A former CBS employee is suing Unum Life Insurance Company of America to reinstate her disability insurance benefits.

As an employee of CBS Radio Corporation, plaintiff Brenda M. was a beneficiary of a disability insurance plan administered by Unum.

Her disability insurance lawsuit says she suffers from “connective tissue disease, rheumatoid arthritis, fibromyalgia and multiple undiagnosed auto immune issues.”

Brenda says that Unum paid her claim for disability insurance benefits from March 2014 through March 2015. But after that, Unum stopped making payments on the grounds that Brenda was no longer disabled. After exhausting her administrative remedies, Brenda filed this disability insurance lawsuit.

Brenda is now asking the court to award her over $21,000 as back payment on her claim, plus prejudgment interest, court costs, and attorney’s fees. She also wants the court to issue an injunction keeping her current claim for disability insurance benefits in place, to avoid having to reapply after the court’s award.

This Unum Disability Insurance Lawsuit is filed under Case No. 8:16-CV-00137 in the U.S. District Court for the Middle District of Florida.

Appealing Unum Denials Under ERISA

Brenda’s claim for disability insurance benefits falls under ERISA, the federal Employee Retirement Income Security Act of 1974. ERISA covers most benefit plans provided by employers to their employees.

Some plans, like those sponsored by government entities and some religious organizations, are excluded. Other plans that the claimant purchases directly from an insurance company or insurance agent also are not covered by ERISA; these plans tend to be covered by state law.

While ERISA was originally enacted to protect employees’ benefits, some say that after years of amendments it does more to protect insurance companies. The process for appealing a disability insurance claim denial can be drawn-out and full of pitfalls, but an experienced disability insurance attorney can be helpful along the way.

Before a claimant can file an ERISA lawsuit, she must first complete what’s known as “exhaustion of administrative remedies.” This consists of a written appeal made directly to the insurance company, who gets a chance to review the denial and issue a final decision.

The claimant must issue this appeal process within at least 180 days; then the insurer gets 90 days in which to issue the final decision. The administrative review is then considered complete, and if it results in a denial the claimant can appeal to federal court.

It’s important to note that, generally, claimants cannot submit new evidence once the case has reached a court. That’s why practitioners recommend that claimants submit all the evidence supporting their claim during the administrative process. Courts usually will not consider any evidence that was not before the insurance company when it made its decision.

A court reviewing a denial under ERISA will apply a standard of review that is very deferential to the insurance company, making a successful appeal more difficult.

ERISA also does not provide many claimant-friendly options that state law usually provides. Punitive damages are not available in ERISA claims, and generally attorney’s fees are also not recoverable. ERISA claims also are not presented to a jury; the judge decides the appeal based on attorneys’ briefings and on the evidence that was before the insurance company.