ERISA Disability Claim Alleges Unum Unfairly Denies Fibromyalgia Benefits

Unum Life Insurance Company is facing a recently filed ERISA disability claim from an Ohio woman alleging her benefits were unfairly denied because of her fibromyalgia diagnosis.

The class action ERISA disability claim alleges Unum has a long history of unfairly denying benefits to fibromyalgia patients, with the disability provider allegedly failing to treat the condition as seriously as other disabilities.

Plaintiff Cynthia F. opted to file the class action ERISA disability claim, after discovering numerous other policyholders were allegedly denied benefits and were suffering from fibromyalgia.

According to the ERISA disability claim, Cynthia was fully employed by BRC Properties Inc. and was supposed to be provided with short or long term disability benefits should she ever need them.

Cynthia says she needed these benefits after being diagnosed with fibromyalgia, and applied for long term coverage. Unum reportedly accepted Cynthia’s diagnosis along with the debilitating symptoms of the disease and had approved her claim for long term disability benefits.

According to the ERISA disability claim, Unum approved Cynthia to receive benefits for the next 24 months and ended coverage based on her policy’s limited pay period for “self reported symptoms.”

Overview of ERISA Disability Claim Allegations

According to the ERISA disability claim, Fisher disability policy was composed of standardized forms that Unum uses throughout the United States including a clause for limited pay periods for disabilities based on “self reported symptoms.”

“Self Reported Symptoms means the manifestations of your condition which you tell your physician, that are not verifiable using tests, procedures or clinical examinations standardly accepted in the practice of medicine. Examples of self reported symptoms include, but are not limited to headaches, pain, fatigue, stiffness, soreness, ringing in ears, dizziness, numbness and loss of energy,” the Unum policy states.

Due to fibromyalgia being a characterized as condition based on “self reported symptoms”, Unum allegedly did not investigate or evaluate Cynthia’s claim for disability. Furthermore, Cynthia claims Unum concluded that because Cynthia was suffering from fibromyalgia, her benefits were subject to the limited pay period of self reported symptoms.

Cynthia says she tried to appeal Unum’s decision, but the disability insurance provider upheld its decision and repeatedly stated that her limited pay period would be upheld. Unum allegedly failed to exam all medical evidence submitted with Cynthia’s claim, or the severity of her condition.

Cynthia alleges she has been forced to stop working and has been unable to work in a similar occupation. She says she has been unable to earn a sufficient income, and has been incurring medical bills for her fibromyalgia treatment.

Unum Life Insurance Company of America is one of the oldest and largest disability insurance providers in the United States, and has millions of policyholders throughout the United States. Unum has garnered a negative reputation over the years for allegedly denying disability coverage for insufficient reasons and systematically using claim denial tactics:

• Improperly investigating the claim
• Obtaining opinions from unqualified third parties
• Repeatedly demanding additional medical examinations
• Refusing to acknowledge disabilities (common for fibromyalgia)
• Arguing that the condition is pre-existing
• Using third party, and often unqualified, medical examiners to look over a claim to find any reason to deny it

This ERISA Disability Claim Lawsuit is Case No. 1:18-cv-00391-TSB, in the U.S. District Court of Southern Ohio, Eastern Division.