A Tennessee man has filed an Unum long-term disability benefits lawsuit seeking benefits he says were wrongly denied.

Plaintiff David M. claims defendant Unum Insurance Company of North America improperly cut off his long-term disability benefits. He says Unum based its denial on incomplete medical evidence and “allowed its concern over its own funds to influence its decision-making.”

In his Unum long-term disability benefits lawsuit, David says he is the beneficiary of an Unum insurance policy issued to Land O’ Lakes Inc., where he used to work as a production supervisor.

David says he had to stop working for Land O’ Lakes in July 2014 after he was seriously injured in a motor vehicle accident. Thanks to the head injury he suffered, he now has post-concussive syndrome. He says his residuals include “post trauma headaches, blurred vision, dizziness, light sensitivity, and cognitive issues.”

David filed a claim with Unum for long-term disability benefits. Unum approved his claim, and he received disability benefits until January 2016.

Denial Leads to Unum Long-Term Disability Benefits Lawsuit

At the end of that month, David says he received a letter from Unum stating that he was being denied further benefits. The company justified the denial based on a reviewing physician’s conclusion that David had become capable of light exertion and was therefore able to resume his ‘light exertion’ occupation at Land O’ Lakes.

According to David, the reviewer based the denial on assessments of his capability to lift, sit, stand and walk. What the reviewer failed to account for, David says, was the effect of his post trauma headaches on his ability to work.

Those headaches are severe and frequent enough to impact his ability to work at any level of exertion, David claims. It especially impairs his ability to focus on a computer screen through a full work shift, he says.

David also points out that the reviewing physician made that determination without having conducted an actual in-person exam.

But according to David’s own treating physicians, his daily headaches are the biggest obstacle to his ability to work now – not his ability for physical exertion.

Two of his providers noted that because of his daily headaches, he would need extensive work breaks and would miss entire days of work. Another provider said he agreed with the assessment of David’s physical restrictions but was not asked about the effect of his headaches on his ability to work.

David says he filed an internal appeal with Unum in July 2016. With that appeal he provided new medical records showing this and an opinion by his physician that his headaches would cause him to miss multiple work days per month.

Unum still denied his appeal in September 2016. David says the company relied on the opinions of medical consultants who determined – again without a physical exam – that with some restrictions, David could sustain light work.

The consultants said David could benefit from a sit-stand option and only occasional keyboarding. David counters that this would prevent him from adequately doing his job, which requires three to five hours of computer work per day, according to his Unum long-term disability benefits lawsuit.

Having exhausted his administrative remedies, David filed this Unum long-term disability benefits lawsuit. He is asking the court to award payment of benefits already withheld and to reinstate ongoing payment of benefits.

David’s Unum Long-Term Disability Lawsuit is Case No. 1:17-cv-39 in the U.S. District Court for the Eastern District of Tennessee.