A man, who calls himself John Doe in this lawsuit, is suing Unum Life Insurance of America for wrongfully denying him his long-term disability benefits. He alleges that after following all submission procedures and providing medical testimony, that he is no longer be able to work, but Unum denied him his benefits because his disability came from an addiction.

Doe was a successful medical doctor in the state of Rhode Island, and practiced medicine for many years. His duties included prescribing and administering medications to patients. Due to the nature of his job, the Rhode Island man handled controlled substances on a daily basis. While Doe admits that he was previously addicted to the substances he handled, as it was discovered by his bosses, he did receive treatment for his addiction.

Initially, the Rhode Island doctor applied for short-term disability benefits on Jan. 12, 2011, and received the benefits from Unum after it was confirmed they were needed to cover his addiction treatment. However, on July 15, 2011, Unum transitioned Doe’s short-term disability claim to a long-term disability claim. However, his treatment funds were undercut significantly because under the long-term disability plan he is under, it limits the payment of coverage to 24 months. However, he claims that he was not told of this before the transition was completed.

Additionally, when Unum investigated Doe’s claim, the company determined he was disabled from his regular occupation and paid the long-term disability benefits for approximately 10 months — from July 15, 2011 to June 3, 2012. At the time the payments ended, the Doe’s addictionologist did not officially clear him to return to work, because he would be required to work around the drugs to which he had been addicted.

At all relevant times, the Doe’s addictionologist had stated that in his professional opinion that Doe could not return to work in that occupation, due to the risk of relapse. Despite the testimony, Unum had chosen to terminate Doe’s long-term disability benefits on June 4, 2012, stating that the risk of relapse were “not so significant … to be disabling.” Doe alleges that Unum had denied his benefits based on a financial conflict of interest.

Due to Doe’s addiction, he will no longer be able to practice medicine unless completely treated. As of now, Doe is seeking a declaration that he was disabled under the terms of Unum’s disability plan from July 2011 through July 2013, and that he is entitled to any missed payments, plus additional interest.

Overview of Unum Claim Denial Tactics

Unum claim denials lawsuits are not uncommon, and various characteristics of these claim denials have been pointed out in these Unum lawsuits. These characteristics are the determined tactics Unum and its partners have used to deny claims. These tactics include but are not limited to:

• Changing policies after claims are filed (without the authorization or knowledge of policy holders)
• Improperly investigating the claim and obtaining opinions from unqualified witnesses
• Demanding repeated requests for independent medical examinations or denying a claim without any medical examination
• Refusing to acknowledge their disability, especially mental disorders, fibromyalgia, and chronic fatigue syndrome

The Unum lawsuit is John Doe v. Unum Life Insurance Company, Case No. 1:14-cv-00172-ML-LDA, in the U.S. District Court for the District of Rhode Island.