A woman from Texas with considerable physical and mental disabilities is taking her fight for long-term disability benefits against Unum Insurance to federal court.

Plaintiff Cindi L. used to work for Blanchard Valley Health System as a Director of Emergency Services. While working there, she was a beneficiary of the long-term disability insurance benefits Blanchard Valley provided, which was administered by Unum Life Insurance Company of America.

Cindi stopped working at Blanchard Valley in February 2012 because of symptoms of fibromyalgia, anxiety, depression, and cervical degenerative disc disease. According to the Unum lawsuit, these conditions have severely limited Cindi’s range of motion and inhibited her ability to physically exert herself. The medications to treat her condition further compound her problems by causing sedation and cognitive difficulties. The net result, she says, is that she cannot do any work on a consistent basis, and is therefore “disabled” within the meaning of Unum Insurance’s disability insurance policy.

Unum Disability Insurance Denial

After stopping work, Cindi filed a disability claim with Unum Insurance for short-term disability benefits, which Unum granted. However, Unum denied her claim for long-term disability benefits in July 2014.

Cindi appealed that insurance claim denial. To support her claim on appeal, she submitted the results of a Social Security Administration claim that determined she was indeed disabled. She argues that the SSA’s standard for disability is stricter than the standard in Unum’s policy, so if her disability satisfies the SSA standard, it should also satisfy the Unum standard.

The SSA standard requires the claimant to be unable to work in “any occupation in the National Economy,” while the Unum standard in effect at the time of Cindi’s claim requires inability to work in “Any Occupation.”

In reviewing Cindi’s claim on appeal, Unum Insurance provided a list of medical professionals who allegedly reviewed her claim. Cindi says Unum never provided her with copies of those reviews. She also says that despite being entitled to a physical exam under the terms of the policy, she was never afforded an actual exam during the appeal process.

Unum Insurance affirmed its denial of Cindi’s claim in March 2015 and informed her that her administrative remedies had been exhausted. Following that, she filed this disability insurance lawsuit.

Cindi’s disability insurance lawsuit concludes that Unum’s denial constitutes a violation of ERISA, the federal Employee Retirement Income Security Act of 1974. She says Unum failed to properly weigh the medical evidence relevant to her claim. She also says Unum used a standard for disability that is “unreasonable, arbitrary, and capricious” and contrary to the plain language of the policy.

Cindi now seeks payment of past benefits denied and of regular future benefits. She is also asking the court to award her reimbursement of her attorneys’ fees.

Unum Insurance Conflict of Interest

Cindi now argues that because Unum Insurance both funds the plan and retains sole authority to grant or deny benefits, its operations have an inherent conflict of interest. She says this conflict of interest influenced Unum Insurance to deny her claim.

Cindi is also asking the court to review the denial de novo. This means the court would review the claim as if the denial never happened, giving no deference to Unum Insurance’s own conclusions.

This Unum Disability Insurance Lawsuit is Case No: 4:15-cv-1930, in the U.S. District Court for the Southern District of Texas.