Inexperienced Lawyer Handles Unum Disability Lawsuit and Fails to Provide Evidence to Support Occupational Argument

The case of Stephanie Dorris v. Unum Life Insurance Company of America (Unum) is an example of how an inexperienced lawyer may make the difference in a Plaintiff obtaining or losing long term disability (LTD) benefits. Plaintiff, a former corporation president, was covered under her employer’s LTD insurance plan through Unum.

Under the terms of the policy, LTD benefits would be paid for two years if the insured person could show the inability to perform “each of the duties of her own occupation” due to an injury or sickness. After two years, the definition of disability changed and in order to receive LTD benefits, the employee needed to prove either: 1) She was unable to perform the material duties of any occupation for which she was “reasonably fitted by training, education, or experience;” or 2) She is performing at least one of the material duties of her regular occupation, or another occupation on a part-time or full-time basis and receiving at least 20 percent less than her previous full-time pre-disability income “due to that same injury or sickness.”

Beginning in 2002, Plaintiff received LTD benefits, and continued receiving them, for 13 years due to her inability to perform the duties of her regular occupation based on a diagnosis of endometriosis. Throughout the years, Unum periodically reviewed Plaintiff’s case. In 2007, the Social Security Administration found her totally disabled based on the diagnosis of endometriosis, Lyme disease and other impairments. In 2013, the review revealed the endometriosis was no longer an issue, but Plaintiff was disabled due to Lyme disease.

In 2015, Unum again reviewed Plaintiff’s case. Plaintiff’s Lyme disease treating physician, Dr. Steven Harris, informed Unum that she could not work at all and could not even do sedentary or light duty work due to “extreme fatigue” and “major memory and cognitive issues.” Plaintiff’s other treating physicians deferred to Dr. Harris.

Unum had two consulting physicians review Plaintiff’s medical records. When they both agreed she could return to her regular occupation, Unum again issued its disability insurance claim denial and terminated her benefits. Plaintiff then filed an appeal.

On administrative appeal, Unum had a third physician review her records who agreed she could perform the duties of her regular occupation. Meanwhile, Unum’s vocational consultant updated its definition of the material duties of corporation president to include working more than 40 hours a week and to require some travel. When Unum denied her appeal, she filed an ERISA lawsuit in the United States District Court for the Southern District of Illinois.

The District Court (DC) found Plaintiff was unable to perform the duties of her own occupation according to the definition now provided by the updated vocational consultant report. The DC then gave Plaintiff an opportunity to submit proof that she was also disabled under one of the other two prongs of the policy and therefore entitled to LTD benefits. She failed to carry her burden of proof, so the DC ruled the Unum disability claim denial was correct and issued its ruling in favor of Unum. Plaintiff appealed the Unum denied claimto the U.S. Court of Appeals for the Seventh Circuit.

Seventh Circuit Agrees Plaintiff Did Not Sustain Her Burden of Proof

The Seventh Circuit Court (CC) made it clear that “Plaintiff failed in proving she was entitled to the benefits she seeks.” The CC concluded:

“Stephanie Dorris did not fully recognize her burden. After her disability insurance provider, Unum Life Insurance Company of America, terminated her benefits, she fought hard to prove that Unum’s explanation for its decision was wrong. She convinced the district court that it was, so the court proceeded to decide whether Dorris was then entitled to benefits. It saw barely a thing in the administrative record going to that question, and no attempt from Dorris to supplement the record. Based on this lack of evidence, the court entered judgment in Unum’s favor. On appeal, Dorris contends that some evidence proved her entitlement to benefits, or alternatively, that the district court should have given her the opportunity to supplement the record after judgment. Because we see no clear error in the district court’s factual findings nor an abuse of discretion in its decision to limit itself to the record before it, we affirm the judgment.”

Seventh Circuit Identifies Plaintiff’s Specific Failures Made in the District Court

After the DC found that Unum erroneously denied Plaintiff benefits and that she was disabled from performing the duties of her regular occupation, the only issue left for the DC to resolve was whether she was entitled to receive benefits. The burden was upon Plaintiff to prove that entitlement.

The CC noted several areas where Plaintiff failed in the DC:

The ruling against Plaintiff in this case could likely have been different if the attorney had submitted evidence as noted by both the DC and CC that was missing.

