UNUM denies disability insurance benefits to disabled nurse with fibromyalgia and osteoarthritis

Claiming four counts of misconduct by UNUM Life Insurance Company in the denial of her disability claim, Cynthia A. Keller filed a lawsuit on May 2, 2011 in the Eastern District of Michigan Southern Division. After exhausting all her administrative appeals to the insurance provider, Keller hired a disability lawyer who prepared her complaint stating that UNUM is guilty of breaching its obligations under ERISA, asking for injunctive and declaratory relief, requesting pre-judgment and post-judgment interest, and reimbursement for her attorneys’ fees.

Keller, who was previously employed as a visiting nurse/hospice nurse for OP Hospital Inc., ceased working when the physical demands of her position resulted in her being declared totally disabled, and thus eligible for disability benefits under her employer’s UNUM disability plan. According to the Dictionary of Occupation Titles (DOT), Keller’s job required “physical demands of medium work.” Keller’s disability attorney describes Keller’s job as “heavy work requiring heavy physical demands of moving, lifting, dressing, and caring for disabled, immobile and terminal patients.” Keller’s job also required that Keller bend, stoop, lift, kneel, reach, and engage in fine “hand and finger manipulations.”

Keller’s Disabling Conditions

Keller suffers from pain and fatigue caused from “fibromyalgia and osteoarthritis of the carpometacarpal joints, bilaterally” as well as depression and anxiety. After being unable to perform her work duties as a nurse/hospice nurse, Keller did apply for and receive her short term disability for the full duration of the benefit period of her plan (24 months). After that period of time, Keller was encouraged and required by UNUM to apply for Social Security disability benefits to offset her long term disability benefits; which she did. Keller received a favorable decision on those Social Security disability benefits on February 15, 2011. At one point, Keller attempted to return to work, but lasted a mere 8 months before succumbing to her condition again, and had to cease working a second time.

UNUM’s Denial of Keller’s Disability Benefits

In the face of Keller’s documented deteriorating condition, UNUM denied awarding Keller long term disability benefits even though they had provided her with her entire short term disability benefits and knew that her Social Security disability benefits had been approved. In Keller’s complaint, she and her Michigan disability attorney claim that UNUM did not follow its own procedures, rules, and guidelines because the insurer did not “give weight to the Plaintiff’s favorable Social Security disability determination” as it was supposed to, nor did the insurer consider Keller’s additional evidence of her disability when it denied her long term disability benefits. On March 23, 2011, Keller received her last denial letter from UNUM for reconsidering Keller’s disability claim, which led Keller and her disability attorney to file her lawsuit against the insurer.

Keller and Her Disability Lawyer File a Lawsuit Against UNUM

Keller’s lawsuit details four counts of ERISA violations as summarized below.

Count I – Denial of Plan and Policy Benefits

Keller alleges that UNUM’s denial of her benefits was: 1) “arbitrary and capricious”; 2) that UNUM has a conflict of interest since the insurer is the decision maker of her claim as well as the provider of the Plan’s monies for her disability payments; and 3) that UNUM has breached its contract with Keller, constituting an owing to her of her long term benefits both retroactively and in the future as well as her attorney fees and damages associated with the lawsuit.

Count II – Injunctive Relief and Restitution

As a result of the damages of Count I, Keller asks the Court for: 1) “restitution of all past benefits due” under her policy in addition to pre- and post-judgment interest; 2) to declare Keller disabled and provide her with future disability benefits per her policy as long as she remains totally disabled; 3) to reinstate her employee benefits under the insurance plan; 4) to prohibit the insurer from discontinuing her benefits as long as she remains disabled; and 5) to provide to her any other relief that the Court sees fit.

Count III – Declaratory Relief

Since UNUM has created a controversy as to Keller’s disability designation, Keller and her disability attorney ask for: 1) a declaration by the Court stating that she meets the definition of disability according to the insurer’s plan and is “entitled to continued disability retirement benefits” from them; and 2) the awarding of retroactive benefits due to Keller through the date of judgment on this case.

Count IV – Attorney Fees and Costs

Keller asks the Court to require UNUM to reimburse her for her attorney fees and costs incurred while pursuing this lawsuit.

Learn ore about Unum disability insurance claims.

There is one comment so far

  • I am a nurse and have had my right leg amputed due PVD in May of 2011.

    ninagilbert Jul 13, 2011  #1

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Cynthia B.

I learned in March 2014, that my LTD insurance provider was auditing my case. Two weeks later I received a denial letter. I didn’t even have time to provide the info requests to my doctors much less have them completed and sent back to the LTD company. I promptly called the rep who fumbled about for a few minutes then stated that the letter was mistakenly sent to me. The rep (I’ll refer to him as L) was often rude and aggressive even bordering on threatening on the phone.

They did not contact me from early June, I think, until September when L called me to inform me that my payments had already been stopped and a denial letter was in route. This letter informed me I had not complied in getting information from my Doctors and, he claimed in part that since they were not responsive to the insurance company, I was now in receipt of this denial letter. After all he claimed, I really was just fine (not quoted but implied in my opinion). I had not heard a word from L in 3 months prior to that call. I had been promised I no longer had to talk to L after I complained to the insurance company. How surprised I was to pick up a call from L. He seemed quite pleased to let me know they had already stopped my payments. Long story short, like you perhaps, I was scared and had no idea where to turn. Did I need to find a local attorney? That’s what I started doing. I quickly learned there were a lot of people who had or were currently going through the same thing. Misery really does seem to love company.

I started reading other people’s stories and often ran into the Dell & Schaefer name. I was skeptical. I mean, who chooses an attorney over the internet? I learned there were topics this law firm had placed on You Tube? I intently read everyone of them. I admittedly was impressed as they carefully described the process and what to expect. I read more than once. I called the national number listed. I made my choice when I spoke with Alexander Palamara, Esc. He was very informative, confident and encouraging. All of which I was not feeling prior to that call. I made my decision and never looked back. I knew without question that I would never be able to win this case on my own. I was so naive that I didn’t understand that what I thought was a very reputable and certainly well known Insurance company, would blatantly lie. They did. My attorney learned during the discovery process that they had, had much of the information they said they never got. They had had it for months. I never had to wait for response from Alexander, my attorney. If he was not available, his assistant would contact me. I was always in the loop and well informed. I was still shocked at the glaring discrepancies noted in my filing as opposed to what was noted by the insurance company’s denial letter. Some say, “Trust but verify”. I would Strongly recommend, “Don’t trust And Verify!” Act as early as you are able. Expect to provide your doctors names, addresses and phone numbers and dates. Then expect to be well represented. It’s well worth your time and money to pursue your case with Dell & Schaefer.

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