A North Carolina woman is bringing an Unum ERISA lawsuit, alleging the insurance company improperly denied her claim for benefits.

Plaintiff Robin R. says she used to be an employee of retailer Dollar Tree.

As a benefit of her employment, Dollar Tree provided her with a sponsored long term disability insurance plan that was fully insured by defendant Unum Life Insurance Company of America.

By March 2014, Robin says, she had to stop working. She alleges she had become too disabled to do the duties required of her job and she was forced to resign.

She then filed a claim with Unum for long term disability benefits.

Unum denied Robin’s claim, she says. She filed an internal appeal with the company and exhausted all other avenues by which she could appeal, but Unum continued to stand by its denial.

Appealing Denials Under ERISA

Robin’s Unum ERISA lawsuit is governed by the federal Employee Retirement Income Security Act of 1974.

While this law was originally passed to help protect employees’ access to their benefits, attorneys who deal with cases like Robin’s Unum ERISA lawsuit say the law tends to favor insurance companies.

One of the significant obstacles to appealing a denial under ERISA is the standard of review, which determines how much deference a court must give to the insurance company’s denial.

Today, many disability insurance plans include language that says the insurance company gets discretion to grant or deny claims, or that the company’s decision will be reviewed under an “arbitrary or capricious” standard of review.

Under that standard, courts generally defer to the company’s discretion, and a denial is much more likely to be upheld on appeal.

There are exceptions, however. It’s possible that if the claimant can show the company denied the claim while operating under a conflict of interest, the court would then apply the much more claimant-friendly “de novo” standard.

Under the de novo standard of review, the court would completely re-decide the claim from scratch. The court would form its own decision based on the same evidence that was before the insurance company, and it would give no deference to the company’s original denial.

In her Unum ERISA lawsuit, Robin says Unum was operating under just such a conflict of interest. She says that Unum is both the source of the funds to be paid out for claims and the entity that decides whether to grant or deny the claim.

“Besides being the insurer of the plan, Defendant is also the sole entity responsible for determining whether claims such as the Plaintiff’s should be paid,” Robin says. “Accordingly, Defendant is the claim administrator and a fiduciary of the plan for the purpose of deciding whether benefits are payable.”

Robin says this alleged conflict of interest “improperly and significantly” affected Unum’s decision on her claim.

She is asking the court for a declaration of her entitlement to benefits and an award of benefits withheld so far, plus reimbursement of court costs and attorneys’ fees with interest.

Filing an Unum ERISA Lawsuit

Due to their alleged track record of denying long-term disability claims, Unum and its subsidiaries have been named in various claim denial lawsuits across the nation. Policyholders have charged the company with bad faith practices in the disability insurance lawsuit claims.

If you need help with filing a Unum ERISA lawsuit, contact an experienced attorney today for more information.

Robin’s Unum ERISA Lawsuit is Case No. 6:16-cv-03848 in the U.S. District Court for the District of South Carolina.