Tempur employee suffering from chronic fatigue syndrome sues Union Central Life for denial of disability benefits

A federal lawsuit was recently filed in the U.S. District Court in Pennsylvania against the Union Central Life Insurance Company (Union) by a Pennsylvania disability attorney. The Plaintiff, Janet G., worked as a Direct Sales Supervisor for Tempur World, Inc. (Tempur). Due to her employment at Tempur, Janet was provided long-term disability insurance with Union Central.

In this case, the Plaintiff filed a disability lawsuit to recover payment of long-term disability insurance benefits.

Case Facts Against Union Central Life Insurance Company

The Plaintiff worked as a Direct Sales Supervisor until September 17, 2004 when she became disabled due to Chronic Fatigue Syndrome and was no longer able to perform her essential duties of her Own Occupation as a Direct Sales Supervisor. Plaintiff filed for and received short-term disability benefits from Union. Union then determined in March 2005 that Plaintiff was also eligible for long-term disability benefits. Union paid the Plaintiff long-term disability benefits for the first 24 months as stated by the terms of the Policy.

According to the terms of the Policy, the long-term disability benefits could only continue if the Plaintiff was prevented from performing the essential duties of any occupation for which she was qualified for via education, training, or experience.

As the Plaintiff was still disabled after the 24-month period, Union continued to pay long-term disability benefits.

Union Terminates Plaintiff’s Long-Term Disability Benefits

Via letter dated March 5, 2010, Union terminates Plaintiff’s long-term disability benefits based on the reasoning of internist Dr. V., a graduate of Guntur Medical College in India. Dr. V. claimed that the Plaintiff was disabled due to fatigue and depression, not Chronic Fatigue Syndrome, thereby violating the terms of the Policy and supporting grounds for a termination of benefits.

By letter on August 2, 2010, Plaintiff appealed Union’s decision to deny benefits.

By letter on November 1, 2010, Union denied Plaintiff’s appeal, citing the opinion of another internist, Dr. C. to support its decision to deny benefits.

Plaintiff has exhausted all administrative remedies, which has led to the filing of this lawsuit against Union.

Lawsuit Filed By Disability Attorney Against Union

The lawsuit states that Union failed to provide the following to the plaintiff:

• The long-term disability benefits that were owed to her under the terms of the Policy, a Policy to which the Plaintiff had paid all premiums, thereby insuring her under the terms of the Policy;
• A fair assessment of her claim, as the two expert opinions Union used to deny the Plaintiff’s claim were from internists and not from rheumatologists, who were the proper experts to provide competent opinions in the field regarding Chronic Fatigue Syndrome, thereby not providing solid grounds to terminate Plaintiff’s benefits;
• Not properly weighing the opinion of the Social Security Administration’s decision that Plaintiff is disabled due to Chronic Fatigue Syndrome in evaluating whether Plaintiff’s benefits should be terminated or not;
• Properly evaluating Plaintiff’s condition, conducting Functional Capacity Evaluation and other tests that cannot test fatigue, not providing solid grounds to terminate Plaintiff’s benefits.

Plaintiff Seeks Following Relief From Union Lawsuit

Due to Union actions, Plaintiff wants the Court to provide the following relief:

• All disability payments due as of March 5, 2010 through the time she remains disabled;
• A declaratory judgment that Plaintiff is disabled according to the terms of the LTD policy, which means that Plaintiff is entitled to all benefits ongoing as long as she fits the LTD terms of the policy;
• All prejudgment interest from March 5, 2010 through the date of the Judgment;
• All attorney’s fees, court costs, and reasonable costs;
• All other relief that is deemed just and proper by the Court.