A general surgeon and his legal team at Dell & Schaefer win disability insurance jury trial against Unum

In a federal court in Peoria, Illinois, a jury ruled against Unum Company (NYSE: UNM) and client will receive $246,000 in unpaid disability insurance benefits the insurer withheld from a general surgeon it had claimed was capable of conducting major surgeries, despite the surgeon’s difficulty standing for more than one hour at a time.

The eight-person jury, which included an employee from State Farm Insurance, headquartered nearby, ruled that Dr. Yogihn Parikh, who was a general surgeon at Hammond Henry Hospital in Genesco Il, was partially disabled, and as such was entitled to long-term disability benefits Unum had withheld under the disability insurance policy that Parikh purchased from them.

The case stemmed from an October 2004 claim filed with Unum by Parikh, in which the doctor, who had performed a wide range of major surgical procedures like appendectomies, colon resections and mastectomies, said that lower back pain has precluded him from performing the procedures, and thus greatly reduced his earning potential as a general surgeon. Unum denied the claim in April 2005, citing insufficient medical evidence for the claim.

Subsequent to Unum’s decision, Dr Parikh performed minor and less time-consuming surgical procedures, but gradually lost the ability to perform any surgical procedures. Since November 2008, he has not performed surgery. In the year before he filed the claim, his income as a surgeon was more than $300,000; in 2008, it slid dramatically, to about $60,000.

After the ruling, Parikh’s legal representative, disability insurance attorney Gregory Dell, said that his legal team will be pursuing an Illinois bad faith claim to help Parikh obtain an additional damages award up to 60% of the verdict and attorney fees in excess of $250,000. Dr. Parikh’s trial team included attorneys Gregory Denes, Gregory Dell and Cesar Gavidia.

Unum had maintained that there is insufficient evidence to support Parikh’s claim for benefits, based on the opinion of one of its hired physicians, who after a 20-minute exam of Parikh opined that he had no restrictions and limitations and was capable of performing such procedures as appendectomies, gall bladder removal, colon resections, hernias, mastectomies and other abdominal surgeries.

“This is a victory for Dr. Parikh, who was unfairly denied the benefits which he had paid Unum to provide in the event he was no longer able to perform his job as a general surgeon. It is also a victory for thousands of disability claimants suffering from subjective complaints of pain and the insurance companies deny their claim,” said Dell.

Dell noted Parikh’s case is not unusual. It is one of a host of cases in which Unum’s practices for denying claims have been called into question. Unum has been fined millions dollars for its unreasonable and unlawful denial of disability claims. Earlier this year, a Nevada jury awarded $60 million to a man that sued Unum for a bad faith denial of long-term disability benefits.

“This verdict demonstrates that Unum continues to ignore the 2004 agreement it entered into with 48 states, in which its practices for denying claims without reasonable justification were called into question,” Dell said.  During trial, a Unum employee testified that one way she could verify Dr. Parikh’s back pain would be “if he had a knife in his back.” The same Unum employee testified that she did not know whether an appendectomy required a person’s skin to be cut.