Man Alleges Bad Faith Insurance Denial in Lawsuit Against Unum

A man and former insurance agent from Massachusetts alleges he suffered bad faith insurance denial by Unum.

Allegedly, Unum rejected his claim for long term disability benefits despite the fact that he met all eligibility requirements and submitted relevant medical evidence. However, he says he was still turned down for long term disability coverage.

Plaintiff Timothy C. says he developed a number of symptoms leading to his disability claim, including fibromyalgia. According to his lawsuit, this condition is often the subject of bad faith insurance denial tactics by Unum.

Timothy says he became disabled not long after undergoing a root canal procedure in his left lower jaw on March 17, 2015. Not long after this procedure, Timothy alleges he developed a number of medical conditions that caused him to become disabled.

According to the claim denial lawsuit Timothy developed trigeminal neuralgia from his root canal, and developed other painful conditions like carpal tunnel syndrome and fibromyalgia. In addition, he says he suffers from extreme pain and weakness following a remote C-spine fusion surgery in 2014.

At the time he became disabled, Timothy allegedly worked as an independent contractor in active service for Allstate and was eligible to participate in Unum’s long term coverage policy. If he had been approved, Timothy says he would have received a monthly benefit payment to help cover his medical expenses.

According to the terms of Unum’s long term policy, a claimant is disabled “when Unum determines that you are limited from performing the material and substantial duties of your regular occupation due to your sickness or Injury.”

Overview of Claim Denial Lawsuit

According to the lawsuit, Unum initially approved Timothy’s claim for long term disability benefits between Sept. 14, 2015 through Nov. 14, 2017. However in a letter dated Dec. 15, 2017, Unum allegedly informed Timothy that his benefits would be terminated. Timothy appealed this decision, but Unum upheld its decision in a final letter dated July 20, 2018.

Timothy alleges this was an example of bad faith insurance denial, because Unum did not give sufficient reasons for why his benefits were suddenly terminated. Furthermore, Timothy points out that he is still disabled from the same conditions that lead to his initial long term disability claim.

According to the claim denial lawsuit, Timothy had filed all relevant medical evidence for long term disability benefits and met all eligibility requirements. In addition, Timothy says he submitted the same and additional documentation that proved the severity of his condition.

At all times relevant, according to the lawsuit, Timothy met all eligibility requirements for long term disability benefits and should not have denied the claim. Bad faith insurance denial occurs when an insurance company acts in its own interest, to the detriment of the policyholder.

Unum has reportedly developed a reputation for bad faith insurance denial tactics including:

• Changing policies after claims are filed
• Improperly investigating the claim and getting opinions from unqualified witnesses
• Using independent medical examiners to review medical records, and often focusing on details that may get the claim dismissed
• Refusing to acknowledge disabilities, especially in cases of mental disorders and fibromyalgia

This Unum Lawsuit is Case No. 1:18-cv-12274-GAO, in the Superior Court of Barnstable County, Massachusetts.