An Unum policyholder says that Unum denied long term disability coverage wrongly, despite the fact that she should have been covered by her policy.

Plaintiff Danielle W. says that in 2007, she began to receive disability benefits through Unum. However, she says that after she had received benefits for eight years, Unum offered her a “buyout” of her policy for an amount worth far less than she could have recuperated had she kept the policy, which she rejected.

Allegedly, the company then dishonestly and aggressively investigated her medical condition, and wrongly discontinued her benefits as a result of this investigation.   

Danielle says that she is disabled because she has Complex Regional Pain Syndrome, a condition also known as Reflect Sympathetic Disorder. She says that she was initially approved for long-term disability benefits through Unum because of this condition in 2007. She claims that until 2015, the company minimally managed her claim. She says that the company made a practice of “generally only calling one time per year and otherwise generally not getting medical records or reports or other documentation.”

She goes on to claim that the company’s attempt to offer her a buy-out was an intentional effort to get out of paying the full value of her benefits, which were continuing and not likely to change because her condition is chronic. She says that after she refused the buyout, the company radically changed its approach to her claim, beginning to investigate her thoroughly.

She says that the new investigation into her claim was not for the purpose of evaluating her claim for the continuation of benefits, but for the sole purpose of enabling the company to terminate her benefits. She said that the investigation was intended only to develop documentation to help the company terminate her benefits, but the company did not explicitly tell her this.

According to Danielle, on July 26, 2017, she received a letter from Unum saying that according to the company’s investigation, “no recent exam findings suggest that this is a current active condition; and concluded that [Danielle] could work full time as an information clerk.” The letter allegedly reported that this action was consistent with California law, and invited Danielle to appeal the determination.

Danielle says that she then contacted a lawyers and appealed the termination of her long-term disability benefits around Jan. 17, 2018. In her appeal, she asserted that Unum terminated her benefits as a form of retaliation for her refusal to accept the buyout offered by the company. She says that the company did not fairly investigate her before terminating her benefits, and did not conduct an independent medical investigation of her. She says that the company claimed that she was not disabled, though she continues to suffer from a chronic disability that prevents her from working and going about her daily tasks.

The Unum Denied Long Term Disability Coverage Lawsuit is Case No. 5:18-cv-01879-JGB-SHK, in the U.S. District Court for the Central District of California, Southern Division.

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