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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Bruce R. (Arizona)

Steve Dell has done an exceptional job with my disability application process. The firm is extremely well managed. They have acquired an incredible amount of experience over many years. I recommend them for disability insurance claims without reservation. 

Don (Florida)

I called this firm a few months ago completely disparaged due to a company cutting off disability benefits at a time that nearly caused me to lose everything.

Attorney Alex Palmera and Danielle worked hard to reach an amicable settlement and my case was settled a few months later. This is a good firm and the specific expertise in disability claims saved me countless hours of hassle at a time when an already fragile state existed.

Thank you Mr. Palamara and Danielle.

Sandra B. (Arkansas)

I have nothing but good things to say about how my buyout was handled with my disability claim. The level of professionalism was amazing. All of my questions and concerns were answered either by Danielle L. or Alex P. in such a timely manner and with such care I would recommend them in a heartbeat to anyone needing to approach their provider with buyout options.

They did a fantastic job communicating between the provider and me, always keeping my best interest at heart and always answering my many many questions. They really did take most of the stress out of this whole situation. I would give them a 10 out of 10 for every step of this crazy journey. Thank you so much for helping me through this.

Brenda R. (New York)

I needed assistance with an appeal for a LTD claim that was initially denied. Stephen understood what needed to happen to win the appeal and he did win the appeal for me.

Michael C. (Virginia)

Greg Dell and his assistant Anneli have been extremely responsive and helpful, not only our initial consultations, but in follow-ups 1 and 2 years later with the insurance company to ensure that they comply with their agreements (which they did), as well as a separate and only slightly-related inquiry about our health insurance. I always hear back from them very quickly, which is rare and greatly appreciated.

Jeff P. (Oklahoma)

After a very long and frustrating ordeal to keep my LTD payments coming I decided to seek assistance from and attorney. After much research and asking those in the legal profession Dell & Schaefer seemed to be the top choice. I reached out and Alex Palamara was the attorney assigned to my case. All I can say is the experience was outstanding. Both Alex and his Paralegal, Danielle Lauria were excellent to work with. They were very kind, concerned, understanding of my frustrations and treated me with the utmost respect. Communication was excellent with regular updates and telling me what I could expect in each stage of the process.

Alex was also very straight forward with what to expect and no pie in the sky promises or expectations were made. In the end we won our case and I believe it was solely due to their experience and knowledge of not only the laws but the insurance companies as a whole. I would highly recommend them and am very grateful for the help they afforded to me.

Chad B. (Illinois)

I originally spoke with 3 other long term disability lawyers about my case before contacting Dell and Schaefer. None of those law firms would take it. They said the chances of me winning was not good. After finding Dell and Schaefer online I spoke with one of the attorneys that has since left. He did take my case but later it was picked up by Rachel Alters. Rachel is amazing and a very intelligent attorney. She not only won my case but also was able to get my back pay for 6 months.

I also cannot say enough about Sonia Nogueira. Sonia was always quick to answer any of my questions. I would usually hear back from her within hours of sending her a email. I do not know where I would be if I hadn’t contacted them. My family and I cannot thank them enough. Don’t let an insurance company tell you they are not responsible for paying you. I paid them for 20 years monthly and they looked for any reason they could not to have to pay me when I needed my benefit. Thank you Rachel and Sonia for all you guys do.

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