By Robert J. Boumis  |  October 15, 2014

Category: Consumer News

Unum disabiliy insurance problems

An Unum lawsuit alleges that Unum has wrongfully denied disability insurance benefits to a medical professional.

In the Unum lawsuit, a nurse anesthesiologist, plaintiff Gary Moretti, alleges that Unum perpetrated a bad faith insurance denial. Bad faith is a legal term that means that one party in a contract is trying to avoid their contractual obligations.

In disability insurance lawsuits, the term usually means that the insurer is allegedly trying to avoid paying out on a legitimate disability insurance claim.

In his Unum lawsuit, Moretti describes an injury to his left hand that occurred during his work as a nurse anesthesiologist. The text of the Unum lawsuit stated that the injury started as a hyperextension in an operating room in 2012.

His Unum lawsuit describes how the injury that started out as a simple hyperextension suffered complication after complication, leaving him allegedly unable to use his left hand. According to his Unum lawsuit, Moretti struggles with daily living — even tasks as simple as putting away groceries and mowing the lawn require both hands.

The Unum lawsuit maintains that he can barely function with one good hand, let alone perform life-or-death work in the operating room. Moretti cites several procedures his job demands that requires two working hands.

However, according to the Unum lawsuit, Unum repeatedly denied his claims without cause, denying every appeal he made from 2011 through 2014.

Under federal law, a policyholder is required to exhaust an insurance provider’s internal appeals process before filing an bad faith insurance lawsuit. Moretti has claimed that he has fulfilled this requirement by filing appeals until Unum issued its final denial on his disability insurance claim.

According to Moretti’s lawsuit, it is an inherent conflict of interest that Unum, the party that would be required to pay on a disability insurance claim, is the party that judges whether or not Moretti is disabled. His Unum lawsuit alleges that this conflict of interest caused Unum to deny his legitimate disability insurance claim, regardless of the legitimacy of his disability insurance claim.

Unum has previously faced charges of wrongfully denying legitimate insurance claims in bad faith.

In 2002, the television newsmagazine “60 Minutes” aired an exposé on Unum, alleging several types of misconduct. The program featured an Unum in-house physician who allegedly lost their job after refusing to overrule patients’ personal physicians who declared policyholders disabled.

The program also found that Unum’s agents had “denial quotas,” and that the employee who denied the most insurance claims was awarded the now-infamous “hungry vulture award.”

The Unum Claim Denial Lawsuit is Gary Moretti v. Unum, Case No. 2:14-cv-00380, in the U.S. District Court for the District of Maine.

In general, Unum lawsuits are filed individually by each plaintiff and are not class actions.

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