A former HCBS sales manager diagnosed with lyme disease sues UNUM Life Insurance for disability claim denial
Mark Linder filed a lawsuit against UNUM Life Insurance Company of America (UNUM) in the United States District Court for the Middle District of Pennsylvania under ERISA, 29 U.S.C. § 1132. Linder was forced to seek Court mandated relief when his disability claim was denied by UNUM even though he was classified as totally disabled by his medical provider.
Linder has petitioned the Middle District Court of Pennsylvania for his past due short term and long term disability benefits, future payments of those benefits, attorney fees and expenses he has had to pay in an attempt to receive his disability benefits, and any other relief the Court sees fit to award him.
Linder’s is Disabled by Lyme Disease
Linder, a former Branch Sales Manager at HCBS suffers from multiple medical conditions as a result of Lyme Disease. With symptoms that include dizziness, balance problems, unsteadiness, joint stiffness, tremor, weakness and severe memory lapses, Linder cannot sustain “performance of any work activities on a consistent basis.”
In addition, Linder takes multiple prescribed medications that include narcotic pain relievers for the chronic pain and multiple symptoms he suffers from, which adds to his disabling condition. According to Linder’s physician, Linder has a documented medical history that verifies that he is unable to work, is totally disabled, and thus eligible for his disability benefits as described in his UNUM disability insurance plan.
Linder Hires A Disability Attorney To File His Disability Lawsuit
Having exhausted all his options for administrative procedures to obtain his rightful short and long term disability benefits, Linder was forced to hire a disability attorney to pursue disability benefits from UNUM.
Linder’s UNUM disability benefits policy was effective on January 1, 2005. On April 4, 2006, Linder officially stopped working as a result of Lyme Disease. He officially became disabled on April 5, 2006, at which time Linder filed for, and was awarded, short term disability benefits by his employee disability plan provider, UNUM. With no improvement in his health, Linder filed for his UNUM long term disability benefits in December of 2006 and was granted long term disability benefits on December 24, 2006. All was well until on April 9, 2008, Linder received notification that his long term disability benefits were being denied, and he was told he had a 180-window of time to appeal that decision.
As expected, Linder filed an ERISA administrative appeal on September 26, 2008 and requested an administrative review of his case. At the time of the appeal, Linder supplemented his medical documentation that stated that Linder was totally disabled and unable to perform his work duties. Consequently, UNUM extended Linder’s disability benefits through February 12, 2009, but in November 2008, UNUM informed Linder that they would not approve his disability benefits beyond February 12, 2009. So, Linder filed another ERISA administrative appeal on January 7, 2009 and submitted more information and medical records to show his total disability status. In response, according to Linder’s disability attorney, UNUM “discounted the opinions of Plaintiff’s treating physicians, among others and the documented limitations from which Plaintiff suffers including the effects of Plaintiff’s impairments on his ability to engage in work activities.”
Linder’s Disability Attorney Files Complaint On Behalf of Linder
Having gone as far as he could in appealing his disability claims through administrative methods, Linder turned to a disability attorney for help. Alleging that UNUM’s denial was based on a subjective opinion instead of facts, and claiming that UNUM neglected its contractual and fiduciary responsibility to Linder, Linder’s disability lawyer filed suit on Linder’s behalf claiming UNUM discontinued Linder’s disability benefits as a result of “an inherent conflict of interest,” that UNUM acted in an “arbitrary and capricious” way in administering the standards of Linder’s plan, that the UNUM Plan “fails to give the Defendant said discretion” in the matter, and demands that UNUM fulfill its fiduciary obligation and “furnish disability benefits according to the terms of the Plan,” which would support Linder’s claim that he is entitled to disability benefit payments from his insurance policy with UNUM.