LAFAYETTE — A medical care worker in Louisiana is the latest person to sue Unum, the world's largest disability insurance company that has a long history of allegations saying it wrongfully denies long-term disability insurance claims.
In the case filed in U.S. District Court for the Western District of Louisiana, plaintiff Brenda Andrus, who is employed by Opelousas General Health System Medical Center as a case manager, alleges she suffers from a multitude of serious conditions that prevent her from working and she has been wrongfully denied benefits through Unum.
Previously known as Paul Revere, Provident and Unum Provident, Unum was first reprimanded by the Department of Labor more than 10 years ago for alleged bad faith insurance practices and has been sued several times since, including a class-action suit as part of a multi-state investigation that resulted in the company agreeing to a $46 million settlement earlier this year.
"My client suffers from spinal problems in her neck and low back from years of strenuous work, and has had placement of posterior fixation hardware in her low back from L4-S1 with fusion," attorney Christopher Edwards recently told the Louisiana Record.
Andrus' most recent surgery was on May 4, 2015, according to Edwards. She also had carpal tunnel surgery on May 21, 2014 and July 18, 2014, and a complete left-knee replacement on Jan. 20, 2015. Edwards said she last worked on March 27, 2013 and was paid long-term disability until Feb. 15 when Unum cut her off, allegedly violating the Employee Retirement Income Security Act (ERISA) and the Louisiana Workers' Compensation Act.
Edwards said Unum based the decision to terminate Andrus' benefits on its own doctor's opinions, rather than those of Andrus' personal doctor and other health care providers.
"(Andrus) was cut off despite her vocational expert, Glenn Hebert, providing an expert opinion that there is no work she can perform since the date she last worked in March 2013," Edwards said. "She had worked at Opelousas General Hospital as a nurse for over 10 years. She is 62 years old with a high school education and a nurses’ degree, and this is the only type of work she has done for the last 20 years."
Unum has faced thousands of lawsuits over allegations that it routinely denies claims and unlawfully discontinues disability payments. The company has been accused of basing its rejection of claims on recommendations from unqualified experts and shoddy interpretation of medical records; changing its policies after a claim has been filed; and refusing to acknowledge fibromyalgia, chronic fatigue syndrome and mental illness as legitimate disabilities.
In Andrus' case, her lawyer said Unum is ignoring the "no work status" that her own physician, Dr. George Williams, placed her on.
"Unum based their decision solely upon their own IME doctor’s opinion that her fusion 'should have' healed by Feb. 15, 2016 and she can do sedentary work, and their vocational expert opinion that if she can do sedentary work she is no longer disabled," Edwards said.
Despite past evidence mounting against Unum, Edwards said claimants still bear great burden of proof in suits like this.
Under ERISA's long-term disability policy, "after 24 months the claimant must prove that she is 'unable to perform the duties of any gainful occupation for which she is reasonably fitted by education, training or experience' to continue to be eligible for benefits past the initial 180-day elimination period," Edwards explained. "This means that my client must show that she can do no type of work since Sept. 20, 2015."
"The claimant bears a heavy burden in cases like this, and must prove that Unum violated their duty to reasonably and fairly assess the disability status of the claimant before terminating benefits," Edwards said. "We allege they completely ignored her treating physician opinion, her vocational expert opinion, as well as her affidavit which completely described her medical problems, disability, and restrictions in rendering a denial of benefits."
Unum has yet to respond to the complaint.