Unum Sued By An Ophthalmologist And A BJC Healthcare Employee Who Both Were Denied Disability Benefits
Unum Life Insurance Company Of America (Unum) was sued in two different lawsuits filed in the Federal Courts of Missouri, by two plaintiffs who did not receive the long-term benefits that were entitled to them under the terms of their respective Plans that were issued and administered by Unum.
Western Division Case
In Dale L. v. Unum Life Insurance Company Of America, Administrator Of The Unum Disability Income Policy, Plaintiff through a Missouri disability lawyer filed this lawsuit due to his not receiving the disability benefits that were entitled to him under the terms of the Plan underwritten and administered by Unum. Plaintiff was employed as an ophthalmologist until he stopped working on October 25, 2000 due to degenerative and traumatic injuries that led to severe hearing loss and chronic back pain. This was shown to be caused by the Plaintiff moving an armoire.
Plaintiff filed an application for short-term disability benefits, which Unum granted. Plaintiff then filed an application for long-term disability benefits according to the terms of the Plan, which Unum initially agreed to pay. However, via letter on December 30, 2008, Unum denied further long-term disability benefits as defined in the Plan because Unum claimed the disability was caused by an illness, which limited the amount of payments according to the terms of the Plan. Plaintiff had 180 days to appeal this decision.
On March 1, 2010, Plaintiff requested an administrative review of the denial of benefits, supplying medical records and additional information to prove that he should be entitled to long-term disability benefits. However, on June 30, 2010, Unum affirmed its original decision and declared that Plaintiff had exhausted his administrative remedies. Due to this, the Plaintiff has filed this lawsuit.
Central Division Case
In Roxann P. v. Unum, the lawsuit was filed at the District Court in the Western District of Missouri Central Division because the Plaintiff seeks the withheld benefits that were to be provided under the terms of a disability insurance policy provided by her employer, BJC Healthcare, which was administered and funded by Unum.
As of May 19, 2008, the Plaintiff has ceased working due to being unable to perform the material and substantial duties of her regular occupation because of dementia that was caused by a stroke. She is also unable to perform the material and substantial duties of any gainful occupation for which she is reasonably fitted by education and has suffered a loss of 20% or more of her indexed monthly earnings.
Unum has refused to pay the benefits and issued a final decision on May 11, 2011. Due to exhausting all administrative remedies, Plaintiff has filed this lawsuit (more info about ERISA lawsuits & trials).
Relief Sought By The Plaintiffs
By filing these lawsuits, the Plaintiffs seek to gain the following relief from the Court:
- A judgment declaring that the Plaintiffs are entitled to all disability benefits due to them under the terms of their Plans from the dates those benefits were terminated
- A judgment declaring that all pre-judgment and post-judgment interest be applied to the benefits that were denied to the Plaintiffs
- A judgment that applies punitive damages that deter Unum from committing similar actions against others in the future
- A judgment declaring that all attorney fees be paid
- A judgment declaring that all court costs be reimbursed
- A judgment that applies other proper and just relief that the Court declares to be appropriate compensation.
Resources to Help You Win Disability Benefits
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Q: Does UNUM periodically review Group Long Term Disability Insurance claims/payments? For example, do they verify medical eligibility every five or ten years?
Q: My group long term disability insurance allows me to work part time up to 20% of my pre-disability earnings without affecting my benefit. If I take advantage of this, will Unum use this to deny my benefit?
Q: Unum discontinued the "long term Buy out option" in 2014. I was never aware of or informed of this action by Unum.
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