Our client, a General Contractor who owned his own dry wall installation business, had a long term disability insurance policy he had purchased from Unum in 1988. Like so many professionals, our client never imagined, expected, or wanted to find himself in a position where he would have to rely on long term disability benefits. He simply paid the premiums each month and focused his attention on making his business grow.
In January of 2007, our client was involved in a motor vehicle accident that resulted in herniations at the C6-C7 and C7-T1 levels, as well as left neuroforaminal narrowing at the C6-C7 level. These injuries prevented our client from performing the material and substantial duties of his occupation and he decided to file for long-term disability income benefits. In March 2007, attorneys at Dell and Schaefer were able to secure long term disability income benefits for our client; however UNUM paid monthly disability benefits under a reservation of rights. The reservation of rights means Unum would agree to pay monthly disability benefits, but by doing so they were not acknowledging that our client was disabled under the terms and conditions of the policy. Dell and Schaefer continued fighting on behalf of our client to ensure Unum would adhere to their obligation to pay our clients disability benefits under the terms of the policy.
After a year of fighting with Unum on behalf of our client, Unum finally removed the reservation of rights and acknowledged that our client was totally disabled due to his inability to perform the material and substantial duties of his occupation as a drywall contractor. Despite the objective findings contained in the medical records that clearly established our client was totally disabled, Unum insisted on receiving monthly claim forms from our client and his treating physicians. Unum continually attempted to find a way to justify terminating our client’s benefits. In July of 2008, Unum sent our client to an Independent Medical Examination (IME) to determine the level of our client’s impairment. For several months after the IME, Dell and Schaefer continually requested a copy of the IME report. Unum would not cooperate, sending Dell and Schaefer on a “goose hunt” to locate a copy of the IME report. Finally, after constant pressure by Dell and Schaefer, Unum finally provided a copy of the IME report in November of 2008.
Upon receipt and review of the IME report, it was clear that Unum had to finally acknowledge what attorneys at Dell and Schaefer had been arguing all along: that our client was totally disabled from performing the material and substantial duties of his occupation. To try to bring an end to the constant barrage of requests and harassment to our client from Unum, attorney Gregory Dell contacted Unum to discuss a lump-sum buyout of our client’s long-term disability policy.
The buyout negotiation was challenging as our client’s policy had an own-occupation definition of total disability until age 55 and then changed to the inability to perform any gainful occupation. Unum had fought our client on the own occupation definition and it appeared inevitable that they would battle once again when the definition of disability changes. After extensive negotiations, Attorneys Dell & Schaefer was able to convince UNUM that our client would be disabled from any gainful occupation and secure a confidential lump-sum buyout that extended beyond the own-occupation period.