Whistle-blower lawsuit says insurer wrongly denied disability claims

A novel whistle-blower lawsuit filed in Los Angeles alleges that the United States’ largest disability insurer, UnumProvident Corp., withheld benefit payments to meet financial targets.

Former Unum “customer care specialist” Linda Nee claims that she was fired 18 months ago after bringing reports of wrongdoing to the attention of her supervisors. She is joined in the suit by California consumer advocate John Metz.

They are believed to be the first to sue an insurance company under a whistle-blower-type law in the state’s insurance code. Typically, insurance companies use the law to sue over fraudulent claims.

Although insurance companies have sued to recover money paid to fraud mills under the statute, “recently, cases started being brought against insurers,” said Gary Cohen, general counsel for the California Insurance Commissioner’s Office.

Nee’s suit alleges that Unum, a Chattanooga, Tenn.-based insurance conglomerate with a regional office in Glendale, Calif., engaged in a pattern of delaying, denying and terminating benefits regardless of the claims’ merits.

In order to meet monthly or quarterly financial targets, the suit alleges that Unum convened periodic “round table” claims review meetings with claims handlers, doctors, nurses and other consultants to improperly deny benefits. The suit also accuses the company of delaying claims determinations in order to manipulate the setting of reserves and statements of the insurer’s financial condition.

Unum had not yet been served with the suit, which was filed in July but not unsealed until Thursday in Los Angeles County Superior Court.

Company executives on Friday denied the allegations.