A 53-year-old disabled attorney and her New York disability attorney filed a Federal lawsuit against the insurer UNUM on July 15, 2011 for collection of her disability benefits. A Toxic Tort Trial and Litigation Attorney and partner at a well-known firm, the claimant was forced to stop working due to her deteriorating medical condition in April 2009.
Diagnosed with Choruidal Osteoma, a benign boney tumor of the eye when she was 13, the claimant was diagnosed in 2006 with “Coroidal Neovascularization (‘CNV’),” which causes major visual loss. Experiencing frequent capillary hemorrhages in her eye, pain and worsening myopia, the claimant underwent “intravitreal Lucentis injections,” an injection method in which medication is injected directly into her eyeball for several weeks. Unfortunately, the procedure failed to improve her failing eyesight. Consequently on April 15, 2009, the claimant ceased working and applied for short-term disability benefits from UNUM.
The Claimant Qualifies for Short Term Disability Benefits under Her UNUM Policy
Qualifying for her short-term benefits, the claimant was awarded her short term disability benefits for a full 26 weeks. Being classified as totally disabled, the claimant applied for her long-term benefits per her firm’s group UNUM plan. Offering the claimant Vocational Rehabilitation Services, UNUM admitted that she “was incapable of performing her regular occupation.” And, according to her disability attorney, the offer of Vocational Rehabilitation Services in addition to the award of her short term disability benefits verified that the claimant was disabled per the terms of her UNUM disability plan. However, UNUM denied the claimant her long-term disability benefits in violation of the Employee Retirement Income Security Act of 1974 (ERISA) in a letter dated December 14, 2009. Appealing the denial, the claimant submitted additional medical documentation of her condition in an attempt to reach an amicable resolution and to avoid litigation.
UNUM Denies Claimant’s Disability Claim Appeal
UNUM proceeded to uphold its denial of the claimant’s disability claim, chose not to have her examined by a physician of the insurer’s choice, and chose to rely on paper reviews by out-of-state doctors instead. Failing to pay the claimant’s disability benefits, UNUM has “not honored its contractual obligations” to the claimant which has lead to her and her disability lawyer filing this subject lawsuit to attempt to force the insurer to uphold its obligation to the claimant and approve her disability claim. In the claim against UNUM, the claimant and her lawyer asked the District Court to enter judgment against UNUM for:
- A declaration that the claimant is disabled as defined by her Group Policy since April 16, 2009;
- Reinstatement of her monthly disability benefits from October 13, 2009 and continuing;
- The awarding of interest, costs, and disbursements of the subject litigation; and
- Other further relief as the “Court many deem just, proper and equitable in the circumstances.”