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Unum's denial of woman's claim leads to court battle

Florida has certainly seen its share of Unum lawsuits. The insurance company has a national, if not international, reputation for denying long-term disability claims to policyholders for no reason. Complaints specifically cite Unum for randomly denying claims in an effort to reduce the company's exposure.

Another case has come up, and it's a doozy. A woman, a registered nurse, was forced to leave her job when her physical condition declined. Among her multiple health issues were bilaterial knee osteoarthritis, right ankle post-traumatic osteoarthritis, anxiety and depression.

Her long-term disability (LTD) policy, through Unum, kicked in and paid benefits for about two years. Then, in October 2009, the company stopped paying.

The insurer had decided this woman was no longer disabled. Her LTD policy was terminated.

It's unclear where the insurer got its information. This woman was, according to her doctor, incapable of standing or sitting for more than two hours at a time during an eight-hour period. She is clearly limited in her ability to sit, stand or walk. She also has what doctors refer to as "limited manipulative capacity" -- that is, she cannot easily grasp with her hands, open jars, manage eating utensils and the like.

It doesn't end there. She is at high risk of falling, because she is in pain and because her weight-bearing joints are so arthritic. She uses a motorized vehicle to get around; without it, she uses assistive devices to stand and walk. Finally, the medication that controls her pain has affected her kidneys and liver.

This woman is in very bad shape, but Unum stopped her LTD benefits.

This suit is her second attempt to convince the insurer it's made a mistake. She filed an ERISA appeal when her claim was denied, but Unum stuck to its guns: denial affirmed.

Internet chatter about Unum's practices abounds. One very vocal critic says the company regularly uses its own employees or contract firms to find incriminating evidence against a claimant. The classic example is the guy who claims he's disabled, but the insurer turns up a video of him on a ladder, painting his house -- benefits canceled.

In this case, as in so many, it's hard to imagine the company has found any incriminating evidence against the claimant.

Source: LawyersandSettlements.com, "How Disabled Do You Have to Be to Satisfy Unum?" Gordon Gibb, 05/06/2011

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