Unum is one of the largest insurance companies in the world, a leader in providing group and individual disability insurance policies. They insure millions of workers in the U.S.
Unum doesn’t like to pay for disability benefits and will take extreme — and, sometimes, not so legal — measures to delay and deny a claim.
Disability insurance companies such as Unum, Cigna, Aetna and Prudential often write their policies so as to take full advantage of rules and regulations to make it difficult for a disabled person to get receive benefits or to keep them for the entire length of the term of their insurance policy.
Marc Whitehead & Associates recently represented a 55-year-old woman living in Indiana who became severely disabled while covered under a long term disability insurance policy issued and administered by Unum. Formerly employed as a Refund Specialist, our client was disabled and unable to work due to multilevel herniated discs with nerve root impingement in the lumbar region of her spine. This was accompanied by radiculopathy as well as bilateral carpal tunnel syndrome and severe glaucoma.
Unum Denial despite SSA Ruling
Unum decided to deny our client’s claim for disability insurance benefits, even though they were aware of the fact that the Social Security Administration had issued a fully favorable decision on our client’s claim for Social Security disability benefits under Title II and Title XVI of the Social Security Act, finding that she was “disabled” during the relevant time period.
On December 29, 2009, Unum notified our client that the company affirmed its original decision to deny her claim for long term disability benefits, completely ignoring the findings of the Social Security Administration.
Unum went on to inform our client that she had exhausted all administrative remedies and that the company would consider no further claims or evidence. Unum, in its final denial, discounted the opinions of our client’s treating physicians, among others, and the documented limitations from which our client suffers including the effects of her impairments on her ability to engage in work activities.
In response, our client was forced to file a lawsuit in Federal Court to obtain her rightfully owed disability benefits.
Venue & Jurisdiction of Long Term Disability Lawsuit
Our client’s insurance policy was governed under the Employee Retirement Income Security Act (ERISA), a federal law that regulates the handling of Employee Benefit Plans and provide legal remedies to the beneficiaries of these Plans, including the right to dispute a denial of disability benefits by filing a lawsuit in federal court.
Suit was filed in federal court in Indiana, pursuant to 28 U.S.C. § 1331 (“The district courts shall have original jurisdiction of all civil actions arising under the Constitution, laws, or treaties of the United States”) to our client’s rights under the ERISA, as allowed by:
- 29 U.S.C. §§ 1132 (“A civil action may be brought… by a participant or beneficiary to recover benefits due to him under the terms of his plan, to enforce his rights under the terms of the plan, or to clarify his rights to future benefits under the terms of the plan”),
- 29 U.S.C. §§ 1133 (“Every employee benefit plan shall…afford a reasonable opportunity to any participant whose claim for benefits has been denied for a full and fair review by the appropriate named fiduciary of the decision denying the claim”), and
- 29 U.S.C. §§ 1140 (“It shall be unlawful for any person to discharge, fine, suspend, expel, discipline, or discriminate against a participant or beneficiary for exercising any right to which he is entitled under the provisions of an employee benefit plan”).
We are happy to report that the judge sided with our client, who was awarded the disability benefits she needed and deserved.
Do You Need To Appeal a Unum LTD Denial?
We are able to settle most disability claim denials during the appeals process, but if need be, Marc Whitehead & Associates are ready and able to take your case in front of a federal judge. Don’t let Unum and others try to take advantage of you. If you believe your claim for disability benefits was wrongfully denied, contact Marc Whitehead & Associates.
To learn more about disability insurance benefits process and your rights under the law, you can download Marc Whitehead’s free E-book, Disability Insurance Policies-How to Unravel the Mystery and Prove Your Claim.