Woman Files Lawsuit to Recover Unpaid Unum Disability Benefits

According to the Unum lawsuit, Cook participated in a group insurance policy for employees of SSM Health Care. Unum provided coverage for certain SSM Health Care employees, including Cook, under an employee welfare benefit plan. Cook was a full-time employee of SSM Health Care from 2001 until she injured herself at work on August 25, 2009 when she slipped on a wet staircase and sustained back, neck and head pain. She continued to work for SSM Health Care after she was denied workers’ compensation, even though she continued to experience persistent pain.

In April 2010, Cook stopped working because of the pain. She was later diagnosed with fibromyalgia by Dr. Baak, her Rheumatologist. While some rehabilitation options were available, Cook’s options were limited because of a co-diagnosis of mitral valve stenosis. According to the Unum lawsuit, Cook had previously been diagnosed with depression, anxiety and diabetes. Deborah had received short-term disability benefits until they were exhausted on July 26, 2010.

In August 2010, Dr. Baak concluded that Cook was “completely disabled and does not seem to be responding to currently available treatments.” Cook promptly applied for long-term Unum disability benefits, which were subsequently denied. Cook appealed the Unum disability claim denial. According to her Unum lawsuit, she has exhausted all of the administrative remedies that were available through Unum.

Unum’s own definition of “disabled” includes policyholders who are unable to perform the “material and substantial duties” of their jobs. After 24 months of payments, policyholders will be considered “disabled” if they are unable to perform duties of any occupation that could reasonably be performed with appropriate training and education, given the policyholder’s age, experience, physical and mental capacity.

According to her Unum lawsuit, Cook has submitted timely documentation proving that she is permanently and totally disabled to such an extent that she is unable to do her job. Despite neither consulting with Cook’s physicians nor requesting an examination by an independent physician, Unum denied her claim for long-term disability benefits.

Instead, Unum relied on the assessment of Dr. Tammy Lovette, who disagreed with Cook’s treating physicians and found that Cook was able to perform sedentary work. Further, she concluded that Cook’s claims of mental illness were “not supported.” In making this determination, Dr. Lovette never interviewed or examined Cook.

In September 2010, Cook was awarded Social Security Disability (SSD) benefits for her diagnoses of fibromyalgia and affective mood disorders. Even though Cook was considered disabled under SSD standards, Unum continued to deny her appeals. In her Unum lawsuit, Cook claims that the insurance giant “decided to cherry pick the SSD findings by purportedly agreeing with the physical findings and ignoring the mental disability findings.” She argues that Unum’s disability claim denial was “arbitrary and capricious, an abuse of discretion and not based on substantial evidence.”

In her Unum lawsuit, Cook claims that she is entitled to payment of long-term disability monthly payments equal to 60 percent of her salary for five years, plus interest. She also seeks attorneys’ fees and court costs.

The Unum lawsuit is Deborah Cook v. Unum Life Insurance Company of America and SSM Health Care, Case No. 4:13-cv-1484, in the U.S. District Court for the Eastern District of Missouri.

A growing number of plaintiffs have filed Unum lawsuits, accusing the disability insurance company of denying legitimate disability claims. If you believe you have experienced a wrongful Unum disability claim denial, visit the Unum/UnumProvident Disability Insurance Claim Denial Class Action Lawsuit Investigation. When you submit information about your disability claim denial, a lawyer will conduct a free claim review to determine whether you qualify to take legal action.