A new Unum denied disability lawsuit accuses the insurance company of reducing benefit payments by more than is fair or lawful.

According to this Unum denied disability lawsuit, plaintiff Patrick M. has a disability that developed out of a congenital hiatial hernia, a condition in which the top part of the stomach protrudes upward through the diaphragm.

This hernia went undiagnosed for many years. When it was finally discovered in 1996, Patrick began a series of surgical repairs that attempted to repair this hernia using mesh implants.

In December 2013, Patrick’s doctors discovered the mesh implant had come out of place and was wrapped tightly around his esophagus. His stomach had also migrated upward towards his right shoulder.

Through a series of aggressive surgeries, Patrick has had almost all of his stomach removed. After connecting a permanent feeding tube to the last remaining part of his stomach, his surgeons have admitted that his condition is so unusual they don’t know what else to do for him. He says acid continues to enter his lungs, and he suffers from extreme pain.

The Plaintiff’s Disability Insurance Claims

Patrick says that before he became disabled, he worked two different jobs. Both of those employers, HR Betty and MassMutual, provided him with employer-sponsored disability insurance policies. MassMutual’s policy was issued by Liberty Life Insurance Company of Boston, and HR Betty’s policy was issued by defendant Unum Life Insurance Company of America.

Both these policies contained provisions allowing the insurance companies to reduce their benefit payments in proportion to any Social Security disability payments Patrick would receive.

Unum granted Patrick’s claim for disability benefits in December 2013, assigning him an effective date from August 2013.

Then in June 2015, Patrick says Unum referred him to GENEX, a company that Unum contracts with to help policyholders claim Social Security benefits. Patrick made a Social Security claim, and in January 2016 that claim was granted with an effective date from January 2014 – earlier than the Unum effective date of eight months later.

That was when trouble began, according to this Unum denied disability lawsuit. Patrick says both Unum and Liberty reduced their benefit payments by the entire amount he was receiving from Social Security.

In addition to that offset, both companies demanded he pay them the total amount of his Social Security lump sum payment for backdated benefits, based on those benefits’ earlier effective date.

Patrick says he complained to both companies. Liberty responded by reducing its offset to 39 percent of his Social Security benefit. But Patrick says that Unum rejected his complaint and continued to offset his benefit payments by 100 percent of the Social Security amount.

Patrick followed Unum’s procedures for an internal appeal, but Unum only upheld its denial.

Patrick then filed this Unum denied disability lawsuit. He is raising claims under California state law that limits offsets on a pro rata basis where more than one insurer is involved.

He is asking the court to reform his Unum insurance policy to ensure that Unum will offset his benefits by no more than 61 percent of his Social Security benefits. He also seeks payment of all benefits Unum has withheld in excess of that 61 percent.

This Unum Denied Disability Lawsuit is Case No. 2:17-cv-01163, in the U.S. District Court for the Central District of California.