Disability Benefit Claims Law Blog : Disability Benefits Lawyer & Attorney : Dell & Schaefer : Disability Insurance Claims Law Blog

A Michigan disability attorney, on behalf of a disabled Michigan client, filed a lawsuit against the Unum Life Insurance Company of America (UNUM) at the District Court for the Western District of Michigan. In Kristina M. Arbelius V Unum Group D/B/A Unum Life Insurance Company of America, the plaintiff Kristina M. Arbelius alleged that UNUM committed a breach of a disability insurance policy that the plaintiff participated in.

The Statement of Facts in the Lawsuit

The plaintiff Kristina M. Arbelius was formerly a pacemaker technician working for the Marquette General Hospital. And as an employee of the Marquette General Hospital, she was covered by a disability insurance policy that was issued by UNUM. Under the disability insurance policy, the plaintiff was to be paid monthly long term disability (LTD) benefits in the event that the plaintiff was prevented from doing her job due to an injury or a sickness.

On September 18th 2007, as a result of pain associated with fibromyalgia and behavioral health symptoms, the plaintiff stopped working. The plaintiff, at the time of stopping her employment, was also suffering from diarrhea, fatigue, nausea and vomiting. As a result, the plaintiff was approved for LTD benefits on December 17th 2007. The plaintiff was also informed that she was subjected to a 24 month mental and nervous limitation.

On March 4th 2010, the plaintiff was sent for an independent medical examination conducted by UNUM's hand-picked physician. Subsequently after the medical examination, the plaintiff's LTD benefits were terminated by UNUM on June 15th 2010. According to the lawsuit, the discontinuation of LTD benefits was despite the fact that the plaintiff was having physical conditions and limitations confirmed by her treating physicians which rendered her unable to perform any type of employment. In support of the plaintiff's argument, the Social Security Administration had also classified the plaintiff as being disabled with physical limitations and restrictions which are permanent and prevented her for from ever working again in any capacity.

As such, the plaintiff alleged that as a result of UNUM's unlawful action, UNUM had:

• Breached the terms of the disability policy
• Acted in Bad Faith

The plaintiff further alleged that UNUM had caused her to suffer damages in the form of disability benefits not paid but should have been paid by UNUM under the terms of the policy in addition to the interest on that amount.

Relief Sought By the Plaintiff

Because of UNUM's action, the plaintiff is seeking from the Court the following relief:

• For an amount of money which will fully compensate her for losses sustained;
• For costs, disbursements, and attorney fees;
• For such other and further relief as the court deems just and equitable;
• For an award of punitive damages;
• For a determination outlining her future rights under the terms and conditions of the disability policy from Unum Group, d/b/a Unum Life Insurance Company of America.

In addition to the above mentioned relief sought, the plaintiff is also demanding a trial by a twelve person jury.  

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Many long-term disability cases revolve around the issue of what constitutes the ability or inability to work in any gainful employment for which you “are reasonably fitted by education, training or experience.” The following case is another example.

In July of 2001, Linda Gardner stopped working as an operating room nurse. She had been diagnosed with avascular necrosis (AVN) in both of her knees, explaining the severe pain she had been suffering from. One of the symptoms of AV is its progressive nature. Temporary or permanent loss of blood supply to affected bones destroys the bone tissue and causes collapse. The resulting pain in an affected joint can limit movement severely.

→ Click here to continue reading Appellat Court Reverses Unum's Denial Of Disability Benefits To A Registered Nurse ("RN") And Trial Court Victory

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An opinion issued by the United States District Court for the Middle District of Pennsylvania in November 2009 highlights the challenges an attorney faces when a complaint for denial of disability insurance benefits involves parties from different jurisdictions. An attorney must be very knowledgeable regarding insurance contract law in their state, because the laws of the state in which the contract is signed are the laws that will apply unless preempted by ERISA.

The case we are going to consider involves Edward J. Zaloga, a doctor of osteopathy. He filed his complaint originally in the Court of Common Pleas for Lackawanna County, Penn. in December 24, 2008. Because the claim exceeded the value of $75,000 and neither Provident Life & Accident Insurance Company (Provident Life) nor Unum Group (Unum) had corporate offices in Pennsylvania, jurisdiction over the case resided with the U.S. District Court.

