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Jury orders Unum Provident to pay lifetime long term disability insurance benefits to physician

Dr. G, has been battling Provident Accident and Life Insurance Company (acquired by Unum) since his long term disability insurance benefits were denied in 1999. After two jury trials, multiple motions for summary judgment, and an appeal, Dr. G has once again won a verdict granting him lifetime disability benefits. It is likely that Unum will once again appeal the jury verdict and this case will continue for several more years. Dr. G is currently owed approximately $1,400,000 in unpaid disability benefits and prejudgment interest. This case is an extreme example of the type of litigation that can ensue if a long term disability claim is denied. Our law firm has litigated hundreds of cases of Unum Provident nationwide; however this case was not handled by our law firm. This case deals with the issue of lifetime total disability benefits in ERISA exempt disability policies.

Unum Provident Claim Denial History

Dr. G filed his initial claim with Provident for long term disability benefits in 1997 when he could no longer work as a walk-in clinic physician. He developed a debilitating neurological condition, later diagnosed as chronic motor neuron disease, which made it extremely difficult and painful to stand for any length of time. His clinic was located in Ft. Lauderdale, Florida and he usually treated around 40 patients a day, many of them port or cruise ship workers with some type of injury or illness requiring immediate treatment. Symptoms of his condition first manifested in April 1997, and by August 1997 he had cut back his patient load by around 75%. He asked one his clinic colleagues to examine him and run diagnostic tests. When she couldn’t come up with a diagnosis, he made an appointment with the Mayo Clinic in Jacksonville at the earliest available appointment in early October 1997. After 2 days of tests with the head of the Mayo Clinic neurology dept he was tentatively diagnosed, and was definitively diagnosed at a follow-up appointment on November 14. On the day of that appointment, his neurologist filled out and signed an attending physician’s statement stating he was permanently unable to perform his duties because of his condition, which she sent to Provident in connection with his application for disability benefits which he had signed and submitted on November 10.

Unum Provident Sues Disabled Claimant in Jury Trial #1 and Claimant Wins

Provident wrote two letters assigning a date of disability of November 14 and began paying Dr. G ninety days later at the end of his elimination period. The policy provided for benefits until age 65 if he became disabled after his 60th birthday; and lifetime benefits if disabled before age 60. His 60th birthday was November 19, 1997, 5 days after his second appointment at Mayo and the day his neurologist signed the attending physician’s statement. Provident paid him unconditionally for a year. An internal Provident memo reveals that in February 1999, they discovered that the policy provided for lifetime benefits, and how close their assigned date of disability was to his 60th birthday. Provident immediately issued a reservation of rights, and 6 months later sued Dr. G for declaratory relief, stating that it was unsure whether he was totally disabled. Provident then cut off benefits altogether. The jury’s verdict found him totally disabled at trial in Feb. 2002, but the verdict form, over plaintiff’s objection, contained a second question asking for a date of disability despite the fact that the question of lifetime benefits was never an issue in the 2002 case. The date the jury assigned was December 8, 19 days after his 60th birthday. Provident paid Dr. G until his 65th birthday, and then cut him off again, based on the jury’s date of disability.

Unum Provident Denies Lifetime Disability Benefits at Age 65 and Claimant Sue Unum – Jury Trial #2

Dr. G immediately sued Provident following the denial of benefits at age 65. Four judges and 9 years later, the case finally went to trial again in October 2011. To get there, Dr. G had to argue Provident’s motion for summary judgment based on collateral estoppel – 3 times, before 3 different judges. Provident’s motion was denied every time. Before trial, Dr. G filed a motion to exclude the first verdict form and lost. Provident filed a motion prior to trial to exclude the letters assigning the November 14 date of disability and the internal memo and surprisingly won. At trial, the judge also excluded the deposition of the Provident claims rep who had adjusted the claim and written the letters finding November 14 to be the date of disability. After a week long trial, the jury found in favor of Dr. G and determined that his date of disability was November 14. Nine years of benefits come to $1.366 million, plus prejudgment interest going back to 2002, plus attorneys fees. It is expected that Provident will appeal and the case will continue for several more years. There is a pending action for bad faith that was filed after the first trial and it likely that it will be amended to include this most recent repudiation of Provident’s calculated effort to deny an insured his contractual benefits. Provident was represented by Defense Attorney John Meagher of the law firm of Shutts and Bowen. Mr. Meagher is one of the nation’s best disability insurance defense attorneys and he has been defending Unum Provident for more than twenty years. In this case, even Mr. Meagher could not defend Unum Provident’s wrongful denial.

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Comments (2)

  • Terry,

    It depends on the language in your policy. If your policy was a group disability policy provided by an employer, then most likely your policy will end at 65. Unum often writes policies that indicate that if you are disabled before the age of 60 the benefit will go to 65 (as opposed to some companies that run the benefit to your Social Security Retirement Age). You will need to refer to your policy for details.

    Stephen Jessup Aug 27, 2013  #2

  • If I became disabled before age 60 should my benefits continue? I have received a notice from Unum that my benefits will end when I reach age 65 and that will be in December of this yea (2013).

    Terry J. Whitlow Aug 26, 2013  #1

FAQ

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   *****

Patricia H. (Hawaii)

I would have never received a penny if I did not seek the help of Dell & Schaefer Law Firm. I was not able to get The Hartford Insurance Company to pay me no matter what I did. I had paid into the system which was denying me the benefits when I needed them the most! I was sick, recovering from chemotherapy and was told by my doctors not to return to work until my lab values were within the normal range. Trust me I wanted to get better! Finally, with the consistent help of attorney, Stephen Jessup, we won the case and I received payments.

I am now well and not in need of long term disability. This is a situation where the insurance company denied me until a law firm was there to back me up. When this firm says they will do whatever it takes they mean it. I highly recommend Stephen Jessup. I am thankful for the ability of this legal team to fight for our rights.

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