A Los Angeles resident is taking Unum Life Insurance to task over denying long term disability benefits she was allegedly entitled to under her employee benefit plan.

Plaintiff Adriana R., 44, was employed by Cedars Sinai Health Systems for fifteen years as a materials inventory coordinator/warehouseman.

Cedars Sinai provides its employees with a group long term disability benefits. Unum insures the employee benefit plan.

Adriana first became disabled in November 2012 due to multiple conditions including bicipital tendinitis, medial epicondylitis, synovitis of the right forearm, ulnar neuropathy, and a diagnosis of complex regional pain syndrome of the right upper extremity.

As a result of her condition, Adriana had extensive conservative treatment, including at least 14 stellate ganglion injections over a period of time, and a cubital tunnel injection for neuropathy and epicondylitis.

The painful condition of her right extremity persisted and she received a spinal cord stimulator implant for trial purposes. This was followed by a C5 laminotomy with insertion of spinal cord paddle lead in the cervical spinal cord.

One of Adriana’s doctors gave her a restriction of no lifting greater than five pounds as well as other restrictions in using her right arm. Another one of Adriana’s doctors concluded that she was totally disabled from every occupation.

Adriana received long term disability benefits under her Unum-insured employee benefit plan for two years, up until May 14, 2015, at which time benefits were discontinued and her claim was denied.

According to her employee benefit plan lawsuit, Unum relied on the reports of their own doctor, who saw Adriana only once.  This Unum doctor concluded that Adriana had no restrictions relating to heavy lifting or other use of her dominant right arm.

However, Adriana’s treating physician disagreed with this conclusion, explaining that Adriana was totally disabled from any work since she could only lift five pounds and relies on the use of the spinal cord stimulator.

It should be noted that Unum had an in-home physician agree with their doctor’s opinion based solely on a record review with no medical examination requested by Unum, according to the lawsuit.

Unum Claim Denials and Questionable Practices

As the largest insurance provider of its type in the U.S., Unum has insured an estimated 17 million people across the nation. They have reportedly have a history of denying thousands of insurance claims during the past two decades.

They have supposedly used some of the following questionable tactics when denying claims:

• Partial payment of an initial claim but later denying the same claim
• Improper claim investigation tactics and relying on opinions from “experts” who are not qualified
• Denying a claim despite a lack of medical evidence; or
• Excessive requests for additional medical examinations

Did Unum Breach Your Employee Benefit Plan Contract?

If you are experiencing difficulty with your Unum employee benefit plan claim, you should contact an experienced attorney who understands Unum’s reported history of bad faith practices, and who can help you with filing an Unum lawsuit.

The Unum Employee Benefit Plan Lawsuit is Case No. 2:16-cv-08550 in the U.S. District Court for the Central District of California.