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

Leave a comment or ask us a question

Questions About Hiring Us

Do you help Unum claimants nationwide?

We represent Unum clients nationwide and we encourage you to contact us for a FREE immediate phone consultation with one of our experienced disability insurance attorneys.

Can you help with a Unum disability insurance policy?

Our disability insurance lawyers help policy holders seeking short or long term disability insurance benefits from Unum. We have helped thousands of disability insurance claimants nationwide with monthly disability benefits. With more than 40 years of disability insurance experience we have helped individuals in almost every occupation and we are familiar with the disability income policies offered by Unum.

How do you help Unum claimants?

Our lawyers help individuals that have either purchased a Unum long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer.

Our experienced lawyers can assist with Unum:

  • ERISA and Non-ERISA Appeals of Disability Benefit Denials
  • ERISA and Non-ERISA Disability Benefit Lawsuits
  • Applying For Short or Long Term Disability Benefits
  • Daily Handling & Management of Your Disability Claim
  • Disability Insurance Lump-Sum Buyout or Settlement Negotiations

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

Dell & Schaefer Client Reviews   *****

R. R.

I am very pleased that Mr. Gavidia was able to get my husbands disability insurance with Cigna re-instated. It took time, due to Cigna & the games they play. It is also VERY reassuring that if (& probably when) Cigna denies his disability status again, Dell & Schaefer will be there immediately to speak for us. Neither my husband nor I have the ability to fight Cigna by ourselves, we feel very fortunate that Mr. Cesar Gavidia did it for us.

Part of the reason we pursued this matter is the principle involved here, they had no reason to cancel his disability other than Cigna is a very money greedy company. It is a extremely rewarding feeling knowing that Cigna did not get by with this in our case. I wish that was the case for everyone.

If you are in the same situation as we were, please give this company a call & find out your options.

On a personal note – Thank You Cesar!

***** 5 stars based on 202 reviews

Speak With An Attorney Now

Request a free legal consultation: Call 800-682-8331 or Email Us