A disability attorney recently filed a lawsuit in the District Court for the Central District of California against the Unum Life Insurance Company of America (Unum). In Marjorie McGill Vs Unum Life Insurance Company of America, Administrator of the HCA Management Services, L.P. On Behalf of HCA’s Affiliated Facilities (Los Robles Hospital and Medical Center) Long-term Disability Plan, the plaintiff brought the legal action under the Employment Retirement Income and Security Act (ERISA) to recover short and long term disability benefits that were wrongfully denied by Unum.
The Facts of the Case Against Unum Insurance Company
The plaintiff, Marjorie McGill, was employed as a “registered nurse” by Los Robles Hospital & Medical Center, a properly organized business entity doing business in the State of California. By virtue of her employment, the plaintiff was a covered beneficiary at all times relevant to this action under a group disability benefits policy issued by Unum’s Long-Term Disability Plan. The long-term disability plan would provide a monthly benefit of $4,400 in the event that the insured was considered unable to perform her “own occupation.”
Due to plaintiff’s degenerative injuries, the plaintiff ceased actively working on May 29, 2008, as on this date, Plaintiff suffered from pain and repeated bouts of emesis and was admitted to the ER for severe abdominal pain, diarrhea, and vomiting. Plaintiff alleges that she became disabled on May 29, 2008 and filed for short-term disability benefits with Unum.
Due to suffering from uncontrollable bowel incontinence that results in the inability to perform tasks continuously, severe abdominal pain, nausea, and neuroma, and the failure of medications to ease the pain for Plaintiff to maintain the pace, persistence, and concentration required to maintain competitive employment on a full-time basis, Plaintiff filed for long-term disability benefits through the plan administered by Unum on December 10, 2008.
Denial of Unum Disability Benefits Claim
The plaintiff stated that she was denied herapplication for long-term disability benefits by Unum on April 29th 2009. Subsequently, Unum denied further long-term disability benefits under the Plan pursuant to a letter to the Plaintiff dated April 29, 2009. This letter allowed the Plaintiff 180 days to appeal this disability claim denial.
On November 24, 2009, Plaintiff pursued her administrative remedies set forth in the Plan by requesting administrative review of the denial of disability benefits. Plaintiff submitted additional information, including medical records, to show that she is totally disabled to perform her own or any other occupation under the Plan.
The Plaintiff also submitted documentation to Unum that the Social Security Administration issued a fully favorable decision on Plaintiff’s claim for disability benefits under Title II and Title XVI of the Social Security Act.
Unum notified Plaintiff on August 31, 2010 that Unum had upheld their decision to deny benefits and that Plaintiff had exhausted her administrative remedies. Plaintiff’s only remaining option was to file a long term disability lawsuit with the assistance of her California Disability Lawyer.
Allegations In The Disability Denial Lawsuit Against Unum
According to the lawsuit, the plaintiff alleged that Unum has wrongfully denied disability benefits to Plaintiff in violation of Plan provisions and ERISA because the plaintiff is totally disabled, leading to her not being able to perform the material duties of her own occupation or any other occupation which her medical condition, education, training, or experience would reasonably allow.
Plaintiff also alleged that Unum failed to afford proper weight to the evidence in the administrative record that shows that the Plaintiff is totally disabled. Plaintiff argues that Unum’s interpretation of the definition of disability contained in the policy is contrary to the plain language of the policy, as it is unreasonable, arbitrary, and capricious.
Therefore, Plaintiff claims that Unum has violated its contractual obligation to furnish disability benefits to Plaintiff. Since all available contractual and administrative remedies have been exhausted, all future appeals would be futile.
Relief Sought By Plaintiff In The Unum Lawsuit
As a result of Unum’s actions, the plaintiff is seeking the following relief from the Court:
- All past due short-term and long-term disability benefits yet unpaid under the terms of the Plan
- Unum be ordered to pay all future short-term and long-term disability benefits according to the terms of the Plan until such time as Plaintiff is no longer disabled or reaches the benefit termination age of the Plan
- Restitution of benefits not paid, along with accumulated interest
- Attorney’s fees
- Court costs
- Other and further relief that the court may deem just and proper