A former Functional Manager at a Radio Shack store in California has filed a lawsuit against Unum Life Insurance Company alleging that he was illegally denied disability insurance benefits.

Plaintiff Gerald L. filed his Unum insurance claim lawsuit in California federal court seeking declaratory, injunctive, and monetary relief under ERISA, or the Employee Retirement Income Security Act of 1974.

During his employment with Radio Shack, Gerald states that he was covered under a long-term disability employee benefit plan.

Gerald states in his lawsuit that he had back and neck problems that had spanned decades, and his back pain had worsened progressively over the years.

His pain and problems also led to him suffering from repeated falls, causing more injury.

As a result of his issues, Gerald underwent a laminectomy surgery, a procedure that removes the lamina, or back part of the spinal vertebra that covers the spinal canal.

Gerald only reported partial success from the surgery.

Allegations in Unum Insurance Claim Lawsuit

In his job as a manager, Gerald was required to perform activities that he physically was unable to perform. “This position was a physically demanding job that required extensive walking and lifting, as well as stooping, bending, crouching, crawling, and climbing underneath equipment.”

Based on the terms of his disability insurance plan with them, Gerald “is considered disabled if he is limited from performing the material and substantial duties of his regular occupation due to his sickness or injury, and he has a 20% or more loss in his indexed monthly earnings due to the same sickness or injury.”

Gerald’s Unum insurance claim lawsuit states, “in addition to being unable to engage in his regular occupation [Gerald] is unable to engage with reasonable continuity in another occupation which he could reasonably expected to perform satisfactorily in light of his age, education, training, experience, station in life, physical and mental capacity. He is not able to be and is not engaged in any employment or occupation for weight or profit.”

In March 2015, Gerald filed for disability benefits under his plan.

In August of that same year, Unum approved his claim, retroactively paying him limited benefits for only one month between March and April 2015.

Gerald states that he had no change in his physical condition after April, and should not have had his benefits terminated.

Rather than sending Gerald to an independent medical examiner, his own insurance claim lawsuit states that the company utilized medical reviewers to conduct a “paper review” of Gerald’s medical file.

“Unum’s doctors both selectively used portions of [Gerald’s] claim file to overrule the opinion of his attending physician without sufficient support or evidence of any attempt to derive a thorough understanding of [his] conditions,” the lawsuit states.

The medical reviewers hired by Unum concluded that Gerald’s “claims of pain and mobility impediment or inconsistent with his medical records and that he was able to perform the duties is treating doctors had all uniformly stated he was not fit to perform.”

After exhausting all of his administrative remedies in trying to resolve the matter directly with Unum, Gerald filed his Unum insurance claim lawsuit in an attempt to recover past benefits owed to him and to reinstate benefits from the present into the future. He is also seeking attorneys’ fees and costs.

The Unum Insurance Claim Lawsuit is Case No. 2:16-cv-02433, in the U.S. District Court for the Eastern District of California.