A woman has filed suit against Unum for denying her reinstatement of benefits for disabilities she has suffered since 2003. She has been diagnosed with osteoarthritis, fibromyalgia and other disabling conditions.

Plaintiff Theresa P. was employed as an advertising sales account executive at Time Warner Entertainment Company LP at the time of her diagnosis. Her long term disability plan was a benefit offered through her employer.

This is the second time Theresa has had to fight for her coverage. She began receiving partial benefits beginning in July 2003 until October 2003. From November 2003 through February 2004, she received long-term disability benefits.

Unum discontinued her benefits in March 2004. At that time, the current lawsuit says Unum “arbitrarily, capriciously, and without any reasonable basis refused to provide benefits due to the Plaintiff.”

Unum and Theresa settled that dispute, and Theresa received her reinstatement of benefits from the date of that 2004 settlement until April 26, 2016. Unum said that Theresa could perform her occupational duties and cited the mental illness and self-reported symptoms provisions of the policy.

Her disability denial lawsuit says that Unum’s decision “to apply the 2-year self-reported exception more than a decade after it was set to expire was a violation of the parties’ settlement agreement…” and that it was “unreasonable and disregarded the medical evidence.”

Unum Denies Reinstatement of Benefits

Theresa tried going through Unum’s appeal process to obtain reinstatement of benefits, but Unum refused to overturn the previous denial on Nov. 17, 2016.

In January 2017, Unum and Theresa entered into an agreement to conduct settlement negotiations, but Unum allegedly allowed that agreement to expire without comment on April 24, 2017.

The reinstatement of benefits lawsuit points out that “the person or persons who made the decision to deny benefits, while employed by Unum Group Corporation, claim to have made the decision to deny benefits on behalf of Unum Life Insurance Company of America.”

The doctors, claims handlers, consultants and nurses who work for Unum allegedly receive various bonuses based in part by the company’s profits. This compensation purportedly gives Unum’s evaluation team incentive to deny claims.

According to Teresa’s disability insurance lawsuit, “Unum sets goals for claim terminations, liability acceptance rates and reopen rate goals, among other measures, and ties meeting such goals to the awarding of performance compensation.”

Unum allegedly makes use of a “Manager Toolkit” that focuses on ensuring claims personnel help the company make its financial goals in order to obtain a share of the bonuses.

Unum has its own definition of “totally disabled” that says “Total disability is not insurance upon one’s business, but is a guarantee of continued personal fitness… The continued use of physical vigor and energy in the performances of manual pursuits connected with his business…”

“Unum ignored this definition” in Theresa’s case, says her claim.

The Reinstatement of Benefits Lawsuit is Case No. 1:16-cv-00115 in the U.S. District Court for the Eastern District of Tennessee, Chattanooga Division.