A Michigan urologist has filed a lawsuit against insurance company, Unum, claiming he was subject to disability denial under ERISA and should thus receive disability benefits.

Plaintiff Robert D. is 67-years-old and a urological surgeon in the state of Michigan. He helped found the Michigan Institute of Urology in St. Clair Shores, Michigan and has been Board Certified in urology since 1976.

Approximately seven years ago, Robert says he began experiencing severe back pain that began in his lower back and radiated throughout his buttocks and legs. Robert was diagnosed with significant lower back conditions including L4-L5 spondylothesis lumbar spine, spondylothesis with radiculopathy, connective tissue stenosis of neural canal lumbar region, facet arthropathy lumbar spine, foraminal stenosis lumbar spine and broad disc protrusion L4-L5.

The plaintiff in this Unum disability denial lawsuit claims that he has severe and persistent lower back pain that keeps him from performing his duties as a urological surgeon which require him to stand for long periods of time.

In August 2016, Robert applied for short term disability benefits under his Unum disability insurance policy.

Unum, however, wrote back to him, saying “medical records provided fail to illustrate specific medical exam findings to support any restrictions that would prevent your client form performing the material and substantial duties of his regular occupation on a full time basis as of June 1, 2016.”

This denied disability lawsuit alleges that all of Robert’s treating physicians including board certified neurologists and a board certified orthopaedic surgeon claim that he was unable to continue in his work as a surgeon and was, in their opinions, disabled.

In January 2017, he submitted an appeal to Unum regarding their disability denial decision, and even provided more evidence of his disability. Two months later, in March 2017, Unum denied Robert’s appeal.

According to this Unum disability denial lawsuit, Robert then was informed that under ERISA, he had the right to bring a civil suit against the insurance company.

What is ERISA?

ERISA is the Employee Retirement Income Security Act of 1974. According to the Department of Labor, this federal law sets minimum standards for the majority of employer-sponsored pension and health plans in private sector businesses.

ERISA establishes rules for the way disability policies are governed, and insurance companies must abide by the rules set out under ERISA. In many cases, a disability denial under ERISA can be overturned on appeal.

Roberts alleges that because Unum did not abide by the terms of the disability plan he purchased, Unum is in violation of ERISA. He believes that Unum’s failure to pay disability benefits despite the recommendations of physicians and Unum’s failure to thoroughly investigate Robert’s claims are both in violation of ERISA.

Robert also believes that because Unum has denied him his right to disability benefits, he has suffered damages because he has been ineligible for other benefits including pension, medical benefits and the waiver of group life insurance premiums.

This ERISA Lawsuit is Case No. 1:17-cv-00535-JTN-ESC in the United States District Court for the Western District of Michigan, Southern Division.