Georgia plaintiff James Edward Fletcher is suing Unum Life Insurance of America for allegedly denying his benefits.  Fletcher allegedly applied for short-term disability coverage after an injury, but had been denied without proper justification by the defendant, according to his lawsuit.

Fletcher was fully employed as a pharmacist for CVS, which provided both long-term and short-term disability benefits for their employees.  Like most commerce employers, CVS is governed by ERISA, which entitles full-time employees reasonable benefits and comfortable retirement pensions.  At all times relevant, the plaintiff met the requirements for both disability packages, and is legally entitled to both should he need them.

After working for the company for some time, Fletcher developed his disability on Feb. 7, 2011 which prevented him from working at full-capacity for his occupation.  Fletcher filed a claim for short-term disability benefits in a timely manner after his disability occurred, and provided all required documentation, along with sufficient medical evidence to support his claim.  Fletcher proved without a doubt, that he was disabled due to chronic back injuries and severe depression, which would prevent him from doing his job.

Despite following the submission requirements and medical testimony, Fletcher says Unum chose to disregard the plaintiff’s claim, based on a contract-loophole. Based on the time he was terminated, the defendant company concluded that he was not considered disabled while a member of an eligible group under the terms and conditions of their short-term disability plan.  Fletcher appealed this decision, providing further medical evidence, including a written statement from his treating physician.  His physician stated that he was indeed, disabled, on his last day of employment, which was on February 07, 2011, and thus eligible for benefits.

Unum still kept firm on their decision, stating that the plaintiff had also applied for long-term disability benefits at the time of his 10 day elimination period.  Essentially, because the plaintiff also applied for long-term disability benefits, but did not qualify for them under the plan, Unum denied the benefits completely.

At this point in time, Fletcher has exhausted all administrative remedies, and has filed lawsuit against Unum Life Insurance of America.  He is seeking all missed disability benefits, interest, and legal fee coverage.

This case is  James Edward Fletcher vs. Unum Life Insurance of America, Case No. 5:14-cv-00049-CAR, in the United States District Court of Georgia, Macon Division.

Overview of Unum Claim Denial Tactics

Unum is the oldest disability insurance company in America, and the largest disability insurance provider in the world.  For years, people have been suing Unum for wrongfully denying claims or using unethical tactics to dismiss insurance claims.  The tactics Unum and other insurance companies often use against claimants include but is not limited to:

• Changing policies after claims are filed (and without the authorization or knowledge of policy holders)
• Improperly investigating the claim and obtaining opinions from unqualified witnesses
• Misreading medical records, often by their independent medical examiners
• Demanding repeated requests for independent medical examinations or denying a claim without any medical examination
• Refusing to acknowledge their disability, especially mental disorders, fibromyalgia, and chronic fatigue syndrome
• Arguing that the claim is a pre-existing condition
• Denying a claim with the intent to wear the claimant down to a lower settlement
• Partially paying a claim for total disability
• Use of detectives, friends, co-workers and neighbors in an attempt to discredit the disability