• Is Unum Denying More Disability Benefit Claims Than Usual?
  • Unum / Provident / Paul Revere Long & Short Term Disability Claims (Ep. 13)
  • Unum Disability Denial & Appeal Tips
  • Deposition of Insurance Co. Employee in a Disability Insurance Benefits Denial Lawsuit (Ep. 19)
  • Did Disability Insurance Claims Examiner Understand A Physician's Job Duties? (Ep. 22)
  • What relationship does UNUM have with hired doctors in disability insurance claims?
  • UNUM Lump Sum Settlement / Disability Lump Sum Buyout
  • 24 Month Self Reported Symptoms Limitation in Unum Disability Policy Case Study
  • Tips About a Unum Medical Examination in a Disability Benefit Claim

General surgeon files lawsuit against Provident Life and UNUM for disability benefits award

Having failed to uphold its obligation to provide disability benefits to one Provident Life and Accident/UNUM policyholder, the insurer now finds itself in litigation to solve the matter. A General Surgeon and his disability attorney filed a complaint on July 11, 2011 in an effort to pursue the disability benefits he is entitled to under his UNUM insurance plan.

Alleging damages for the non-payment of disability benefits, the physician and his disability lawyer have sought help from the United States District Court of the Middle District of Florida, Tampa Division. The pair have requested that the Court order UNUM to fulfill its obligations by paying the physician his entitled disability benefits, consequential damages, emotional distress damages, attorney’s fees, and other damages; and they demand a jury trial per Fed.R.Civ.P. § 38(b).

Doctor Seeks Disability Benefits from UNUM on Three Policies

The physician, a general surgeon since 1973 has three UNUM policies, each containing terms and conditions for the payment of disability benefits should he become disabled and unable to perform his job as a general surgeon. In the complaint, the physician and his lawyer explore the history of Provident Life, which is a subsidiary of UNUM, with both company’s duty-bound to fulfill all obligations under policies sold before and after their affiliation with one another. According to the history that the physician and his attorney show, they determined that “[d]uring the time from 1995 forward, defendants instituted a number of practices intended to manage claims on Provident individual disability insurance policies to avoid full payment of benefits due.” When Provident became a part of UNUM, the physician’s policy was and continues to be managed by that insurer, and according to the attorney, UNUM continues to try to avoid paying certain benefits to the physician as well as other similarly situated claimants.

Background of Doctor’s Disabling Condition

The physician was diagnosed with renal disease in January 2000 and filed a disability claim with his insurer, which claim was honored for his short-term disability payments. And, after moving to Florida in 2001, he returned to work on a part time basis as a gastroenterologist, but never returned to his general surgery practice. After being involved in a class action suit that attacked Provident and UNUM for an earlier litigation matter involving duplicity, the physician asked the insurer to reassess his claim in 2005 to retrieve his unpaid, entitled disability benefits. During the 2000 reassessment process, the physician’s claim for residual benefits was concealed and he only discovered this concealment when he ask UNUM to reassess his individual claim. The class action settlement agreement required the insurer to reassess claims in 48 states; among those claims was his. “Under the terms of the settlement agreement that led to the re-assessment, the claim by (the physician) was tolled until defendants denied it by letter dated July 10, 2006.” With an obligation to inform him of the state of his policy and the fact that residual benefits were a part of his plan, UMUM concealed this from the physician and misrepresented him his rights to pursue a residual benefits claim from 2000-2006 when he received a denial letter.

The physician had until June, 17, 2006 to pursue his claim, and he did, in fact, submit his claim for Residual Benefits before the June 17, 2006 deadline. The insurer did not ask for additional proof of loss. The physician provided his proof of loss within the 90-day period to do so, making that deadline of September 16, 2006. All was taken care of as far as he was aware of. Unfortunately for the physician, UNUM has refused to pay his entitled residual disability benefits that should have been paid from April 1, 2000 through June 14, 2006 in the amount of $3,950.00 per month for the 5-year and 2-month period plus appropriate inflation, AIB and interest adjustments, which has led to the filing of this complaint.

Allegations that UNUM Breached Its Contract to Pay Disability Benefits

In the compliant, the physician and his disability attorney allege that UNUM breached its contract with the doctor. They ask that the District Court declare that the physician “submitted adequate proof of income loss” and deserves “relief to establish coverage under the Residual Benefits clause” of his policy. And, they allege that UNUM breached its implied covenant of good faith with the doctor. Consequently, they ask for policy relief, damages, attorney’s fees and other damages, and that the case be heard by a jury.

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Questions About Hiring Us

Do you help Provident claimants nationwide?

We represent Provident 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 Provident disability insurance policy?

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

How do you help Provident claimants?

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

  • 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.

Dell & Schaefer Client Reviews   *****

Mary R.

I first started working with Dell & Schaefer after two failed back surgeries forced me to stop working. I was the major breadwinner of our family and had a very generous compensation package that included long term disability. I was certainly glad to know that I had the long term disability policy to help us during this major change in my family’s life. I was surprised to learn that long term disability means something very different to the insurance company (MetLife) who held my policy. They wanted to place an 18 month restriction on pay out and wash their hands of me. Hardly “long term”.

I hired Dell & Schaefer to fight for me and that they did. They were well schooled in the tactics of insurance companies and they expertly navigated the many barricades the insurance company placed in front of me. They were extremely knowledgeable in all areas of the law and quickly identified a course of action. They were fair and sensitive with my personal concerns and I always felt that I had an advocate on my side. Their experience proved invaluable as they were able to successfully argue my case and win my long term disability case, securing my benefit and my family’s income needs. And they continue to support me, as insurance companies continue to find ways to challenge the validity of your claim even after the initial decision is made in your favor.

Dell & Schaefer handles everything for me. This is an extraordinarily difficult thing I have had to endure. Without this money, I have no idea how my family would have been able to survive. Insurance companies can be brutal on individuals and when one is at their most vulnerable as I was, it is critical to have a knowledgeable and powerful attorney on your side. I like the fact that I don’t have to worry about anything and that everything is handled for me by Dell & Schaefer. I am glad to recommend Dell & Schaefer to anyone who needs a strong advocate on their side.

***** 5 stars based on 202 reviews

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