Attorney claims disability due to back, leg and foot pain, receives disability benefits for three years until Unum terminates based on surveillance video, IMEs and an FCE. On appeal Unum reinstates benefits until notified by scorned boyfriend that she was committing fraud. Unum again terminates benefits claiming fraud and requests repayment for over $1 million in overpaid benefits.
In the Fifth Circuit case of Truitt v. Unum decided in September of 2103, an attorney received benefits from Unum for her inability to work in her occupation due to back, foot and leg pain. After receiving benefits for approximately three years her scorned boyfriend reported her to Unum for fraud providing Unum with over 600 pages of emails, photographs and documentation which indicated she was traveling frequently, dancing, litigating cases, shooting guns and fishing.
Unum terminated her claim after reviewing the evidence sent by her boyfriend, stating she was not disabled as she could clearly sit, stand for extended periods of time, and she clearly was capable of the continued practice of law. Truitt appealed Unum’s decision to terminate her claim stating that the emails were unreliable as her computer had been hacked by her disgruntled boyfriend, the information came from an unreliable source, Unum failed to properly investigate her claim, used an improper definition of her job description and cherry picked medical records during the review process.
Will Attorney be Ordered to pay Unum Back Over $1 Million in Benefits Unum Alleges She Fraudulently Received?
Unum upheld its decision to terminate her benefits and sought reimbursement of over $1 million in overpayments from Truitt. Truitt filed suit in Texas, where the district court found that Unum abused its discretion by basing its decision on unreliable emails and rejected Unum’s counterclaim for reimbursement of overpayments.
On appeal, a Fifth Circuit Judge held that (1) Unum had no duty to investigate the accuracy of the information it received from the scorned boyfriend; (2) Unum had no duty to consider the source of where the information was obtained and received no valid information from Truitt proving the emails were unreliable; (3) The emails and surveillance video demonstrated that she was able to performed the duties of her occupation as an attorney; (4) Unum did not arbitrarily or capriciously deny benefits to Truitt; and (5) The lower court’s holding that Truitt did not fraudulently obtain benefits and did not have to repay over $1 million was vacated and remanded for further proceedings. Unum will not be obligated to provide any further disability benefits to Truitt.
It remains to be determined whether Truitt will have to pay back the money she fraudulently received from Unum. It is important to note that once a claim is submitted to an insurance company for disability benefits, all information provided in support of the disability during the application process and thereafter must be accurate and truthful to the best of the claimant’s ability.
An insurance company will most certainly have a claimant followed with surveillance during the course of the claim and if they receive information from any source that the claimant was not truthful about their restrictions and limitations the claim will be denied and the claimant can be responsible for paying the insurance company back for benefits received and may also be prosecuted for committing insurance fraud. This is why it is very important to have representation by an experienced attorney at the inception of a disability claim so as to insure that a claim is not exaggerated or that misrepresentations are not made which may result in a similar catastrophic situation as described above.
If you are considering filing for disability benefits or your disability claim has been denied, then contact our disability insurance lawyers for a free consultation to discuss your potential claim.