In Jeffrey D Vs. Unum Life Insurance Company of America, the Plaintiff, with the help of his Connecticut Disability Attorney, filed this lawsuit due to the wrongful denial of long term disability benefits as promised under theERISA welfare benefit Plan that is underwritten and insured by Unum.
History of Plaintiff
Plaintiff, who is 46 years old, worked as a machinist at two companies in Bristol, Connecticut for a total of 16 years. He then worked as an Electrical Discharge Machine Operator at EDAC Technologies Corporation (EDAC) in Farmington, Connecticut since 2000. His job required him to position and secure workpieces on a table using clamps; measure parts; manually input data into a computer; and regularly exert between 10 and 50 pounds of force with his hands to move objects.
Plaintiff suffers from gout, a form of severe arthritis characterized by joint pain, tenderness, and reduced mobility in the areas affected. These areas usually include the hands, wrists, feet, and ankles. wrists, feet, and ankles. This medical condition causes him consistent severe pain, occasional complete immobility, and a regular inability to use his hands, wrists, feet, and ankles for almost anything, including grasping, pushing, holding, walking, and standing. His dominant (right) hand and wrist are affected more than his non-dominant hand and wrist. Plaintiff first suffered from gout approximately 20 years, and it has worsened progressively over the years.
Due to the continuing deterioration of his gout, Plaintiff can no longer operate as a machinist or in any other occupation. This has been the case since late-September 2010. Plaintiff takes powerful prescription drugs to combat the consistent pain, but the serious side effects from these medications include lightheadedness, forgetfulness, nausea, and fatigue. These prevent him from driving a motor vehicle or operating other types of machinery and industrial equipment.
Plaintiff filed an application for benefits under EDAC’s Unum Plan in September 2010. He was to have received 60% of his "monthly earnings" until a maximum age of "Social Security Normal Retirement Age." According to the terms of the Plan, the Plaintiff satisfied the definition of being disabled both regarding his own occupation (first 24 months of benefit collection) and any other occupation (after 24 months of benefit collection).
Unum Denies Claim
On June 29, 2011, Unum denies Plaintiff’s benefit application due to the reason that the medical evidence did not support that his gout was disabling under the Plan’s definition; he did not satisfy the Plan’s requirement that he work 35 hours per week prior in order to qualify for benefits; and he held another part-time job that he did not disclose to Unum, which disqualified him from benefit collection.
Plaintiff filed an appeal on September 24, 2011 disputing these reasons, which Unum essentially admitted as being true and that it was mistaken in Plaintiff having a part-time job. Plaintiff added 68 pages of medical records, letters from his physicians, Unum’s internal claim evaluation notes, and seven sworn records to his appeal.
Plaintiff underwent wrist surgery in fall 2010. His surgeon said in June 2011 that he will have no use of his right hand and wrist, further strengthening Plaintiff’s claim that he is disabled under the terms of the Plan. A fusion procedure that is recommended for the Plaintiff would prevent him from undertaking any gainful employment that requires Plaintiff to use his right hand to any significant degree.
Plaintiff also demonstrated that he has done no work for his wife’s vending cart business. Plaintiff also showed that he briefly dropped under 35 hours of work per week due to gout flare-ups in his feet.
Despite showing all of this, Unum denied Plaintiff’s appeal on October 20, 2011 on the same reasons as its original denial. Due to exhausting all administrative remedies, Plaintiff has filed this lawsuit against Unum.
Reasonings Behind the Lawsuit
Plaintiff claims that Unum’s failure to pay these benefits was wrongful, arbitrary, capricious, and otherwise unlawful. Additionally, Unum also chose to disregard the opinion of its own claim reviewer nurse who stated that "it is unlikely that the insured will regain his premorbid level of" functional capacity.
Unum also never requested that Plaintiff undergo an independent medical examination or functional capacity evaluation so that it could attempt to determine the severity of his gout or its impact on his ability to work in his own job or others.
Plaintiff wants the following relief to be granted by this Court:
- Payment of all unpaid monthly disability payments
- All prejudgment interest
- Costs associated with filing this lawsuit
- All appropriate attorney’s fees
- Reinstatement of Plaintiff’s eligibility for continued disability benefit payments in the future
- All other relief deemed proper by this Court
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.