→ Click here to continue reading Unum's Attempts To Dismiss A Physician's Bad Faith Disability Lawsuit Are Denied By Pennsylvania Federal Court

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In a federal court in Peoria, Illinois, a jury ruled against Unum Company (NYSE: UNM)and awarded more than $300,000 in disability insurance benefits the insurer withheld from a general surgeon it had claimed was capable of conducting major surgeries, despite the surgeon’s difficulty standing for more than one hour at a time.

The eight-person jury, which included an employee from State Farm Insurance, headquartered nearby, ruled that Dr. Yogihn Parikh, who was a general surgeon at Hammond Henry Hospital in Genesco Il, was partially disabled, and as such was entitled to long-term disability benefits Unum had withheld under the disability insurance policy that Parikh purchased from them.

→ Click here to continue reading A General Surgeon And His Legal Team At Attorneys Dell & Schaefer Win Disability Insurance Jury Trial Against Unum

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Individuals who pay for disability insurance premiums hope to be able to rely on the disability benefits if they are ever unable to work for any extended period of time. However, many times these employees’ claims are denied without any reasonable basis for denial. As in the case below, it is often abusive claims handling tactics by disability insurance companies that leads to disabled individuals being denied their benefits and forced to try and support their families in any way that they can.

→ Click here to continue reading New York Federal Court Exposes Unum's Disability Claims Handling Tactics

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Our client, an ophthalmological surgeon, was diagnosed with bi-lateral carpal tunnel syndrome following a traumatic accident. The client attempted to continue working for a few months following her injury in hopes that her hand numbness and pain would stop. While the pain stopped, the lost of sensation in her fingers remained. The client was forced to stop performing all eye surgeries a few months after her injury, but she continued her practice in a non-surgical capacity.

→ Click here to continue reading Attorneys Dell & Schaefer Resolve Lawsuit Against Unum On Behalf Of Ophthalmologist Suffering From Bi-Lateral Carpal Tunnel Syndrome

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Our client, a general surgeon for 25 years, was forced to stop performing surgery due to chronic degenerative cervical disc disease. Fortunately, our client had purchased a long-term disability policy from Paul Revere Insurance Company (acquired by Unum), during the early years of his career. The Unum long-term disability policy provides a monthly disability benefit in excess of $12,000 in the event our client is unable to perform the substantial and material duties of his occupation.

→ Click here to continue reading A General Surgeon With Cervical Degenrative Disc Disease Is Approved For Disability Benefits By Unum

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Our client was a successful, experienced financial advisor who operated her own practice. In December of 2008, while stopped at a red light, her car was hit from behind by a cement mixer. As a result of the accident she sustained multiple herniated disks in her neck, and pain that radiated into her shoulders and down her arms. Despite her efforts to continue working following the auto accident, she was unable to do so. No longer able to advise her clients as to important financial decisions affecting their futures, she was left with little choice but to apply for long term disability benefits under her individual disability policy purchased from Unum. In April of 2009 she contacted Dell and Schaefer to assist with her application for long-term disability benefits. Despite our client contacting us in April of 2009 and her continued attempts to work, we were able to prove that her date of disability should be the same as the date of her accident.

→ Click here to continue reading A Financial Advisor Diagnosed With Multiple Cervical Herniations Is Approved For Long-Term Disability Benefits By Unum

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Our client, a trial attorney representing parents and children in dependency, delinquency, and guardianship cases contacted Attorneys Dell & Schaefer to see if she would be eligible for long-term disability benefits under her individual disability income and business overhead expense policies purchased from Unum. Upon consultation with attorney Robert Kerr, the client retained the law firm of Attorneys Dell & Schaefer to assist with the filing of her application for disability benefits under both types of policies based on paresthesias in her hands and feet. Additionally, her diabetic neuropathy was causing increased difficulty with walking, numbness and tingling in her feet and hands, and intense pain when sitting, standing, and walking.

