A New Jersey disability attorney filed a federal lawsuit against the Unum Life Insurance Company Of America (Unum) and MOL (America) Inc. Plan (MOL). The Plaintiff, Aleksandr K., worked as a computer programmer for MOL, which contracted with Unum to provide long-term disability insurance benefits to its employees. Plaintiff, because of his employment at MOL, was eligible and covered under this group policy.
Aleksandr K., like so many others before him, was forced to file a lawsuit in order to gain payment of long-term disability insurance benefits that were owed to him.
Facts of the Case Against Unum and MOL
Plaintiff worked full-time as a Senior Application Programmer/Analyst for MOL. He had experienced mild pain in his back and neck since 1980. In 2008, Plaintiff experienced pain in his lower back due to prolonged sitting. That same year, he came under the care of Dr. L., who diagnosed Plaintiff with arthritis, spinal stenosis, radiculopathy, arthropathy, coccygodynia, and fibromyalgia. Dr. Leybel and other doctors provided various medical treatments, including medication, therapy, and epidural injections to relieve the pain.
Plaintiff’s spinal condition worsened over time, as shown by periodic MRIs. By January 11, 2010, the pain was interfering with Plaintiff’s ability to focus and concentrate, but he still remained at work.
On March 4, 2010, due to debilitating pain in his back, Plaintiff did not report to work. An MRI showed the presence of degenerative disc disease, which explains why Plaintiff experiences pain with an intensity level of 10 on a 10-point scale.
Plaintiff submitted a claim for short-term disability benefits, which Unum granted. Plaintiff received these benefits for the maximum period of 6 months. Plaintiff underwent physical therapy during this time period, but there was no relief for his condition. Plaintiff also underwent acupuncture treatment.
Plaintiff filed a claim for long-term disability benefits due to being unable to work as a programmer since March 2010.
Unum undertook an investigation of Plaintiff’s claim; Plaintiff underwent an independent medical examination and Dr. L. filled out Attending Physician Statements on March 15, 2010 and August 17, 2010 to support Plaintiff’s claim.
Unum’s Denial Of Plaintiff’s Long-Term Disability Benefits
On October 13, 2010, behind its career medical consultant and its in-house physician, Unum denied Plaintiff’s claim for long-term disability benefits.
As part of the appeal process, Plaintiff willingly volunteered for an examination.
Plaintiff applied for Social Security Disability benefits on December 4, 2010.
Before Unum’s final denial of Plaintiff’s claim, Unum received many records from the Social Security Administration (SSA) regarding the interview questionnaire conducted with the Plaintiff. The SSA approved Plaintiff’s claim for benefits.
As part of Plaintiff’s appeal to Unum, many reports, records, and a custom designed questionnaire completed by Dr. L. were included to show that Plaintiff had constant pain that kept him from being able to work at any occupation.
Despite all of the records and evidence submitted, Unum did not review it and upheld its denial of the Plaintiff’s appeal on May 27, 2011.
In a letter dated September 16, 2011, Unum wrote another letter to counsel, stating that it did not review all records that were submitted, so it was reopening the Plaintiff’s appeal.
However, Unum never reversed its original denial of Plaintiff’s claim.
The lawsuit claims that Unum committed the following wrongs toward the plaintiff:
- Did not consider the evidence that was submitted in regards to the Plaintiff’s medical condition and its impact on his disability claim
- Relying on experts who had little expertise in the area that directly relates to the Plaintiff’s condition to base their decision to deny Plaintiff’s LTD claim
- Failing to pay long-term disability benefits that Plaintiff is entitled to under the terms of the Policy that Plaintiff is covered under by virtue of the premiums paid
Following Relief Sought By Plaintiff From The Unum Lawsuit
Unum’s actions have caused Plaintiff to request the following relief from this Court:
- To pay all benefits to Plaintiff as defined by the terms of the Policy
- To pay total disability benefits that are owed from the period of September 1, 2010 to the present, along with all pre-judgment interest
- To pay all past benefits as defined by the terms of the Policy, along with all pre-judgment interest
- That Unum will pay all future disability benefits as long as Plaintiff qualifies for benefits under the terms of the Policy
- All reasonable attorney’s fees
- All court costs
- All other relief that the Court rules to be fair and proper