An Unum lawsuit filed by physical therapist says the insurer wrongfully characterized her cancer as a pre-existing condition.

Plaintiff Teresa E. worked as a physical therapist for Kindred Health Care Operating Inc. As a Kindred employee, she was a beneficiary under the company’s employee benefit plan. One benefit available under that plan was a long-term disability insurance policy administered by defendant Unum Life Insurance Company of America.

According to this Unum lawsuit filed by a physical therapist, Teresa is disabled with lung cancer. She says Unum denied her claim for long-term disability benefits, claiming her cancer is a pre-existing condition.

Her disability troubles began in August 2015, when a slip on wet pavement left her with pain in her left hip. The pain stayed with her for several days. At first she got some relief from physical therapy, but then the pain returned. X-rays of her hip showed nothing other than hip strain.

In late October 2015, she saw her primary care physician for an annual physical. Her blood work showed a vitamin D deficiency, but there was no further assessment of her hip injury.

She went back to her orthopedic doctor in January 2016 because her hip pain still wouldn’t go away. An MRI study revealed she had lesions in her pelvis suggestive of metastatic cancer.

Further imaging studies revealed the source of the cancer was a large tumor in her right lung. By that point, the cancer had spread to her bones. Later imaging studies showed she had lesions throughout her skeletal system.

In that same month, Teresa’s care providers told her there was a particular targeted chemotherapy treatment for her type of cancer, but the side effects of this particular treatment would be profound enough to prevent her from returning to work.

Denial Leads to Unum Lawsuit Filed by Physical Therapist

She applied for long-term disability benefits from Unum and for Social Security Disability Income. Social Security granted her claim for benefits effective January 21, 2016, based in part on the side effects of her chemotherapy and radiation therapy.

Unum, however, denied her claim for long-term disability benefits, finding that her lung cancer was a “pre-existing condition.”

Under the terms of Teresa’s policy, a “pre-existing condition” is one for which the claimant sought treatment, consultation, care or services during what’s called a “look back period.” The policy excludes coverage for conditions that meet this definition.

In Teresa’s case, the look back period was October through December 2015. During that time she sought treatment for her hip pain. Her cancer had yet to be diagnosed, however, and neither she nor her doctors had even considered cancer as a possible etiology of her hip pain.

Nevertheless, Unum found that the treatment she sought in December was treatment for the lung cancer for which she sought disability benefits, making her cancer a pre-existing condition.

That denial is now the subject of this Unum lawsuit filed by the physical therapist. Teresa argues that the treatment she received during the look back period does not make her cancer a pre-existing condition.

She points out, with her treating physicians’ support, that she was not diagnosed with cancer within the look back period. Nor did she receive any treatment, consultation or medication during that period, she claims.

She raises one claim under ERISA, the federal Employees Retirement Income Security Act. She seeks a court order requiring Unum to pay back benefits and to continue paying her so long as she meets the requirements for benefits in her policy.

Teresa’s Unum Lawsuit is Case No. 1:17-cv-00296 in the U.S. District Court for the District of Colorado.