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Anesthesiologist files lawsuit against Paul Revere Life Insurance Company alleging wrongful deduction of social security retirement benefits

On April 29, 2011, Dr. Phillip W. Watson and his disability attorney filed a lawsuit in the United States District Court Southern District of Florida as a last resort to settle Watson’s claim that in violation of ERISA, Title 29, United Stated Codes 1000-1461, Paul Revere Life Insurance Company arbitrarily decided to deduct part of his disability benefits payments when Watson applied for his early Social Security retirement benefits (SSR).

Dr. Phillip Watson, formerly an anesthesiologist, submitted his disability claim to his insurer Paul Revere Life Insurance Company in February of 2007. At the time, Dr. Watson was 63. Consequently, in August 2007, Watson began receiving $6,000.00 per month from his claim which was approved to be continued until February 24, 2013. Everything went as expected, with Watson receiving his monthly benefits from August 2007 until October 2009.

According to the Summary Plan Description (SPD) Paul Revere gave to Watson, he was eligible to file for early Social Security Retirement (SSR) benefits at age 62. So, Watson opted to receive his early SSR benefits and applied for them in July of 2009. Watson began receiving those SSR benefits in September 2009 in the amount of $1,720.00/month. Watson notified Paul Revere of his award of early SSR benefits immediately. Then, Watson received correspondence from Paul Revere, dated October 1, 2009, which stated that Paul Revere would be deducting money from his Paul Revere benefits payments and that Watson was to repay Paul Revere $3,591.23 in disability benefits to take care of the overpayment Watson had been receiving as a result of the combined Paul Revere disability benefits and the SSR. Watson, trying to be cooperative, honored the request under protest and handed over the $3,591.23.

Did Paul Revere Wrongfully Deducted Money From Watson’s Disability Benefits?

Watson then began a letter campaign, protesting Paul Revere’s deductions of the SSR amounts from his Paul Revere disability benefits and attempted to resolve the issue through administrative avenues, but was denied his requests. Once Watson exhausted his remedies for the deduction debate, he received a letter from the insurer, dated January 21, 201, denying his appeals.

According to Watson’s complaint, Watson had “at various times and for various reasons” requested that Paul Revere supply him with a copy of his policy since July 1, 1997. Each request was met with the provision to Watson of a copy of only the insurer’s SPD. On November 12, 2009, only after Watson had elected to take his early SSR benefits, did Paul Revere send him a copy of his policy. On receipt of the policy, Watson discovered that the SPD does not state that early SSR will result in a deduction of that amount from benefits, but the full policy does contradict that.

Watson’s Disability Attorney Claims Insurer is Guilty of ERISA Violations

Consequently, Watson’s lawsuit against Paul Revere charges the insurer with two counts of ERISA violations:

Count I – states that Paul Revere improperly deducted funds from Watson’s disability benefits and continues to do so; and asks for damages in an amount equal to Watson’s past due disability benefits that were improperly deducted along with attorney fees and any other relief the Court sees fit.

In light of the recent Supreme Court decision in Cigna v. Amara it will be difficult for the claimant to prevail. The claimant in this case appears to have relied on the summary plan description and not the actual plan documents. It will be unfair if the Plaintiff loses due to his reliance on incorrect documents that Unum sent him. The bottom line is that a claimant should always rely on the actual plan documents and not the SPD.

Count II – requests that Paul Revere be penalized for not adhering to ERISA’s requirements that employees should be provided with a full and complete copy of their insurance policy upon request. Watson asks that the insurer be penalized in the amount of $110.00/day beginning the day after Watson requested those documents in reference to his disability benefits claim (January 28, 2010) which amounts to $50,160.00. And, he seeks damages of an additional penalty calculated as the difference between “Watson’s February 2009 request for the Policy (when he was making a decision about taking his early SSR benefits and the actual production of the Policy on November 12, 2009, which is calculated to be $24,860.00. On this count, Watson also requests attorney fees, court costs, and any other penalties the Court sees fit.

The claimant may have a hard time prevailing on this Count if he did not send a request for the plan documents to his former employer. The disability company is usually not responsible for providing a copy of the plan documents. It is the responsibility of the Plan Sponsor, which is usually the employer. A request must be sent in writing to the correct party in order to enforce the $110 a day penalty.

Disability policies are often ambiguous and difficult to read. A claimant should consult with an attorney so that they don’t mistakes which could result in thousands of dollars in lost disability benefits.

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FAQ

Do you help Paul Revere claimants nationwide?

We represent Paul Revere clients nationwide and we encourage you to contact us for a FREE immediate phone consultation with one of our experienced disability insurance attorneys.

Can you help with a Paul Revere disability insurance policy?

Our disability insurance lawyers help policy holders seeking short or long term disability insurance benefits from Paul Revere. We have helped thousands of disability insurance claimants nationwide with monthly disability benefits. With more than 40 years of disability insurance experience we have helped individuals in almost every occupation and we are familiar with the disability income policies offered by Paul Revere.

How do you help Paul Revere claimants?

Our lawyers help individuals that have either purchased a Paul Revere long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer.

Our experienced lawyers can assist with Paul Revere:

  • ERISA and Non-ERISA Appeals of Disability Benefit Denials
  • ERISA and Non-ERISA Disability Benefit Lawsuits
  • Applying For Short or Long Term Disability Benefits
  • Daily Handling & Management of Your Disability Claim
  • Disability Insurance Lump-Sum Buyout or Settlement Negotiations

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

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