By Robert J. Boumis  |  September 22, 2014

Category: Consumer News

Unum disabiliy insurance problems

A woman battling breast cancer has filed a Unum disability insurance denial lawsuit against Unum, alleging the company improperly cut off her disability insurance benefits.

According to her Unum lawsuit, plaintiff Carol Pilkington worked in the medical field as a cardiopulmonary perfusionist for 28 years. Through her employer, she received an Unum disability insurance policy. In the summer of 2011, she was diagnosed with bilateral breast cancer. Her physicians worked up a treatment plan for her to undergo a double mastectomy and a five-year course of chemotherapy to treat her cancer.

For the month following her diagnosis, Pilkington continued to work. She underwent her mastectomy in early September 2011, which led to complications and further surgery. According to her Unum lawsuit, Pilkington tolerated her chemotherapy drugs poorly, with symptoms including an inability to focus and serious memory issues. Her physician declared that she was disabled due to cognitive and memory impairment. However, Unum cut off her disability benefits in November 2013, alleging that Pilkington was no longer disabled. In her Unum lawsuit, Pilkington states that Unum denied her on the grounds that the disability insurance company believed she “did not have any medical restrictions or limitations” preventing her from returning to work.

After exhausting Unum’s internal appeals process, with her physicians still stating that she was mentally and physically unable to return to work, Unum informed Pilkington that her only remaining option was to seek civil redress through the court system, which she did by filing the lawsuit.

Under U.S. law, a policyholder in a disability insurance policy may file a lawsuit once they have exhausted internal appeals with the insurer. This is covered under a law called ERISA (Employee Retirement Income Security Act). Unum has faced numerous lawsuits like Pilkington’s in the past, alleging that the company is denying legitimate insurance claims in order to increase their profit margin.

A 2002 investigation by the television news magazine “60 Minutes” found evidence that employees were given “denial quotas” and the now-infamous “Hungry Vulture Award” was given to the employee that denied the most insurance claims in a given time frame. However, ERISA gives policyholders a means of using the legal system to reinstate their insurance benefits if they can prove that disability insurers have acted in bad faith. Lawsuits like this typically seek to overturn denied disability insurance claims, receive back-owed disability insurance benefits, and recover legal fees involved in the process.

The Unum Lawsuit is Carol Pilkington v. Unum Life Insurance Company, et al., Case No. 3:14-cv-01770, in the U.S. District Court for the Middle District of Tennessee, Nashville Division.

In general, Unum lawsuits are filed individually by each plaintiff and are not class actions.

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