In Hoang N VS Unum Life Insurance Company of America and Northrop Grumman Long Term Disability Plan, Plaintiff wants reinstatement of long term disability payments that were originally paid, then terminated, by Unum.
The Plaintiff, with the help of his California Disability Attorney, has filed this lawsuit in the United States District Court Central District of California against Unum.
Plaintiff’s History and Reasons For Filing a Claim
Plaintiff worked as a systems administrator and network engineer at Northrop Grumman. His employment entitled him to be a participant in the Long Term Disability plan and other employee benefit plans that were established and maintained by Northrop Grumman.
Plaintiff suffered serious injury to his cervical spine when a heavy metal door fell on his head at work and knocked him to the ground unconscious. This accident caused the Plaintiff to become disabled as defined under the terms of the LTD Plan. Plaintiff filed a claim with the Defendants for LTD benefits under terms of the Plan. The Defendants originally approved the claim for LTD benefits.
Unum and Northrop Grumman Improperly Terminate Long Term Disability Benefits
On or about November 4, 2008, Defendants abruptly terminate the LTD benefits received by the Plaintiff. From the period of November 2008 through June 2009. Plaintiff’s doctor reports that the Plaintiff was suffering from the following conditions:
- Dysphoric mood
- Excessive worrying
- Insomnia
- Confusion
- Irritability
- Lack of appetite
- Intermittent suicidal ideation
- Social isolation
- Paranoia
Plaintiff filed an appeal of Defendants’ denial on June 12, 2009. Unum replied to Plaintiff on June 15, 2009 that they could not review Plaintiff’s claim because the appeal came after the 180-day deadline, meaning that the original decision on the claim must stand.
After Plaintiff received a Social Security Administration decision in his favor, Plaintiff again requested that Defendants reinstate his long term disability benefits on April 25, 2011. Once again, on May 2, 2011, Defendants deny Plaintiff’s request.
Due to the fact that Plaintiff has exhausted all administrative remedies required under ERISA, Plaintiff has filed this lawsuit against Unum and Northrop Grumman.
Basis for Plaintiff’s Lawsuit
Plaintiff claims that Defendants failed to allow Plaintiff to file an administrative appeal against California’s notice-prejudice rule, which only prevents a person from filing an administrative appeal after a deadline if the Defendants are actually and substantially prejudiced by the delay. Plaintiff also claims that Defendants prevented Plaintiff from filing an administrative appeal when Defendants knew that the Plaintiff was suffering from severe cognitive problems.
Plaintiff also claims that Defendants did not provide any reasonable explanation of why Plaintiff’s appeal was not considered, nor why his original claim was denied. Defendants also did not provide any explanation of what materials could have been added to increase the chances of a successful claim.
Plaintiff also claims that Defendants failed to adequately inform the Plaintiff of notice requirements under ERISA. Additionally, Defendants failed to properly investigate the merits of the Plaintiff’s claim.
Type of Relief Requested from the Court
Plaintiff requests that the Court grant the following relief:
- Plaintiff is able to file an administrative appeal of the denial of his original claim
- The administrative appeal will be given full and fair consideration
- All associated costs are paid
- All appropriate attorney fees are paid
- All other relief decided upon by the Court is fulfilled
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.