An Arizona woman has filed a Unum lawsuit over an alleged unfairly denied disability claim, stating that because the doctors who denied her disability benefits worked for Unum, there is a conflict of interest.

Unum Lawsuit Filed for Denied Disability Claim

Plaintiff Karin M., a resident of Maricopa County, Arizona, was an employee of Shamrock Foods as an accountant. She became disabled on September 15, 2012 and became unable to work.

Due to serious medical conditions, Karin has since remained disabled and cannot work. Her company’s long term disability insurance was insured by Unum Life Insurance Company of America.

Unum originally approved her claim and began paying her long term disability benefits. She submitted medical evidence which proved she was unable to work.

However, on January 16, 2015, Unum terminated her benefits. According to this Unum lawsuit, Unum claims that Karin’s disabilities were due to a medical condition that was subject to a “limited pay period.”

According to the Unum lawsuit, Karin’s medical conditions did not qualify under the “limited pay period” conditions outlined in her group disability policy. What this means is that insurance will not pay for some medical conditions under long term disability, but will only pay for them for a limited time. But other, more serious conditions qualify for long term pay.

The nature of this Unum lawsuit is that Karin as well as her own personal physicians disagree with Unum’s doctor reviewers as to the nature of her medical condition. Unum believes that her conditions fall under a “limited pay period” and she believes they do not.

She claims that her “disabling and serious medical conditions are not subject to any Policy limitation and that Unum’s determination in this regard is unlawful, unreasonable, erroneous and palpable evidence that its conflict of interest is the reason it applied the Policy limitation.”

During this time, Karin applied for and was approved for Social Security disability benefits. Social Security restrictions on medical conditions considered for long term disability benefits are much more stringent than those of Unum.

Karin explains, in her Unum lawsuit, that because the Social Security Administration approved her disability benefits and has continued to pay her benefits, that this is more than enough medical evidence for Unum to continue to pay her benefits.

Karin’s medical conditions were reviewed by two physicians whom, she believes, are Unum employees. Surprisingly, Unum functioned as both the claim administrator and the insurer of her plan.

In essence, Unum employees both paid out benefits and decided whether or not she should receive them. If Unum found her disabled, then they were obligated to pay her long term disability insurance. In her opinion, this is a grave conflict of interest.

During this time, Karin obtained numerous letters and affidavits from medical professionals stating she should quality to receive long term Unum benefits, however Unum continually has denied her claims.

Karin calls for her long term disability benefits to be reinstated, asks Unum to compensate her for any losses accrued over this time and for her attorney’s fees to be paid.

The Unum Lawsuit is Case No.2:16-cv-02015 in the U. S. District Court of Arizona.