Insured denied benefits by Unum due to failure to receive “appropriate care”

Larry Mack claimed that he is totally disabled from his occupation as a marriage and family therapist due to diabetes. He sued his disability insurer, Unum Life Insurance Company, after being denied his claim for long-term disability benefits. Unum argued that Mr. Mack is not entitled to long-term benefits because he did not receive “appropriate care” as required by his policy. Mr. Mack admitted to not seeking help from his internal medicine doctor for long periods of time but argued that during these months he was “self-treating” his diabetes by taking Glucophage daily and by monitoring his diet.

The court said such “self-treatment” does not meet the policy requirement that the claimant be under medical treatment in order to receive benefits. The court reasoned that Mr. Mack failed to abide by the standard of care his internal medicine doctor prescribed for diabetic patients, U.S. Judge Linnea R. Johnson granted partial summary judgment to Unum.

See Larry B. Mack v. Unum Life Insurance Company of America, No. 06-80308, S.D. Fla.; 2007 U.S. Dist..

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I had been on long term disability for over 10 years, with Aetna disability company. I had 3 heart surgeries in that time and some other pretty serious medical issues. I was very ill, during that time, seeing my physicians regularly and in and out of the hospital. It was very stressful keeping up with the vast amounts of paperwork, physicians attending statements, and communicating full time with the disability company.

One time, right before my open heart surgery, they stopped paying my claim for 4 months, for absolutely no reason. I did get that straightened out, eventually, but we were almost homeless, in the process. I decided to consider a buy out, on my disability claim and I wanted to use a large, reputable attorney’s firm, to handle this negotiation and contract. I called and talked to an attorney named Rachel Alters, who worked for Attorneys Dell & Schaefer. They had a very large attorneys practice and I was very comfortable using them.

She was very professional, but also really compassionate, about everything I had been through. I felt like she would really be someone I could trust. It turned out the gentleman she ended up talking to, from Aetna, was someone she knew from dealing with them in the past. This made everything go so much easier, I think, but either way, Rachel is wonderful! I would recommend her very highly, to anyone. She has my five star recommendation!

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