Unum Life Insurance Company of America is facing legal action from a Texas woman who alleges the company wrongfully denied an ERISA disability claim.

By denying her ERISA disability claim, the woman alleges, the company failed in its duty to properly evaluate her claim for disability benefits and ignored relevant medical testimony from her physicians.

Plaintiff Lisa F. argues her ERISA disability claim for long-term disability coverage was initially approved by the insurance giant but was later terminated. Lisa states that she was legally entitled to long-term benefits under ERISA (Employee Retirement Income Security Act) by being fully employed through her company.

Lisa argues Unum was supposed to pay her long-term disability benefits, as she was on an ERISA employee welfare benefit plan.

Overview of ERISA Disability Claim Denial

According to the claim denial lawsuit, Lisa was fully employed as a receptionist and clerk for a San Antonio veterinarian clinic. However, due to chronic back issues and radiating pain, Lisa had to cease working after Dec. 23, 2015.

Even though Lisa had sought treatment for her back pain, she also began experiencing severe depression, anxiety, and mood disorder. Even though doctors approved her to go back to work in January 2016 after her back pain was treated, Lisa could not continue working due to her severe psychiatric conditions.

When Lisa first filed her ERISA disability claim, it was for short-term disability benefits for her psychiatric conditions. At that time, she had followed all administrative procedures and had submitted relevant medical testimony from her physicians.

The claim was approved and paid for the maximum time period of six months, with Lisa filing for long-term disability benefits after her short-term disability expired.

Lisa opted to file for long-term disability benefits after finding that she was still not ready to return to work, and then filed medical evidence with the insurance company to prove she needed it.

Unum initially approved the long-term ERISA disability claim and began paying monthly installments on June 26, 2016. However, this suddenly changed when Unum sent notice to Lisa on Dec. 13, 2016, stating her long-term disability benefits were discontinued.

According to Unum’s notice, the company stated that Lisa could return to work at her former place of employment at the veterinarian clinic and therefore was no longer eligible to receive disability benefits.

Lisa quickly appealed this decision by filing additional medical records and a psychological evaluation dated Feb. 8, 2017, which supported her claim that she still needed long-term disability benefits.

The psychological evaluation had found Lisa to be severely impaired due to major depressive disorder and unspecified delirium and shared that Lisa would be unable to return to her former job or any similar occupation.

Even though her psychiatrist had provided medical testimony that proved her disability, Unum reportedly upheld its decision to terminate Lisa’s long-term benefits. At this point in time, Lisa has exhausted all administrative options and has been forced to file legal action against the disability insurance giant.

Lisa is filing this claim denial lawsuit, alleging her long-term ERISA disability claim was wrongfully denied and that the disability insurance provided owes her for all missing disability installment payments.

This Unum Claim Denial Lawsuit is Case No. 5:17-cv-00956-XR, in the U.S. District Court of Western Texas, San Antonio Division.