→ Click here to continue reading A Trial Attorney Suffering From Diabetic Neuropathy Is Approved For Long-Term Disability Benefits

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During the week of July 13, 2009, Attorney Gregory Dell spent several days in Portland, Oregon deposing multiple employees of The Standard Disability Insurance Company. Prior to taking the depositions, The Standard refused to make their employees available for deposition and instructed their attorney to file a motion preventing Attorney Gregory Dell from taking the depositions. The court received multiple motions and entered an opinion stating that our client has the right to take the depositions and The Standard must produce their witnesses. The Standard’s motion for attorney fees against our client was denied. It is obvious that the Standard did not want their claims handling practices exposed through deposition testimony.

→ Click here to continue reading Attorneys Dell & Schaefer Win Motion Against The Standard Disability Insurance Company

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The Second Circuit U.S. Court of Appeals has denied First Unum Life Insurance Co.'s request to reconsider a decision in which it found the company arbitrarily denied long-term disability benefits to a tax attorney with colon cancer.  First Unum, a unit of Unum Group (NYSE: UNM), filed the petition for rehearing with the New York-based federal appeals court in January, saying that the court "misapprehended key facts and law" (BestWire, Jan. 9, 2009).

Attempts to speak with Unum Group to see if First Unum plans to appeal to the U.S. Supreme Court were not immediately successful.  According to the December 2008 decision, written by Circuit Judge John M. Walker Jr. for a three-judge panel, First Unum operated under a conflict of interest because it was both the claims administrator and payor of benefits.

→ Click here to continue reading Unum Provident's Appeal of Long Term Disability Benefits Awarded to a New York Tax Attorney Is Denied

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To hear company officials tell it Unum is emphatically on the mend, this after the disability insurer was wracked by scandal and losses earlier in the decade.

In 2005, Unum reached a costly settlement with attorneys general in 49 states over allegations of unfairly terminating or denying coverage to disabled clients. That was after a 60 Minutes exposé pilloried the company.

Its other big problem was in the profit department, the result of horribly underpricing policies sold to doctors, lawyers and other professionals. Those policies are now in "run-off" mode, with beefed-up reserves for claims, meaning they can die a slow but less costly death.

→ Click here to continue reading What Is The Financial Future Of Unum?

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Feb 3, 2009 - Unum Group said on Tuesday that net income fell sharply in the fourth quarter, hurt by investment losses, but operating earnings beat Wall Street expectations by a penny.

→ Click here to continue reading Unum Profit Falls in 4th Quarter Due to $167.6 Million in Investment Losses

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Our client, a chiropractor, fractured his arm and tore his rotator cuff as a result of a skiing accident in March 2008. Despite his injuries our client attempted to return to full-time chiropractic performing manual spinal adjustments. His treating physicians advised him that he should cut back on the number of patients he was treating pre-accident and see if he can handle a limited patient load. This client came to Dell & Schaefer for guidance and help in filing his disability claim.

→ Click here to continue reading National Life (UNUM) Agrees To Pay Long-Term Disability Benefits To A Chiropractor Following A Skiing Accident

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A federal jury in Boston found that Unum, the nation’s largest disability insurer, had committed fraud in some cases by requiring customers to apply for Social Security benefits even though it knew they were not eligible.

But the verdict, based on a sample of six claims, contained enough ambiguity to leave both sides declaring victory in the case, filed on behalf of the Social Security Administration. In a verdict returned Wednesday, the jury found that two of the disability claims had been fraudulent and two others had showed no evidence of fraud. The jury was unable to reach a decision on the other two cases.

→ Click here to continue reading Unum Found Guilty Of Social Security Disability Fraud By A Federal Jury

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Our client, a window coverings salesman, began developing significant vision loss in November 2006 and approached Attorneys Dell & Schaefer for assistance in applying for long-term disability benefits with Unum. His policies stated that he would be entitled to benefits for the rest of his life if he were totally disabled prior to his 65^th birthday or if he qualified as totally disabled under the “Presumptive Total Disability” provisions of his polices. The policy defined total disability as “inability to perform the substantial and material duties of your occupation.” Through the efforts of Attorneys Dell & Schaefer, our client will now receive total disability benefits for the rest of his life.

