A New Jersey man filed an Unum disability insurance lawsuit against the life insurance giant, claiming Unum wrongfully denied his claim for disability insurance.
Plaintiff Dealin L. worked for Saks, Inc. when he became limited in his ability to perform his regular job.
In August 2015, his fibromyalgia condition became too problematic for Dealin to perform the substantial and material duties of his regular occupation.
Fibromyalgia is a debilitating, autoimmune condition which is incurable and causes great and diffuse pain throughout the body.
The disability insurance policy that the plaintiff had through his employer with Unum allowed for benefits to be paid if he became unable to “perform the substantial and material duties of his regular occupation.” The policy also allowed for benefits to begin 180 days after the elimination period ended in February 2016.
Allegations in the Unum Disability Insurance Lawsuit
According to this Unum disability insurance lawsuit, because the plaintiff was then eligible for payment of his long-term disability benefits, he submitted a claim to Unum.
A letter from Unum dating June 1, 2016, showed that Unum refused to pay the plaintiff’s claim. Just 9 days later, on June 10, Dealin appealed the decision by the insurance company but he was denied in another letter from Unum on July 27, 2016.
The Unum disability insurance lawsuit claims that the reasons given by Unum for denying payment are “inconsistent, not supported by substantial evidence, and were simply used as a pretext to support Defendant’s decision to deny payment.”
This letter, dated July 27, 2016, stated that the plaintiff was not disabled after he was discharged from physical therapy on February 2, 2016, but then contradicts itself by saying that because he is disabled, he should engage in daily aerobic activity, cognitive therapy and use neuropathic pain medications.
According to this Unum disability insurance lawsuit, the plaintiff claims that given the nature of fibromyalgia, neither aerobic activity, cognitive behavior therapy nor pain medications will be in any way effective.
He claims that because he is covered under the Employee Retirement Income Security Act (ERISA) and Unum is a plan fiduciary of ERISA, these “meaningless” suggestions by Unum was simply in order to deny payment. He states that there is no evidence any of these supposed solutions would work.
Dealin claims that Unum’s decision to terminate payment is not reasonable and was not supported by any evidence. The Unum disability insurance lawsuit states that the plaintiff is disabled under his Unum plan and is therefore entitled to payment of long-term disability benefits.
The plaintiff accuses Unum of breaching its fiduciary duty by “failing failing to fairly review and reasonably interpret the reports prepared by Plaintiff’s treating and examining physician and failing to consider material information relevant to Plaintiff’s medical condition.”
What is owed to the plaintiff, according to the Unum disability insurance lawsuit, is $1200 per month until he is age 65.
However, Dealin is asking Unum to pay his long-term disability insurance benefits from February 2016 when the 180 waiting period ended at a rate of $1900 per month until he is no longer disabled.
This Unum Disability Insurance Lawsuit is Case No. 3:16-cv-04897 in the U.S. District Court for the District of New Jersey.