UNUM Life Insurance Company of America has refused to honor its obligation to provide Scott A. Boles with his disability insurance benefit income even though Mr. Boles qualifies for benefits stipulated in two UNUM Life Insurance Company disability insurance policies. UNUM denied Mr. Bole’s disability insurance benefits on both his individual disability policy, on which he has paid all premiums on time and in full since 1994, as well as an employee group disability policy from his employer that has been in effect since 2006.
Boles purchased his individual UNUM disability policy in 1994. He dutifully paid all the premiums on that disability policy on-time and in-full since the initiation of the policy. As for the group insurance policy, Mr. Boles has been entitled to benefits under a Telesis, Inc. group long term disability insurance policy issued through UNUM to Telesis since 2006. Telesis, Inc.’s paid the premiums of this employee policy which constituted an employee welfare benefit plan in accordance with ERISA (the Employee Retirement Income Security Act of 1974).
An original shareholder of Telesis, Inc., Mr. Boles managed several of Telesis’ various Lazlos Restaurants until he became disabled in October 2007. Succumbing to several medical conditions, Mr. Boles ceased working for Telesis, Inc. because he was unable to fulfill his work duties. Mr. Boles was diagnosed with several debilitating conditions, including fibromyalgia, chronic fatigue syndrome and neurally mediated hypotension. With symptoms that include incapacitating fatigue, orthostatic intolerance, memory loss, impaired concentration, mental confusion, ataxia, weakness, joint pain and light-headedness, Mr. Boles was forced to discontinue working at his managerial position, and applied for his disability income benefits under both his individual and group disability UNUM policies.
Denial of Boles’s disability insurance benefits
UNUM denied Boles his long term disability insurance benefits under both policies, stating that Mr. Boles’s medical condition did not constitute a claim of disability under the terms of either his individual disability policy or his group employee disability policy. Mr. Boles appealed both claims a second time, again, through UNUM’s appeal process and was again denied his disability benefits.
Boles’s disability lawyers file a lawsuit against UNUM
UNUM’s denial of disability insurance benefits to Mr. Boles resulted in Mr. Boles’s Lincoln, Nebraska disability attorneys filing a two-count disability complaint against UNUM Life Insurance Company of America in the United States District Court of Nebraska. According to the first-count of the disability complaint, UNUM’s denial of disability insurance benefits to Boles under Telesis, Inc.’s group policy was wrong in that UNUM had a conflicted role in the decision to deny Boles’s benefits since the insurance company acted as both the insurer and Telesis, Inc’s delegated benefits decision maker.
As for the second count of Boles’s disability complaint, his Nebraska disability attorneys argue that Boles’s individually-purchased disability income insurance policy was not a part of an employee welfare benefit plan, was not governed by ERISA and that Boles’s condition constitutes a disability under the terms of the policy. Consequently, UNUM’s decision to deny Boles his disability benefits breaches the contract between Boles and UNUM.
In both counts, Boles’s Nebraska disability attorneys request that the Court require UNUM to pay Mr. Boles his disability benefits from October 10, 2007 through the duration of his disability, award Boles reasonable attorney fees and that UNUM bear the tax costs of the action. In addition, in the second count of the disability complaint, Bole’s disability attorneys demand a jury trial to decide the outcome of the denial of Mr. Bole’s disability benefits.