Insurance Denial Forces Another Policyholder to Take Unum to Court

Mariann Kaiser assumed that her Unum disability insurance would cover her in the event of an emergency until it was too late and she needed her policy to start paying for long-term disability (LTD). Kaiser is suing Unum for allegedly denying her disability insurance claim without reason.

Unum, as one of the largest insurance providers in the country, is the go-to choice for many employers. Employees like Kaiser often know little about their policies, hoping that they’ll never need to use them.

Kaiser filed her Unum lawsuit on June 11, 2013. The Illinois woman “actively worked full-time as an employee of Resurrection Healthcare/Holy Family Medical Center until July 2008, when she stopped working due to polymyositis with indolent substitute course with the underlying osteoarthritis of her knees, hips and ankles, spinal stenosis of her lower lumber spine, chronic pain, loss of motion, and osteopenia. Since July 2008, Kaiser’s impairments prevented her from engaging in any substantial gainful activity,” the Unum lawsuit says.

Learning that a person is disabled is scary enough—but then add in a loss of income with no recourse for getting due compensation and Unum sufferers have it much worse. “On Sept. 4, 2008, Kaiser filed a Short Term Disability Claim pursuant to Unum’s Short Term Disability Income Protection Insurance. On October 23, 2008, Unum denied her short-term claim because it held that she was not disabled per its definition,” the lawsuit states.

This was just the beginning of Kaiser’s roller coaster ride. According to her lawsuit:

“On Jan. 5, 2009, Kaiser filed an administrative appeal, which resulted in an approval of her short-term benefits on Feb. 3, 2009. On Feb. 16, 2009, Kaiser filed a long-term disability claim pursuant to her long-term disability plan and on March 27, 2009, Unum approved her claim and her first benefit check in the amount of $1,291.94 covered the period of Jan. 28, 2009 through Feb. 27, 2009.”

By now, Kaiser thought everything was taken care of—but Unum allegedly stopped payments with little information provided.

“On Aug. 31, 2009, Unum denied Kaiser’s claim for benefits because it held that Kaiser had the ability to perform her regular occupation on a full-time basis and no longer met the policy’s definition of disability.” This is another tactic that Unum policyholders have reported.

“Kaiser subsequently filed an administrative appeal and on June 8, 2010, Unum’s Appeal Unit confirmed the denial, despite the introduction of overwhelming and convincing evidence to support her appeal, because it held that she was capable of performing her occupation on a part-time basis, thereby exhausting all avenues of the administrative appeal process.”

It took almost a full year from Kaiser’s second appeal for Unum to even reply. When the company did come back with a decision, it had switched from unable to work full-time to unable to work part-time. While this might seem maddening, Kaiser is actually a little better off than some other Unum policy holders who never received written explanations for denials.

Nowhere Left to Turn

Kaiser, like others who share her experience, sees filing a lawsuit against Unum as a last effort to get the compensation she deserves. Unable to work, her savings have been dwindling. It’s been over three years since her last compensation check. Her SSA disability was approved back in 2008, with the agency stating that she “could not return to work because she no longer had the capacity for even a limited range of sedentary exertion on a sustained basis because of chronic pain and a loss of range of motion.”

Even though Kaiser claims she met Unum’s following description of disability throughout the process, she was still denied: “You are limited from performing the material and substantial duties of your regular occupation due to your sickness or injury and you have 20% or more loss in your indexed monthly earnings due to the same sickness or injury.”

She’s seeking a judgment against Unum, all past compensation and reinstatement of her claim moving forward, and applicable court costs. “Unum’s resolution that Kaiser is not disabled is contrary to the welfare benefit plan, contrary to the evidence, and lacks rational support. Moreover, the decision to terminate benefits is contrary to the treating and examining physician’s assessment,” reads her Unum complaint.

Kaiser says she clearly meets Unum’s disability definition, and “is entitled to reinstatement of monthly disability insurance payments, and such benefits must continue until she recovers from her disability, death, or to age 65, whichever comes first.”

The case is Mariann Kaiser v. Unum Life Insurance Company of America et al, Case No.: 1:13-cv-04321, the United States District Court for the Northern District of Illinois Eastern Division.

Do You Have a Similar Unum Story?

Whether you never received compensation, had payments stop wrongfully or are otherwise struggling with a disability claim you believe is accurate, you might have an Unum legal claim. You can find out more by visiting the Unum/Unum Provident Disability Insurance Claim Denial Class Action Lawsuit Investigation today. Submit your information and an attorney will contact you if you have a case for a free Unum claim review.