A former director of information systems has filed an Unum lawsuit, challenging the insurance company’s denial of his disability insurance claim.

Plaintiff Carl S. says Unum Life Insurance Company of America issued an improper claim denial when he tried to claim benefits related to several different disabilities. Carl says he is a beneficiary of a disability insurance plan provided by his employer World Vision Inc. and administered by Unum.

Before he became disabled, Carl says, he had been working for World Vision as their Information Systems Director and Director of Web Development.

Carl says he became disabled due to the onset of several different medical conditions. He says he suffers from lumbar spine conditions severe enough to require three surgeries in less than three years. Carl says the chronic pain attendant to these conditions plus the side effects of his pain medication are also disabling.

On top of his lumbar spine problems, Carl says he also suffers from diverticulosis, cognitive disability, migraine headaches, obstructive sleep apnea with restless leg syndrome. Carl says all these disabilities have been verified as totally disabling by his treating physicians and psychologist.

Carl says he submitted a timely claim for benefits to Unum. He included on his application a summary of his hospitalizations and the prescription medications he was taking. Unum never requested Carl’s medical records, he alleges, despite having a signed release from Carl authorizing disclosure of those records.

An Unum physician did speak to one of Carl’s treating physicians, Dr. Shelton, about Carl’s condition. Dr. Shelton explained that Carl was capable of some sedentary activity, but that due to his post-laminectomy syndrome he was unable to sit through most of an eight-hour workday without experiencing severe pain.

Dr. Shelton also explained that Carl’s cognitive impairment prevented him from meeting the required mental demands of his job.

Unum issued its claim denial in October 2014. The company based its decision on Carl’s supposed ability to perform full-time sedentary work, and it also claimed to have a lack of evidence of Carl’s cognitive impairment, according to Carl’s Unum lawsuit.

Carl appealed his claim denial in March 2015, submitting updated medical records and the results of new cognitive testing that showed he had deficits in complex attention adaptive problem solving. Unum nevertheless upheld its denial in June 2015, Carl says.

Carl’s Unum Lawsuit Under ERISA

Having exhausted his options for an internal appeal, Carl then filed this Unum lawsuit under ERISA, the federal Employee Retirement Income Security Act.

Carl says Unum ignored the evidence of his disability but instead cherry-picked evidence from the record to fabricate a claim denial. Carl also says Unum failed to follow certain procedural requirements under ERISA that could have made a difference in the outcome of his disability insurance claim.

Specifically, Carl claims Unum failed to:

• Request relevant medical records
• Provide qualified medical consultants to review his medical records
• Order an exam when one was warranted
• Evaluate Carl’s current occupation according to updated standards, instead using standards created years before Carl’s occupation existed
• Identify the consultants used to review Carl’s record

Carl’s Unum lawsuit is Case No. 2:16-CV-01172 in the U.S. District Court for the Central District of California.