This case was not handled by our office, but we believe it can be instructive to those struggling with presenting evidence to a court in order to sustain their burden of proving they are entitled to either LTD or short-term disability (STD) benefits. If you have questions about this case, or any question about your disability claim, contact a disability lawyer at our disability insurance law firm of Dell & Schaefer for a free consultation.

We are passionate about helping individuals that have been denied Unum disability insurance benefits and we have resolved more than 1,000 disability denial lawsuits against Unum.

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Steve Dell has done an exceptional job with my disability application process. The firm is extremely well managed. They have acquired an incredible amount of experience over many years. I recommend them for disability insurance claims without reservation. 

Don (Florida)

I called this firm a few months ago completely disparaged due to a company cutting off disability benefits at a time that nearly caused me to lose everything.

Attorney Alex Palmera and Danielle worked hard to reach an amicable settlement and my case was settled a few months later. This is a good firm and the specific expertise in disability claims saved me countless hours of hassle at a time when an already fragile state existed.

Thank you Mr. Palamara and Danielle.

Sandra B. (Arkansas)

I have nothing but good things to say about how my buyout was handled with my disability claim. The level of professionalism was amazing. All of my questions and concerns were answered either by Danielle L. or Alex P. in such a timely manner and with such care I would recommend them in a heartbeat to anyone needing to approach their provider with buyout options.

They did a fantastic job communicating between the provider and me, always keeping my best interest at heart and always answering my many many questions. They really did take most of the stress out of this whole situation. I would give them a 10 out of 10 for every step of this crazy journey. Thank you so much for helping me through this.

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Jeff P. (Oklahoma)

After a very long and frustrating ordeal to keep my LTD payments coming I decided to seek assistance from and attorney. After much research and asking those in the legal profession Dell & Schaefer seemed to be the top choice. I reached out and Alex Palamara was the attorney assigned to my case. All I can say is the experience was outstanding. Both Alex and his Paralegal, Danielle Lauria were excellent to work with. They were very kind, concerned, understanding of my frustrations and treated me with the utmost respect. Communication was excellent with regular updates and telling me what I could expect in each stage of the process.

Alex was also very straight forward with what to expect and no pie in the sky promises or expectations were made. In the end we won our case and I believe it was solely due to their experience and knowledge of not only the laws but the insurance companies as a whole. I would highly recommend them and am very grateful for the help they afforded to me.

Chad B. (Illinois)

I originally spoke with 3 other long term disability lawyers about my case before contacting Dell and Schaefer. None of those law firms would take it. They said the chances of me winning was not good. After finding Dell and Schaefer online I spoke with one of the attorneys that has since left. He did take my case but later it was picked up by Rachel Alters. Rachel is amazing and a very intelligent attorney. She not only won my case but also was able to get my back pay for 6 months.

I also cannot say enough about Sonia Nogueira. Sonia was always quick to answer any of my questions. I would usually hear back from her within hours of sending her a email. I do not know where I would be if I hadn’t contacted them. My family and I cannot thank them enough. Don’t let an insurance company tell you they are not responsible for paying you. I paid them for 20 years monthly and they looked for any reason they could not to have to pay me when I needed my benefit. Thank you Rachel and Sonia for all you guys do.

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Words can only scratch the surface regarding my experience working with Attorneys Dell & Schaefer. It’s a very emotional experience making the decision to utilize disability insurance. The unknowns were/are scary. From the very first phone call, the support staff was/are very professional and reassuring. I have been working with Attorney Steven Dell for approximately 10 years. He is confident, reassuring, listens to and addresses all my concern, and is extremely dilligent in understanding my specific policies for how they impact me. It is very reassuring that Steven handles and deals with the insurance company on my behalf. Attorney Dell’s team, and specifically Merlin, Attorney Dell’s assistant, is simply fantastic. Her professionalism and attention to detail have made all my communications with the office seamless.

Simply put, my experience with Dell & Schaefer made the emotional rollercoaster experience of my neck surgery seem like a walk in the park.

Thank You, Thank You, Thank You, to both Attorney Steven Dell and to Merlin for how you have helped me over these past 10 years.

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