Unum / Provident / Paul Revere

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In Pamela Fleming v. Unum Life Insurance Company of America (Unum), Plaintiff, a litigation attorney, was in a car accident in 1994 and suffered serious injuries to her spine. She never fully recovered and by July 2005, she was only able to work four hours a day and eventually had to completely stop working.

In December 2005, Unum approved Plaintiff’s claim for LTD benefits. Through the years, she periodically submitted updated medical records and continued to receive benefits until September 26, 2016, when Unum informed her by letter that her benefits were terminated. Unum stated that it believed she was no longer disabled and could return to work. After exhausting her administrative remedies, Plaintiff filed this ERISA lawsuit.
Continue Reading Court Rules Unum Life Insurance Company Wrongfully Terminated LTD Benefits

In Kevin C. McCusker v. Unum Life Insurance Co. of America, Et al., Plaintiff found his wife dead in their house on February 10, 2016. The wife had been employed by Fidelity Bank where she was a participant in a group life and accidental death plan through Fidelity’s employee welfare benefit plan. Plaintiff was named as the beneficiary. Under the plan, “Unum is vested with discretionary authority to make benefit determinations…”
Continue Reading Court Remands to Unum for Review of Plaintiff’s Claim for Death Benefits

In David L. Rothman v. Unum Group, Unum Life Insurance Company of America (Unum), Plaintiff was a Certified Financial Planner who had worked for almost 30 years in a business owned by his father, Rothman Securities, when he developed a drug addiction. He was unable to perform the duties of his regular occupation and received disability benefits from October 12, 2012, until October 2015. On October 1, 2015, Unum terminated Plaintiff’s benefits. Plaintiff’s appeals were denied and he then filed this lawsuit against Unum for breach of contract and bad faith.

Background

In addition to his drug abuse problems, in March 2013, Plaintiff pled guilty to wire fraud and money laundering and was fired by Rothman Securities. In January 2014, he was sentenced to a 4-year prison sentence and in February that same year, his professional license was revoked due to his criminal conviction.
Continue Reading Court Rules in Favor of Unum and Finds Plaintiff Not Factually Disabled

Insurance companies are known for having delays. In this video Attorney Gregory Dell & Stephen Jessup discuss very specific facts surrounding the timeframe for which UNUMS’s extension was to begin and could be tolled in McFarland vs. First UNUM. Learn about the importance of providing all pertinent information during the ERISA administrative appeal process.

Collins v. Unum Life Insurance Company of America is a case with an unfortunate result for plaintiff Daniel Collins who fractured his ankle when he fell in the employee parking lot. Initially surgery was performed and various screws put in place to hold the tibia and fibula together and securing the medial malleolus. For about three months, he had no complaints and the fracture appeared to be healing appropriately.
Continue Reading Ohio Court Upholds Unum’s Denial of Accidental Dismemberment Benefits

UNUM insurance company seems to been firing up more denials and looking at people that have been on claim for a while. Most claimants think that if they have been on claim for a few years, then they should remain on claim until the policy ends. Unfortunately this is not true as Unum is constantly reviewing the claim of each person receiving benefits. We recently were contacted by a claimant that was denied benefits after 15 years and that is not unusual. In this video disability insurance lawyers Gregory Dell and Cesar Gavidia discuss Unum’s claim handling activities and some of the reasons that a long term disability insurance claim could be denied.

Can a Functional Capacity Evaluation be Useful to determine if a Claimant with Fibromyalgia is disabled?

It is very common for an insurance company to deny disability benefits to individuals suffering from Fibromyalgia. This happens more often than not due to the inability to provide the insurance company with objective proof of the disability, as none exists. There are no known objective tests for fibromyalgia at this point in time. Continue Reading Unum abused its discretion by disregarding results of a functional capacity evaluation (FCE) of a disabled registered nurse

In this recent case out of the Eastern District of Pennsylvania the court found that Unum had abused its discretion when it failed to consider whether the claimant could do the material and substantial duties of her regular occupation. The case answers a question posed by many claimants: Is the insurance company obligated to consider my job duties when evaluating my claim?
Continue Reading Unum was wrong for not considering the claimant’s job duties during its claim review

Disability Blog & Cases:
Boeing Employee Suffering From Severe Chronic Back Pain Sues Aetna For Denial Of ERISA Benefits

An Oregon disability lawyer has filed a lawsuit in the District Court of Oregon against The Boeing Company Employee Benefit Plan (Boeing) and Aetna Life Insurance Company (Aetna). The Plaintiff, Susan A, worked as an assistant to the Vice President and General Counsel of The Boeing Company. Due to her employment, Plaintiff was protected by Boeing’s Employee Benefit Plan.

Disability Blog & Cases:
Unum Disability Denial With Medical Record Review Only

Can Unum deny disability claims and appeals by merely conducting paper reviews of a claimant’s medical records? Yes, apparently they can.

Disability Blog & Cases:
Sedgwick And AT&T Disability Denial Scheme Exposed In ERISA Lawsuit

On May 14, 2012, the U.S. District Court for the Northern District of California issued an order on a very hot topic for ERISA Disability Lawsuits. The issue concerns how much “Discovery” a denied person is able to obtain from the Disability Insurance Company while litigating a case.

FAQ: Appeals & Lawsuits:
If my long term disability benefits are governed by ERISA and I win at trial, does the insurance company have to pay me for the remainder of the policy life, or a lump sum amount?

Should your case go to trial under an ERISA governed disability plan and you win the insured is only entitled to an award of disability benefits that have not been paid by the insurance company. This is further contingent on whether the insurance company denied your claim under the “own occupation” or “any occupation” definition of disability…

Disability Blog & Cases:
Aetna Is Sued For Failure To Pay ERISA Benefits To Boeing Employee For Injuries Sustained In A Shooting

A Washington disability lawyer filed a federal lawsuit in the District Court for the Western District of Washington, at Seattle, against Aetna Life Insurance Company (Aetna) and The Boeing Company Long Term Disability Plan (Boeing). The Plaintiff, Patrick D., worked as a real-time software engineer for Boeing, which contracted with Aetna to provide long-term disability coverage to its employees. The Plaintiff’s employment with Boeing afforded him the protections under this Plan.

Disability Blog & Cases:
Unum Sued By An Ophthalmologist And A BJC Healthcare Employee Who Both Were Denied Disability Benefits

Unum Life Insurance Company Of America (Unum) was sued in two different lawsuits filed in the Federal Courts of Missouri, by two plaintiffs who did not receive the long-term benefits that were entitled to them under the terms of their respective Plans that were issued and administered by Unum.

Disability Blog & Cases:
Misrepresentation By Claimant Results in Unum Disability Claim Denial

Unum disability claimants need to be aware that when filling out an application for disability insurance benefits it is necessary to disclose your medical history accurately and to make sure your insurance agent is doing the same. Should the insurance company discover a material misrepresentation, the policy could be rescinded, and the claimant could be required to pay back any and all benefits previously paid and then be subject to a fraud investigation…