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.