Big Law Employee Sues Unum Group for Denial of Benefits

June 22, 2018, 2:15PM. By Lori Prapas

Former Jones Day employee suffering from twelve health conditions claims that Unum denied her disability claim to meet its monthly denial target

Greeneville, TNOn May 14, 2018, Janet Mitchell, a former employee of the mega law firm Jones Day, filed a lawsuit against both Unum and Jones Day in a Tennessee Federal Court. Mitchell states that she suffers from a constellation of health conditions that prevent her from being able to work, including coronary artery disease, fibromyalgia, osteoarthritis, hypertension, and chronic obstructive pulmonary disease. She alleges that Unum denied her claim for long-term disability benefits even though several of her treating physicians provided Unum with medical reports supporting her claim. Yet Unum denied her claim without ever having one of its own physicians examine her. The lawsuit says the denial was issued in bad faith, in order for Unum Provident to meet its monthly target.

Unum (formerly known as Unum Provident and First Unum), has been fighting numerous lawsuits nationwide for bad faith denials of Unum life insurance and Unum disability insurance claims. This newly filed case, Mitchell v. Unum Life Insurance Co. of America, et al., is representative of the specific, recurring allegations against the insurance giant.

Double Denial: Unum Had a Hand in Denying Mitchell’s Short and Long-Term Disability Claims

The papers filed with the court do not state what Mitchell’s official title was with mega firm Jones Day, or how long she had worked there. With headquarters located in Cleveland, Ohio, Jones Day describes itself as a “legal institution with more than 2,500 lawyers on five continents.” It has 43 offices in 18 different countries. Mitchell worked in the firm’s Washington, D.C. offices. The law firm boasts billions of dollars in revenues, and represents numerous global business powerhouses including Goldman Sachs, Chevron, Starbucks, and Toyota. Yet when Mitchell could no longer work for the firm due to the combined effect of a dozen health conditions, she says her short-term disability benefits were prematurely terminated. Unum may have had a role in terminating coverage for these short-term benefits. After her short-term benefits were cut, she filed for long-term benefits under the Jones Day Insured Welfare Plan, which was overseen by Unum insurance. The insurance giant flat out denied her claim for long-term benefits.

Unum Disability Claims Denied Without an IME

Typically, when an insurance carrier or employer questions a person’s alleged health condition, they conduct an independent medical examination, or IME. An IME is when a health care provider who has not previously been involved in a patient’s treatment examines them and reports back to the insurance carrier or employer. According to Mitchell, Unum Group never even requested that she undergo an IME. Instead, it denied her claim based solely on a review of the papers provided by her own treating physicians—each of which supported her claim of a legitimate disability.

Unum Group is routinely accused of denying claims without conducting an IME. In some cases, Unum has been accused of using the opposite tactic—attempting to wear patients down by demanding they undergo one IME after another until they get a diagnosis that is in Unum’s interest. Unum is also known to deny claims for conditions like fibromyalgia where the symptoms are self-reported by a patient, and therefore difficult to verify.

Does Unum Have A Policy Encouraging the Denial of Legitimate Unum Disability Claims?

One of the most interesting allegations Mitchell makes is that Unum affirmatively sets monthly goals for denying legitimate claims. These monthly targets, called recovery plans, are allegedly established prior to the beginning of each month, and Unum agents are instructed to deny a number of legitimate claims just to meet those targets—as opposed to simply denying claims based on their lack of merit.

When purchasing an insurance disability policy, one creates a contract with the insurance carrier. In exchange for paying a premium, the insured is promised disability benefits in the event of an unexpected short or long-term disability, as provided by the policy. It is expected that these policies, developed by the insurance carrier, will likely be stacked in the carrier’s favor—with carve outs to deny many types of claims. But Unum has been targeted for years for a practice of denying claims that are legitimate under the policy as written.

Unum does not apply a universal definition of “disability” across all its policies. In some cases, depending on how a given policy defines disability, Unum may claim that an insured is not disabled because they could still work in some other occupation. This kind of disability insurance policy effectively holds no value to the insured. Unum has a never-ending supply of denial tactics, and Unum long-term disability insurance is routinely accused of questionable denial practices.