Pennsylvania Court rules Unum did not abuse its discretion in denying LTD benefits to woman who claimed she could not work for her employer under her current supervisor

When making a claim for LTD benefits, it is extremely important to read and understand the definitions contained in your policy such as the “own or regular occupation” and “any gainful occupation” definitions. If you are not aware of these definitions in the policy before you submit your claim, your treating doctors may not be providing the proper support from your inability to work. An example of this very situation arose in a Pennsylvania District Court case, Pini v. First Unum et al.

In Pini v. Unum, the existence of a disability was dependent upon the probability Ms. Pini would suffer a relapse of her cardiac condition if she were to work in her occupation as a product analyst, but for a different employer. According to the Plaintiff’s treating doctors, she would likely experience a relapse of her cardiac condition if she were put back into the extremely stressful work conditions she experienced in her specific job with her previous supervisor which may cause her stress induced cardiomyopathy. Unfortunately, Pini’s doctor stated that she could perform the duties of her occupation for a different employer. As a result, the Court determined Unum was correct in denying her benefits.

The Plaintiff’s policy defines “regular occupation” as follows:

Regular Occupation means the occupation you are routinely performing when your disability begins. The Plan Administrator will look at your occupation as it is normally performed in the national economy, instead of how the work tasks are performed for a specific employer or at a specific location.

The court held that Unum did not abuse its discretion denying Pini’s benefits since her own treating physicians stated that she was able to work in her occupation for a different employer, just not her current employer as her supervisor caused her severe stress. Under the terms of the policy, one is disabled if they cannot perform their regular occupation when the disability begins, however, it is how that occupation is performed in the national economy and has nothing to do with the specific work conditions a claimant is exposed to in his or her pre-disability occupation.

It is very important to review your policy and have a conversation with your treating physician prior to filing a claim in order to ensure that they are supporting your inability to work in accordance with the terms and definitions of your LTD policy.

Our disability lawyers are available to answer questions related to a Unum disability insurance claim or denial or any other disability insurance related claim.

Leave a comment or ask us a question

Questions About Hiring Us

Do you help Unum claimants nationwide?

We represent Unum 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 Unum disability insurance policy?

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

How do you help Unum claimants?

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

  • 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, 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   *****

Joseph B. (Arizona)

What an accomplishment Dell & Schaefer had done for my case against Reliance Standard Life Ins Co. The process was better than I could of thought. I could not of recovered my counter action without them. Great people and professionally handled with integrity, honestly and no strings attached. I was right and the firm got me my rights. Thank you Alex and the Dell & Schaefer team.

***** 5 stars based on 202 reviews

Speak With An Attorney Now

Request a free legal consultation: Call 800-682-8331 or Email Us