A disability insurance benefits lawsuit was filed against Unum Life Insurance Company of America on Aug. 22, 2017 in U.S. District Court, Northern District of Georgia, Atlanta Division.

The complainant is plaintiff Cecelia D., a resident of the State of Georgia and a disabled former employee of Sibley Heart Center Cardiology. The defendant is a corporation doing business in Georgia and the U.S. at large.

According to the legal documentation in this disability insurance benefits lawsuit, Unum Life Insurance Company was in a legally-binding contractual agreement with Sibley Heart Center Cardiology to provide its employees with long-term disability and life insurance policies.

Under the Employment Retirement Income Act of 1974 (ERISA), the U.S. established standards to protect its citizens working in private industry from potential abuses through their enrollment in employer-sponsored health and pension plans.

This protection was granted by establishing a set of minimum standards. Sibley Heart Center Cardiology was bound to these standards through their relationship with Unum Life Insurance.

The Plaintiff’s Disability Insurance Benefits

According to the Unum lawsuit, Cecelia D. had both a long-term disability and a life insurance policy with the defendant through her employer. Her disability insurance benefits outlined what constituted a disability by the following guidelines:

• The employee is limited in their capacity to perform the essential duties of their occupation by sickness, injury or both
• The employee’s limitation results in at least a 20% loss of income

Cecelia D.’s policy also spells out a timeline for determining what constitutes long-term:

• After two-years of payments (24 months), Unum considers an employee disabled if, due to sickness, injury, or both, they cannot perform any job that would be a reasonable substitution for pre-existing position based upon education, work experience, and other training.

Under the terms of the plaintiff’s life insurance policy with Unum, she was allowed benefits as follows:

• If the employee could not work in any capacity during an “elimination period.”
• If after the “elimination period,” the employee was unable to work in any equivalent job that was a reasonable substitution based upon education, work experience, and other training.

The Plaintiff Rejection and Appeal of Disability Insurance Benefits

Cecelia D. quit working due to a primary diagnosis of fibromyalgia and neuropathy with secondary symptoms of blurry vision, ambulatory imbalance and insomnia in August 2014.

Her claim for disability insurance benefits was denied by Unum by May of 2015. Unum claimed that she is able to perform her job, which was sedentary in nature.

The plaintiff appealed this denial by Unum in November 2015 by providing an independent functional capacity evaluation with pharmacy and hospital records via certified letter. All her efforts to appeal the defendant’s decision came to naught in February 2016 when she received yet another denial letter. It was then that Cecelia D. determined that she had to take this issue to court to resolve.

In this disability insurance benefits lawsuit, she is asking for her 100% of her disability benefits retroactive to November 2014 with all interest up to the present day.

She is also asking for her life insurance and waive of premium benefit associated with that retroactive to May 2015 up to the present day. She requests that all expenses related to litigation also be reimbursed which would include attorney’s fees, and court costs.

The Unum Disability Insurance Benefits Lawsuit is Case No.1:17-cv-03172-AT in the U.S. District Court for the Northern District of Georgia, Atlanta Division.