Recently, an Unum lawsuit filed by an MS patient against the insurance company has revealed that Unum allegedly did not pay long-term disability insurance as they should have.

Georgia plaintiff Akil K., an employee at New York Presbyterian Hospital, has filed a lawsuit against Unum Life Insurance claiming that Unum denied his long-term disability benefits.

New York Presbyterian Hospital contracted with Unum to provide disability insurance for its employees and provided this long term disability coverage to its employees as part of an overall welfare benefit plan as defined under ERISA.

According to this Unum lawsuit filed by an MS patient, a patient is disabled when he or she is limited from performing the material and substantial duties of the regular occupation due to sickness or injury and he or she has a 20% or more loss in indexed monthly earnings due to the same sickness or injury.

When Unum has paid for 24 months and if Unum determines the patient is still unable to perform duties of any gainful occupation, he or she is still considered disabled.

There is a limitation provision regarding mental illnesses which states that disabilities due to mental illness, alcoholism or drug abuse have a limited pay period for up to 24 months.

Allegations Raised in Unum Lawsuit Filed by an MS Patient

Akil worked for New York Presbyterian Hospital as the Director of Quality Improvement but ceased working January 27, 2012, due to complications caused by multiple sclerosis (MS).

Multiple sclerosis is a disease in which the immune system eats away at the protective covering of nerves and is incurable. Debilitating symptoms of MS can include vision loss, chronic pain, fatigue, paralysis and severe problems with coordination.

Unum paid Akil disability benefits for two years, ending in July 2014. But in November of that year, Unum denied continuing benefits noting that Akil’s claim was under the mental health provision.

Even though the plaintiff provided copious information regarding the illness and provided evidence of multiple sclerosis, Unum continued to deny the claim.

According to this Unum lawsuit filed by an MS patient, on July 24, 2015, Unum upheld its decision stating that the “reviewing psychologist did not find that the test data supported deficits in cognitive functioning from an organic non-behavioral health medical condition.”

The plaintiff provided significant evidence to the contrary including multiple MRIs. Regardless, this last June, Unum once again denied the claims.

This Unum lawsuit filed by an MS patient raises a claim for entitlement to long term disability benefits for the following reasons:

• These benefits are permitted under the plan
• The plaintiff has satisfied all the conditions to receive the benefits
• The plaintiff has not waived or relinquished his entitlement to these benefits

The Unum Lawsuit is Case No. 1:16-cv-04380 in the U.S. District Court for the Northern District of Georgia, Atlanta Division.