Unum disability attorneys Marc Whitehead & Associates sometimes have to file suit in federal court on behalf of Unum insurance holders who were unfairly denied their benefits.
Millions of workers in the U.S. have bought individual and group disability policies from Unum, one of the largest insurance companies in the world. The plans promise great benefits. However, when one of these workers becomes unable to work due to illness or injury they often encounter difficulties in obtaining these benefits. Big insurance companies like Unum, Cigna, Aetna, Prudential and others often write their policies so to take full advantage of rules and regulations to make it difficult for a disabled person to get receive benefits or to keep them for the entire length of the term of their insurance policy.
Our Client
Marc Whitehead & Associates recently represented a 59-year-old worker living in Bowling Green, Kentucky, who became severely disabled while covered under a long term disability insurance policy issued and administered by Unum Life.
Our client, formerly employed as a registered nurse at the Bowling Green Medical Center, became disabled due to degenerative disc disease of the lumbar spine, lumbosacral radiculopathy, and spondylosis, limited range of motion and chronic pain as well as cognitive dysfunction as a side effect of pain medication. These impairments and their symptoms preclude our client from performing any type of work activities on a consistent basis.
Despite the overwhelming evidence to support our client’s inability to work, Unum denied our client’s claim for disability insurance benefits.
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Unum Denial despite Social Security Administration Ruling
We were shocked to discover that Unum had made the decision to deny our client’s claim for disability insurance benefits, even though they were fully aware of the fact that the Social Security Administration had issued a fully favorable decision on our client’s claim for social security disability benefits under Title II and Title XVI of the Social Security Act, finding that he was “disabled” during the relevant time period.
Completely ignoring the findings of the Social Security Administration, Unum notified our client on January 14, 2009, that they were sticking with their original decision to deny his claim for long term disability benefits.
A few months later Unum informed our client that he had exhausted all administrative remedies and that the company would consider no further claims or evidence. Unum, in its final denial, discounted the opinions of our client’s treating physicians, among others, and the documented limitations from which our client suffers including the effects of his impairments on his ability to engage in work activities.
Left with no further options, our client filed a lawsuit in Federal Court to obtain the disability benefits rightfully owed to him.
Our Client’s Rights under ERISA
This claim was governed under federal ERISA law. A claimant challenging a disability denial under an ERISA governed plan or policy must bring the claim pursuant to ERISA regulations and procedures.
ERISA stands for the Employee Retirement Income Security Act of 1974. It’s a federal law that regulates the handling of Employee Benefit Plans and the remedies of the beneficiaries of these Plans. It applies to all employee benefit plans established or maintained by an employer engaged in commerce or by an employee organization representing employees engaged in commerce. Practically all long term disability plans offered by a private employer are governed by ERISA.
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Venue and Jurisdiction of Long Term Disability Lawsuit
- Suit was filed in federal court in the Western District of Kentucky pursuant to 28 U.S.C. § 1331 (“The district courts shall have original jurisdiction of all civil actions arising under the Constitution, laws, or treaties of the United States”) to our client’s rights under the ERISA, as allowed by:
- 29 U.S.C. §§ 1132 (“A civil action may be brought… by a participant or beneficiary to recover benefits due to him under the terms of his plan, to enforce his rights under the terms of the plan, or to clarify his rights to future benefits under the terms of the plan”),
- 29 U.S.C. §§ 1133 (“Every employee benefit plan shall…afford a reasonable opportunity to any participant whose claim for benefits has been denied for a full and fair review by the appropriate named fiduciary of the decision denying the claim”), and
- 29 U.S.C. §§ 1140 (“It shall be unlawful for any person to discharge, fine, suspend, expel, discipline, or discriminate against a participant or beneficiary for exercising any right to which he is entitled under the provisions of an employee benefit plan”).
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Don’t Wait Until It’s Too Late to Get Help With Your Unum Appeal
Long term disability insurance claims are governed by a complex set of laws and procedures. These laws are full of traps for the unwary, even attorneys not experienced in ERISA law. Don’t make the mistake of thinking you can handle the insurance company’s administrative appeal process all by yourself and then hire a lawyer as a “last resort” if you lose and have to file a lawsuit. This is totally backwards thinking that could cost you the benefits you deserve.
We had a client come to us with such a claim. He said, “Don’t worry about the administrative appeal, I filed it myself. I just need you to file my lawsuit.” It turns out he filed a one page letter asking the insurance company to reconsider because he “really was disabled.” He was astonished to learn that this one page letter was the only evidence the judge could consider in his case other than what the insurance company chose to include when they denied him. In other words, he had blown any chance to present his case in court. Don’t let this happen to you. Contact the Unum claim denial attorneys at disabilitydenials.com before you file an appeal.
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