First Unum Life Insurance Company is facing a new claim denial lawsuit from a man alleging his disability benefits were canceled under wrongful circumstances. The man alleges that even though he had met all eligibility requirements and had been previously approved to receive long term coverage, Unum declared his disability benefits canceled.

Plaintiff Francis C. alleges he had his disability benefits canceled in bad faith and is filing legal action to reinstate them. According to the claim denial lawsuit, Francis became disabled on Aug. 1, 2015 and was initially approved for coverage after meeting all eligibility requirements of the plan.

Francis alleges he had been previously fully employed by Pearson Inc., which provides employees with disability benefits if they become unable to work. In addition, Francis says he had paid all premiums and insurance payments and had met all eligibility requirements to receive coverage.

He claims he filed a claim for long term benefits in a timely manner, alleges the lawsuit, and had submitted all relevant medical testimony to prove the severity of his condition. One of the pieces of medical evidence submitted was a functional capacity evaluation (FCE), which allegedly concluded Francis would not be able to work even in a sedentary occupation.

The document also allegedly showed he could not work on a full time basis, and has been unable to earn a sufficient living. The findings of the medical examiner  contradicted the physician and FCE medical report, which allegedly led to Unum to cancel Francis’ benefits.

Overview of Unum Claim Denial Lawsuit

Francis had been reportedly receiving benefits on a months basis until April 27, 2017, when his disability benefits canceled a day earlier. Even though Francis appealed the decision, Unum had upheld its decision to have his disability benefits canceled on Jan. 12, 2018.

Unum allegedly relied on the opinion of a medical professional who was paid by Unum to review Francis’ claim. This means the medical examiner was acting on behalf of the insurance giant instead of Francis, alleges the lawsuit, which Francis claims is an act of bad faith insurance.

Bad faith insurance is when the insurance provider does not act within the best interest of the policyholder, and will improperly try to deny or have disability benefits canceled.

Francis and numerous other policyholders allege Unum has a systemic claim denial process when reviewing claims for benefits, in order to find the most minor excuse to deny or cancel benefits. Some of these claim denial tactics reportedly include:

• Improperly investigating claims and getting opinions from unqualified third party medical examiners
• Repeatedly demanding requests for independent medical examinations or denying a claim without sufficient explanation
• Refusing to acknowledge the disability in question
• Using third party sources to discredit the claim

Francis claims Unum used tactics like these to have his disability benefits canceled, even though he was eligible under his policy.

At this point in time, Francis has exhausted all administrative options and has been forced to file legal action against Unum, according to the lawsuit. Ever since his disability benefits canceled, Francis says he has not been receiving sufficient income and is seeking damages for all missing and future payments.

Francis’ allegations are not uncommon, with the insurance company’s denial tactics spurring the federal government, state regulators, and individuals to file claim denial lawsuits.

This Claim Denial Lawsuit is Case No. 0:18-cv-00475-JNE-FLN, in the U.S. District Court for the District of Minnesota.

Do YOU have a legal claim? Fill out the form on this page now for a free, immediate, and confidential case evaluation. The bad faith insurance attorneys who work with Top Class Actions will contact you if you qualify to let you know if an individual lawsuit or Unum class action lawsuit is best for you. [In general, Unum bad faith lawsuits are filed individually by each plaintiff and are not class actions.] Hurry — statutes of limitations may apply.

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