous cervical fusion.

In addition, Kevin developed myelodysplastic anemia, which caused “severe restrictions and limitations in the claimant’s physical stamina and compromised his immune system to the point that he could not work in any close proximity to others due to risk of developing severe infections.”

Unum Halts Disability Income Benefits

When Kevin became physically disabled while collecting disability income benefits for his mental disabilities, he submitted medical records and other proof to Unum that he was “disabled solely on the basis of his medical impairments.”

Despite offering Unum this proof of disability due to severe medical conditions, Unum sent a letter dated March 16, 2016, to let Kevin know his benefits were ending.

According to the disability income benefits lawsuit, the benefits “were being terminated on the basis of their allegation that he was disabled solely due to a mental and nervous condition, and Unum alleged in their denial that Plaintiff had satisfied a ‘mental and nervous’ limitation on benefits to 24 months under the relevant LTD (long term disability) plan.”

Kevin followed the appeals process, submitted further medical evidence and reports from his doctors that attested to his total disability.

Unum seemingly disregarded all of that evidence because in another letter dated Dec. 5, 2016, the insurance company provided Kevin with “a final determination of his claim upholding the termination of benefits based upon the application of an alleged ‘mental and nervous’ limitation.”

Kevin’s lawsuit alleges Unum had a conflict of interest because it acted as both the payor as well as the adjudicator in the disability income benefits claim.

Unum also “completely ignored and failed to give weight to the opinions” of Kevin’s own medical doctors who determined that Kevin was “totally disabled as the term is defined in the Plan due to medical issues, aside from his mental state.”

Unum also allegedly failed “to analyze and consider all relevant diagnoses” and relied more heavily on “its own non-examining medical consultants over the well supported opinions of Plaintiff’s treating physicians without adequate explanation.”

Kevin’s lawsuit also calls Unum’s denials of his claim for disability income benefits “arbitrary and capricious.”

The Disability Income Benefits Lawsuit is Case No. 2:17-cv-00762-KSH-CLW, in the U.S. District Court for the District of New Jersey.