Insurance giant Unum Life Insurance Company of America is facing a new claim denial lawsuit from a woman who developed severe fatigue and gastrointestinal disease during her career. Despite showing overwhelming medical evidence, Unum had allegedly used third party reviewers to discredit her long-term disability insurance claims, according to the lawsuit.

Plaintiff Michelle D. is filing legal action against the disability insurance company for allegedly practicing bad faith insurance and for using illegal tactics to deny her long-term disability benefits. She further alleges that Unum acted on behalf of itself, and had denied Michelle’s claim for their own best interest.

Michelle had been previously been employed by Coast Aluminum & Architectural as a Territory Manager, and expected to have been provided  disability insurance in the case of her  medical condition, the claim asserted.

Overview of Unum Claim Denial Allegations

According to her lawsuit, Michelle had worked for her employer for over twenty years and was forced to stop working due to the severity of her medical conditions. Beginning in early 2012, Michelle began experiencing severe fatigue, nausea, abdominal pain, and weight loss.

At the time, she had been diagnosed with a blood platelet deficiency condition known as Thrombocytopenia which had been causing a number of her health conditions. Michelle was later diagnosed with acute herpes simplex virus, which further compounded her symptoms as stated in the complaint.

Michelle became disabled while covered under Unum’s plan on Aug. 25, 2012, and had received medical advice from an oncologist and hematologist to stop working several days later, she claimed. Michelle asserted that her treating physicians had submitted medical testimony to Unum on her behalf, describing her conditions and repeatedly stating she would be unable to continue working due to her condition.

Despite reporting her condition directly to Unum representatives with medical testimony, Michelle reported that she still faced claim denial. According to her lawsuit, Unum had used a third party medical expert to review her claim for long-term disability insurance coverage and found that her weight loss and fatigue did not indicate she could not work.

Michelle’s claim was officially denied on Jan. 29, 2015, which forced her to go through a number of medical appointments to reaffirm the severity of her condition, the claim noted. She filed for appeal on July 24, 2015, pointing out that a bacterial growth had developed in her small intestine and that it continued to be a struggle to maintain weight.

Once again, Unum used a third party medical expert to review her claim who concluded that there was not sufficient evidence to indicate permanent impairment, Michelle claimed. Based on this assessment, Unum denied her appeal on Oct. 20, 2015.

Michelle’s claim indicated that the insurance situation was difficult to begin with because her insurance had been combined with Covered California, which caused her physicians to be dropped from her insurance plan.

Michelle stated that her husband’s insurance covers her medical needs, but this does not change her eligibility for Unum disability insurance. Michelle claims the Unum practiced bad faith insurance to deny her disability insurance claim, and is seeking all missed payments since Jan. 29, 2015.

The Unum Bad Faith Insurance Claim Denial Lawsuit is  Case No. 2:2016cv00678, in the U.S. District Court for the Central District of California.