A recent disability insurance lawsuit filed by a doctor takes Unum Group and Paul Revere to task for an alleged bad faith denial.

Plaintiff Mark B., an anesthesiologist, says he purchased a Preferred Professional Disability Insurance Policy from defendant The Paul Revere Insurance Company in 1992. He purchased a second Paul Revere policy in 1994.

Paul Revere later went through a series of acquisitions and mergers that left the company now under the control of defendant Unum Group.

During the first quarter of 2015, Mark says, pain in his back and knees began to worsen and spread to his hips, knees and ankles.

Imaging studies revealed he was suffering from degenerative disc disease in his spine, with spinal stenosis and a disc protrusion in his lumbar spine.

An electromyelogram confirmed he was also suffering from lumbar radiculopathy, a condition that occurs when damage within the lumbar spine affects the peripheral nerves that run down to the legs.

Because of these conditions, Mark says, he can no longer practice as an anesthesiologist. The pain from these conditions prevents him from moving and positioning patients as his practice requires.

He also says his pain and fatigue compromise his ability to focus.

Mark filed claims under his Unum disability insurance policies in July 2015.

He submitted a few more rounds of paperwork and several months’ worth of medical evidence showing his spinal problems and osteoarthritis in both hips.

Records showed that multiple epidural steroid injections had provided only minimal relief and that Mark had started taking hydrocodone for his pain.

Unum finally denied his claim the next December. The company claimed Mark’s medical evidence showed no support for his claimed restrictions and limitations.

The company also denied his waiver of premium benefit, forcing him to keep paying premiums to keep his coverage in force.

In this disability insurance lawsuit filed by a doctor, Mark says that Unum’s own medical reviewer Dr. Austin Philbin, also a named defendant, minimized the severity of Mark’s pain and disabilities.

Dr. Philbin effectively cherry-picked evidence in the record that would support a denial of the claims, Mark says.

Even after contacting two of Mark’s treating physicians, and without ever examining Mark himself, Dr. Philbin continued to understate the severity of Mark’s condition, he claims.

A second Unum doctor, defendant Dr. Suzanne Benson, sided with Dr. Philbin and against the opinions of Mark’s treating physicians. Mark says Dr. Benson failed to give the required significant weight to the opinions of his treating doctors.

Disability Insurance Lawsuit Filed by a Doctor

In the current action, Mark accuses Unum of forcing its doctors to operate under a conflict of interest.

Both Dr. Philbin and Dr. Benson may be compensated with bonuses that depend on the financial success of the company, Mark says.

Mark points out that in the process of handling his claims, Unum erroneously tried to classify the policies as being governed by the federal Employee Retirement Income Security Act, or ERISA.

Under ERISA, companies like Unum are exposed to less liability for bad faith conduct. Mark says Unum has historically attempted to miscategorize non-ERISA policies as falling under ERISA.

In this disability insurance lawsuit filed by a doctor, Mark is raising claims against Unum and Paul Revere for breach of contract and for breach of the obligation of good faith and fair dealing.

He accuses Dr. Philbin and Dr. Benson of aiding and abetting the tort of insurance bad faith.

This Unum Lawsuit is Case No. 2:16-cv-03631, in the U.S. District Court for the District of Arizona.