Tenet Healthcare Corporation employee sues UNUM Life Insurance Company Of America under ERISA for wrongfully denying disability benefits by disregarding attending physician’s medical opinion
A disability attorney recently filed a lawsuit at the District Court for the Northern District of Alabama against the Unum Life Insurance Company of America (Unum). In Joan Allred vs. Unum Life Insurance Company of America, the plaintiff Joan Allred sued Unum for the recovery of long term disability benefits due under her disability insurance plan sponsored by Tenet Healthcare Corporation.
The Nature of the UNUM Lawsuit – disability attorney filed complaint under ERISA
The Plaintiff was formerly an employee of the Tenet Healthcare Corporation. During her tenure as an employee at the Tenet Healthcare Corporation, she participated in an employee disability benefits plan that was maintained or administered by Unum. According to the lawsuit filed, on August 26th 2007, the plaintiff had a motor vehicle accident and suffered severe injuries:
- A sternal fracture
- Complete surgical removal of her Spleen
- Fractured femur which needed surgery to correct
- Fracture to her wrist.
- Torn and disrupted ligaments in her neck.
Permanent Disability Status of the Plaintiff
As a result of the injuries she suffered, the plaintiff stated that she effectively stopped working on August 26th 2007. Subsequently, the plaintiff made a timely application for disability benefits under the above mentioned plan. According to the plaintiff’s attending physician opinion, the plaintiff was permanently disabled and suffers from chronic pain and fatigue. “She now uses a cane and walker and is subject to infections due to the loss of her spleen. She, in fact, suffered one serious infection that required hospitalization.” The attending physician also stated that the plaintiff could not sit down for a very long period of time. She is required by her doctor to lie down during the day and due to the chronic pain suffered by the plaintiff, would not be able to return to meaningful work.
Denial of claim for Disability Benefits by UNUM
Despite the above medical conclusions given by the plaintiff’s attending physician, Unum denied the plaintiff her claim for disability benefits under the plan on the ground that the plaintiff was no longer disabled under the terms of the plan. The plaintiff alleged that Unum had made its determination to deny her claim for disability benefit without any proper evaluation or investigation of the plaintiff disabling status. In addition, the plaintiff claimed that none of her attending physicians had drawn a conclusion that she was no longer disabled.
The plaintiff further argued that Unum’s determination that the plaintiff was no longer disabled was contrary to written medical conclusions provided by the plaintiff’s attending physicians. The plaintiff also stated that her ERISA appeals were also denied by Unum without proper consultation with the plaintiff’s supervisor or the plaintiff’s attending physicians. Above all, the determination was in spite of the more stringent finding by the Social Security Administration that the plaintiff is disabled. Hence, the plaintiff argued that Unum had unilaterally determined that the plaintiff was no longer disabled.
Alleged Wrongful Actions by Unum
The plaintiff alleged that Unum had practiced selective reading of the medical records to support its determination to deny the plaintiff’s claim for disability benefits. Unum was also alleged to have relied on biased conclusions of its in-house professionals or conflicted or non partial third parties. The plaintiff also argued that Unum is both the party that makes the claims determinations and as well is the payor of the benefits under the Tenet Healthcare plan. As such, Unum operated under an inherent conflict of interest while making its determination of the plaintiff’s claim for disability benefits.
Relief Sought by the Plaintiff under the Lawsuit
Because of the above mentioned actions by Unum, the plaintiff is requesting the following relief through the Court:
- A determination that the plaintiff is and was entitled to receive long term disability benefits and medical insurance under the terms of the Plan.
- A determination that Unum had breached its contractual obligations to provide such benefits to the plaintiff.
- An order to compel Unum to remedy the breach of contractual obligations by restoring benefits due and paying any benefits not paid as a result of the termination of the plaintiff’s long term disability benefits.
- An order to compel Unum to pay reasonable attorney fee plus costs of the litigation.
- An order to compel Unum to pay re-judgment interest on amounts owed.
- An Order awarding the plaintiff any legal and/or equitable relief that is needed to remedy the Unum’s breach of contractual obligations.