A plaintiff, Joseph P., filed a lawsuit in South Carolina federal court against Unum Life Insurance Company of America alleging the unlawful denial of his disability insurance coverage.

Joseph is a resident and citizen of Heminway, South Carolina. He sought long-term disability benefits under an ERISA plan.  According to the denied disability insurance coverage lawsuit, Joseph was employed by CVS pharmacy until March 2013. Through his employer, he was provided long-term disability coverage and was fully insured by the defendant.

The denied disability insurance coverage lawsuit alleges that Joseph became disabled and was then forced to cease working due to his disability. Once he was no longer able to work, Joseph filed a claim for long-term disability benefits.

Unum then denied Joseph’s claim. Joseph attempted to appeal the denial and exhausted all administrative remedies. According to the lawsuit, Unum refused to provide Joseph any additional benefits.

The denied disability insurance coverage lawsuit alleges that Unum had made the decision to deny Joseph’s claim while “operating under a conflict of interest.” Joseph claims the Unum reached the decision by relying on biased information and flawed expert opinions. Unum’s rejection was not based on a reasoned decision-making process or upon any substantial evidence, Joseph claims.

Denied Disability Insurance Coverage Lawsuit Facts

Approximately 40% of the disability insurance policies in the U.S. are handled by Unum and UnumProvident. These companies provide disability insurance to 17 million Americans.

According to a 60 Minutes broadcast from 2002, claims against the company allege that UnumProvident has abused its power and has “systematically denied disability insurance claims filed by thousands of policyholders to line its pockets.”

Former employees told 60 Minutes that Unum “sets a claim-denial quote each month, and rewards claims adjusters who meet the goal by denying injured people the benefits they paid for.”

In addition, 60 Minutes also interviewed a former physician who worked for the company. He claims that after he refused to help the company deny benefits to injured policyholders he was fired.

Since then former in-house physicians employed by UnumProvident have testified that they were told to “review medical records for disability claims and falsely state that a policyholder was not disabled so that UnumProvident could deny disability benefits, regardless of the true condition of the insured.”

This alleged systematic claim-denial process has led to over 3,000 lawsuits filed by Unum attorneys who represent wrongly denied benefit insurers, along with state regulators, and the federal government.

The Denied Disability Insurance Coverage Lawsuit is Case No. 4:17-cv-02705-RBH, in the U.S. District Court for the District of South Carolina, Florence Division.