A woman has filed a suit against Unum because she was denied disability insurance coverage.

Plaintiff Leslie O. was employed by AJS Services, Inc. in Fort Gordon, Ga. Unum Life Insurance Company of America is the administrator of the long term disability insurance plan for AJS employees.

Leslie is a former employee who says she became disabled while working at AJS and is now entitled to disability benefits under the Unum plan.

She reports she was denied disability insurance coverage according to a Nov. 8, 2016 final decision by Unum, which followed its own administrative process. Leslie has attempted all of the administrative steps the plan provides, but has been unsuccessful in convincing the plan’s administrators that she is completely disabled as the term is defined by the plan.

Denied Disability Insurance Coverage Allegedly Capricious

Unum’s decision to deny coverage “was arbitrary and capricious as to defy common sense and logic and is a bad faith breach of the terms and conditions” of the plan, says the denied disability insurance coverage lawsuit.

Leslie submitted a letter dated March 15, 2016 that included her initial claim for benefits under the Unum plan. Her request was initially denied in a response she received May 13, 2016.

She filed an appeal on Oct. 14, 2016, which was met with a final denial on Nov. 8, 2016.

At that point, Leslie demanded to see papers or documents that were used to justify Unum’s denial of her claim. Unum refused to provide the documentation, simply stating the company was not required to provide such proof.

According to the denied disability insurance coverage claim, Unum also refused to provide professional profiles or resumes of the medical and vocational experts who provided opinions and interpretations of Leslie’s physical condition. Their conclusions were reached exclusively by reviewing the medical records in the claims file.

Leslie’s medical records include details of an “ongoing, intensely painful physical condition that has been exacerbated by the mental pain and anguish” that she has documented.

The denied disability insurance coverage lawsuit contends that Unum had a conflict of interest in making the decision on whether or not to cover the claim.

“As the Plan Administrator and the fiduciary, they failed to maintain ‘revenue neutral’ compensation, as required by ERISA,” says the denied disability coverage claim. ERISA stands for Employee Retirement Income Security Act of 1974 and regulates employee benefit plans.

In violation of ERISA, Leslie says, Unum uses methods to evaluate and deny claims to satisfy the company’s own financial interests. Unum’s reasons for denial of Leslie’s claim do not coincide with the statements and determinations made by her own doctors, she claims.

Leslie seeks payment of her attorney’s fees and interest on the unpaid disability benefits in addition to punitive damages.

The Denied Disability Insurance Coverage Lawsuit is Case No. 1:17-cv-04414-SCJ in the U.S. District Court for the Northern District of Georgia, Atlanta Division.

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