California Federal Court Finds Man Disabled, Overturns Unum’s Decision that denied Long Term Disability Benefits

A former Assistant Sales Manager for HSBC was forced to leave work on May 14, 2008. This claimant suffered from constant low back pain due to spinal stenosis, disc bulges and protrusions, spondylosis at the L3-L4 and L4-L5 interspaces with T2 signal loss in the discs and disc space narrowing. The claimant described his constant pain like “the point of a bayonet into his back” that was “made worse by prolonged sitting, standing, or even a basic movement such as twisting…” Due to his pain, the claimant had tried several medications such as meloxicam, soma, oxazepran, Norco and hydrocodone.
This claimant was unique due to the fact that he was covered under two separate Unum long term disability policies. The first was a group disability insurance policy that he got through his employment at HSBC. He also had an individual policy that he purchased on his own separate from his employer’s policy.

Shortly after leaving work due to his conditions, the HSBC employee made a claim for long term disability benefits under both policies. While one policy was an ERISA governed policy and the other an individual policy, the definitions of disability (what it means to be disabled under the policies) were very similar in both policies. The ERISA group policy defined disability as follows “you are limited from performing the material and substantial duties of your regular occupation due to your sickness or injury…” The individual policy defined it as “a disability that renders you unable to perform with reasonably continuity the substantial and material acts necessary to pursue your usual occupation in the usual and customary way.”

While the definitions of disability were similar, Unum’s decisions under them were quite different. In fact, Unum approved the claim for disability benefits under the individual policy, but found the claimant was not disabled under the ERISA long term disability policy. This was done even in light of the fact that Unum had the same information for both claims. The portion of Unum that handled the individual policy found that his medical documentation was sufficient to find him disabled. Unfortunately, the portion of Unum that handles ERISA long term disability claims found the same information to be insufficient.

After filing administrative appeals challenging Unum’s decision that were also denied, an ERISA disability lawsuit was filed in the Northern District of California. In its decision on the case, the Court noted that there was substantial evidence in the record to support the limitations imposed by several doctors including an independent medical evaluator hired by Unum. Each of these doctors restricted the claimant from walking, sitting or standing continuously for no more than 30 minutes at a time. The Court found that this was sufficient to preclude him from performing his occupation. The Court also discounted surveillance conducted by Unum that showed him “driving a couple of hours to a cat show and showing cats during the day.” The Court noted that this surveillance did not cause Unum’s independent medical evaluator to alter his findings that the claimant was limited to semi-sedentary work.

Accordingly, the Court found the HSBC employee disabled under the terms of the ERISA Long Term Disability Policy and awarded him benefits.

If you have been denied benefits by Unum or any other disability insurance company, please do not delay and please contact Attorneys Dell and Schaefer for a free consultation and review of your claim.

Read more information about Unum disability claims on this page.

DISABILITY INSURANCE COMPANY INFORMATION
Videos, Questions, Resolved Cases, Lawsuit Summaries & Company Reviews

disability insurance companies complaints

Leave a comment or ask us a question

FAQ

Do you help Unum claimants nationwide?

We represent Unum 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 Unum disability insurance policy?

Our disability insurance lawyers help policy holders seeking short or long term disability insurance benefits from Unum. 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 Unum.

How do you help Unum claimants?

Our lawyers help individuals that have either purchased a Unum 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 Unum:

  • 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.

Reviews   *****

Michael K.

I contacted Dell & Schaefer after my disability claim from MetLife was denied. After researching other people’s experience with MetLife disability, I realized I needed professional help if I was going to win my claim. I contacted Dell & Schaefer and have been dealing with Cesar Gavidia. Cesar is a dedicated professional with vast experience in dealing with MetLife. He is an expert at navigating the minefields and roadblocks that MetLife uses to deny claims.

Read 424 reviews

Speak With An Attorney Now

Request a free legal consultation: Call 800-682-8331 or Email Us