→ Click here to continue reading Unum Challenges The Long Term Disability Claim Of A Blind Salesman

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Pamela A. Ray, an attorney, was insured under a UNUM disability policy. A Denver trial court ruled recently ruled in her favor that working in a large office building was a material duty of a disability claimant’s occupation as an attorney specializing in major real estate, oil and gas and mining transactions. The court determined that UNUM Life insurance Company of America’s denial of benefits was arbitrary and capricious.

→ Click here to continue reading Unum Ordered to Pay Disability Benefits to Attorney Suffering From Sick Building Syndrome

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Larry Mack claimed that he is totally disabled from his occupation as a marriage and family therapist due to diabetes. He sued his disability insurer, Unum Life Insurance Company, after being denied his claim for long-term disability benefits. Unum argued that Mr. Mack is not entitled to long-term benefits because he did not receive “appropriate care” as required by his policy. Mr. Mack admitted to not seeking help from his internal medicine doctor for long periods of time but argued that during these months he was “self-treating” his diabetes by taking Glucophage daily and by monitoring his diet.

The court said such “self-treatment” does not meet the policy requirement that the claimant be under medical treatment in order to receive benefits. The court reasoned that Mr. Mack failed to abide by the standard of care his internal medicine doctor prescribed for diabetic patients, U.S. Judge Linnea R. Johnson granted partial summary judgment to Unum.

Larry B. Mack v. Unum Life Insurance Company of America, No. 06-80308, S.D. Fla.; 2007 U.S. Dist.

About the author: Gregory Michael Dell is an attorney and managing partner of the disability income division of Attorneys Dell & Schaefer. Mr. Dell and his team of disability attorneys have assisted thousands of long-term disability claimants with their claims against every major disability insurance company. Attorney Gregory Dell is a nationally recognized disability attorney and the author of a long-term disability insurance law book published by Thomson Reuters, which is a legal reference for attorneys and judges. For a free consultation, please call 800-828-7583 or use our contact page.

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Nancy Mikrut, a pediatric nurse practitioner for Danbury Health Systems, was insured under the company’s group disability plan administered by Unum Life Insurance Company of America. In 1999, Ms. Mikrut was injured in an automobile accident and was unable to return to work due to severe back pain. In January 2000, Ms. Mikrut was diagnosed with spinal stenosis and filed for long-term disability benefits. After an intradiscal electrothermal therapy, Ms. Mikrut has a second surgery in March 2001.

After 24 months of benefits, Unum re-evaluated Ms. Mikrut’s claim. Without meeting her, a Unum medical consultant found Ms. Mikrut capable of full-time sedentary work. In August 2002, Ms. Mikrut’s treating physician told Unum that she was disabled from any occupation in which she had to bend, lift, pull, sit, or stand for periods of time. Unum terminated Ms. Mikrut’s benefits and she filed suit, seeking benefits under the Employee Retirement Income Security Act.

U.S. Judge Stefan R. Underhill of the District of Connecticut found that Unum failed to account for subjective complaints of pain and the treating physician’s opinions before terminating Ms. Mikrut’s benefits. The judge ruled that Unum did not adequately consider an award of benefits by the Social Security Administration. Judge Underhill held that Ms. Mikrut is eligible for continued long-term disability benefits under the plan since she is unable to perform the duties of any gainful occupation. While Unum is not required to credit treating physician’s opinion over other evidence, Judge Underhill stated that Unum cannot “arbitrarily refuse to credit a claimant’s reliable evidence, including the opinions of treating physicians.”

Nancy P. Mikrut v. Unum Life Insurance Company of America, No. 3:03cv1714, D. Conn.; 2006 U.S. Dist.

About the author: Gregory Michael Dell is an attorney and managing partner of the disability income division of Attorneys Dell & Schaefer. Mr. Dell and his team of disability attorneys have assisted thousands of long-term disability claimants with their claims against every major disability insurance company. Attorney Gregory Dell is a nationally recognized disability attorney and the author of a long-term disability insurance law book published by Thomson Reuters, which is a legal reference for attorneys and judges. For a free consultation, please call 800-828-7583 or use our contact page.

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