In Chrilon Daniels Vs Unum Life Insurance Company of America the plaintiff filed a disability lawsuit under the Employment Retirement Income and Security Act (ERISA) to recover long-term disability benefits that were wrongfully withheld by Unum.
The Facts of the Case Against Unum Insurance Company
The disability policy issued by UNUM to Ms. Daniels defines “disability” by the following criteria:
- A person is limited from performing the material and substantial duties of one’s regular occupation due to injury or illness;
- The same injury or sickness causes a person to have a 20% or greater loss in one’s indexed monthly earnings; and
- During the elimination period, a person is not able to perform any of the material and substantial duties of his/her regular occupation.
- After 12 months of payments, you are disabled when Unum determines that the same injury or illness causes a person to not be able to perform the duties of any gainful occupation for which the person is able to fit based on his/her training, experience, and/or education.
Plaintiff ceased working on or about September 28, 2007, as she became hospitalized due to symptoms that are associated with fibromyalgia and lupus. The symptoms the plaintiff suffered included acute anemia, acute pneumonia, dehydration, lumbago, and severe body pain.
Despite the prescription of large doses of pain medications to alleviate the pain symptoms of her debilitating conditions, the plaintiff’s symptoms prevented her from returning to her position as machine operator at Shaw Industries Group, Inc.
Plaintiff applied for long-term disability benefits in accordance with the terms of the Plan on or around April 2008 and was approved for those benefits on or around May 28, 2008.
Dr. John Szczencey, a rheumatologist, reported the following in a letter to Unum:
This patient has no expected recovery date due to the chronic nature of fibromyalgia.
Denial of UNUM Disability Benefits Claim
On December 17, 2008, a letter was received from Laura Poureshmenantalemy of Unum alerting the plaintiff that her disability benefits from Unum were denied. Unum claimed that the plaintiff could still perform work in a sedentary occupation despite the lack of improvement in her medical condition.
The plaintiff submitted an ERISA appeal in response to her disability benefit denial. Despite letters from Dr. Szczencey and Dr. Ronald McLean, the plaintiff’s primary care physicians, that affirmed the plaintiff’s debilitating condition from fibromyalgia and the request to maintain long-term disability benefits, Unum upheld its decision on May 22, 2009 via letter to deny plaintiff’s long-term disability benefits claim.
Georgia Disability Lawyer Files Lawsuit Against Unum
According to the lawsuit, the plaintiff alleged that Unum failed to provide the following to the plaintiff:
- A full and fair review of her claim
- To administer the Plan in accordance with the terms that govern that Plan
- To consider all of the medical evidence submitted by the plaintiff
- To administer the Plan in accordance with E.R.I.S.A. Claim regulations
The plaintiff also claims Unum committed the following wrongful acts:
- Unlawful denial of Plan benefits,
- Erroneously denying plaintiff’s disability benefits,
- Denying plaintiff’s disability benefits was made in bad faith, arbitrarily, and without substantial justification,
- Denying plaintiff’s disability benefits was a breach of the terms of the policy under which the plaintiff was covered,
- Denying plaintiff’s disability benefits was a breach of the Defendants’ duties in discharging its fiduciary responsibilities to the plaintiff,
Relief Sought By The Plaintiff In The Unum Lawsuit
As a result of Unum’s actions, the plaintiff is seeking the following relief from the Court:
- Render judgment against Unum for back and future long-term disability benefits in accordance with the terms of the plan and the policy, plus pay the maximum allowable interest on all back benefits
- An award of attorney’s fees, including litigation expenses and the cost of this action
- Declaration that Unum breached fiduciary duties owed to plaintiff
- Grant other and further belief that is deemed just and proper by the Court