The Unum Group is facing a new claim denial lawsuit from an Oklahoma woman alleging the insurance giant denied her claim for long term disability for lupus under wrongful circumstances.

The wrongful claim denial lawsuit alleges Unum engaged in bad faith insurance tactics to deny the woman’s claim for long term disability for lupus, meaning that the plaintiff resorted to filing legal action against the insurance company.

Plaintiff Shelley C. says she had previously been fully employed by The Physician’s Group LLC, but had to file for long term disability for lupus after being diagnosed with the disease.

Shelley alleges she became eligible for long term disability coverage after meeting the company’s minimum time frame, which means she allegedly should have received long term disability for lupus when she needed it.

Overview of Unum Claim Denial Allegations

According to the Unum claim denial lawsuit, Shelley had been forced to cease working due to systemic lupus along with cognitive impairment, gastrointestinal problems, and migraine headaches. These medical conditions allegedly forced Shelly to stop working in October 2015, which is when she filed for long term disability.

However, Shelley claims Unum Group denied her request for long term disability for lupus on April 11, 2016, even though she had been completely disabled under the terms of the insurance plan. During the claim filing process, Shelley followed all administrative procedural instructions and submitted testimony from her physician.

Even with her physician’s medical testimony, Shelley was still denied long term disability for lupus. Shelly appealed this decision but was again met with claim denial on Jan. 5, 2018, even though she submitted all necessary paperwork that proved the severity of her disability.

According to Unum Group’s insurance plan, the policyholder is considered disabled when they are unable to perform their occupational duties due to injury or sickness.

The plan also states the person must also be unable to work in a similar occupation or earn a sufficient income, which Shelley says she has not been able to do. Shelley says she has been unable to return to work since her diagnosis and has been facing compounding medical bills due to her lupus treatment.

At this point in time, Shelley has exhausted all administrative options and has been forced to file legal action. Shelley is filing this Unum claim denial lawsuit seeking compensation for all missing long term disability for lupus benefits along with any other relevant damages.

Shelley’s allegations are not uncommon, as numerous policyholders have been describing alleged bad faith insurance tactics to maximize claim denials. Beginning the 1990s, Unum and other insurance companies allegedly started denying insurance claims on insurance policies sold in the 1980s.

At the beginning of the 1990s, the interest rates dropped and claims for insurance benefits had begun overwhelming insurance companies. Unum has been accused of looking for any excuse to deny insurance claims, in an effort to cut down on financial losses.

Some consumers alleged the company engaged in bad faith tactics. The claim denial tactics alleged by policyholders include but are not limited to:

• Improperly investigating claims and obtaining opinions from third part medical reviews
• Having independent medical examiners review medical records
• Demanding repeated medical examinations or denying the claim without any medical examination
• Refusing to acknowledge injury or disease

This Unum Claim Denial Lawsuit is Case No. 5:18-cv-00226-HE, in the U.S. District Court of Western Oklahoma.

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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