On April 13, 2011, a Morgan Stanley employee and her California disability attorney filed a lawsuit against First UNUM Life Insurance Company for breach of the Employee Retirement Income Security Act of 1974(ERISA), after she was denied long term disability benefits.
On June 22, 2007, the claimant became disabled due to "a series of physical medical conditions, inter alia, a variant of Dejerine Roussy (Central Pain) Syndrome called central hypoperfusion syndrome, fibromyalgia, severe immunodeficiency, and server adrenal deficiency." Suffering from "chronic disabling pain of her right lower abdomen, whole body pain of muscles, joints and bones (including sensations of severe numbness and burning in her legs, face and neck, irritable bowel syndrome, dizziness and nausea, severe fatigue, severe migraine headaches, and chronic hormonal imbalances," the claimant takes powerful corticosteroids and other medications that cause side effects of cognitive difficulties, sleepiness, dizziness, fatigue and other symptoms that preclude her from performing her occupation as a Morgan Stanley Banking Associate.
Background of Banking Associate’s Disability Lawsuit against UNUM Life
Unable to perform "the substantial and material duties of her prior occupation as a Banking Associate," the claimant applied for long term disability benefits from UNUM, and was awarded those benefits on November 13, 2007. Approved for $5,000 per month in disability benefits, the claimant’s disability benefits were calculated incorrectly by taking into consideration only Sconiers’ base salary and failing "to calculate her basic monthly earnings as her HWEE defined as prior year annual gross W-2 earnings" as specified by the UNUM plan. In addition, without "conducting any reasonable or thorough investigation" and without having evidence supporting that the claimant’s condition had improved, UNUM terminated her disability benefits on March 24, 2010. The insurer asserted that the claimant "suffered from a mental condition" that had passed the disability plan’s 24-month limitation period and thus she "was no longer disabled under the terms of the Group Policy."
Disability Lawyer Goes to Battle for Claimant in California District Court
After filing several appeals to UNUM’s termination and miscalculation and being denied at every turn, the claimant and her disability attorney filed the subject lawsuit to obtain her entitled disability insurance benefits through litigation. Alleging that the insurer violated ERISA (the Employee Retirements Insurance Security Act of 1974), California law, and its fiduciary duty in respect to the management of her Stanley Morgan disability insurance plan, the claimant and her California disability attorney accuse the insurer of:
- Denying benefits based upon an incorrect interpretation of total disability as defined in the plan;
- Obtaining biased medical input constituting a conflict of interest;
- Miscalculating the disability benefits the insurer did pay to the claimant; and
- Improperly "interpreting disabling medical conditions as mental illnesses or psychological conditions."
The claimant and her disability attorney, in her complaint, ask the District Court to permanently enjoin UNUM from "ever again serving as a fiduciary with respect to the Plan," award the claimant attorney’s fees and costs, provide the claimant with appropriate equitable relief from UNUM and issue an order awarding the claimant the "full amount of benefits due since November 13, 2007," plus interest and "other losses resulting from UNUM’s breach."
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 lawyers have assisted thousands of long-term disability claimants with their claims against every major disability insurance company. To request a free legal consultation call 800-411-9085.