UNUM ordered to pay disability benefits to legal secretary

Swintek-Hallinan v. UNUM Life Ins. Co. of Am., 2005 U.S. Dist. Lexis 13458 (US District Court Minnesota 7/6/05)

Facts:

In March of 1984, Insured, a legal secretary for Winthrop and Weinstine P.A., was involved in an automobile accident which caused her to sustain severe cervical and lumbar back injuries. For over two decades, Insured has been treating with various physicians, in hopes of eliminating or reducing her chronic back pain. However, when an assortment of treatments including: two surgeries, significant physical therapy, and numerous medications proved futile, Insured admitted defeat and applied for long-term disability benefits.

Despite a plethora of objective medical evidence documenting the Insured’s disability, UNUM Life Insurance Company of America (hereinafter “UNUM”), denied Insured’s claim for long-term disability benefits. After expending an exorbitant amount of time and energy into filing two appeals, the Insured was ultimately left with no benefits and a debilitating condition which prevents her from working. Having no other alternative, Insured brought the instant suit to seek recovery of her long-term disability benefits.

Holding:

The Court held that in light of the substantial medical records documenting the Insured’s disability and UNUM’s failure to put forth a reasonable explanation, other than, Insured is not disabled because her treating physician did not list any restrictions for Insured, UNUM abused its discretion when it denied Insured’s claim for long-term disability benefits.

In arriving at its conclusion, the Court began with a determination of whether the long-term disability plan issued to Insured provided UNUM with discretionary authority. Concluding that discretionary authority to determine benefit eligibility was given to UNUM, the Court recognized that it must review UNUM’s decision to deny benefits under an abuse of discretion standard. The traditional abuse of discretion standard holds that UNUM’s decision to deny benefits will stand if a reasonable person could have reached a similar decision. Woo v. Deluxe Corp., 144 F.3d 1157, 1162 (8th Cir. 1998). In determining whether a decision to deny benefits is reasonable a court should consider both the quantity and quality of the evidence and must determine whether the decision is supported by substantial evidence, which is more than a scintilla, but less than a preponderance. However, the Court goes on to recognize an exception, whereby the Court’s review can be less deferential to the administrator. The less deferential exception arises when the claimant presents material, probative evidence demonstrating that (1) a clear conflict of interest or a serious procedural irregularity existed, which (2) caused a serious breach of the plan administrator’s fiduciary duty. If the two prongs are satisfied, a court will review an administrator’s decision under an abuse of discretion standard, however, it will also decrease the deference given to the administrator in proportion to the seriousness of the conflict of interest or procedural irregularity.

DISABILITY INSURANCE COMPANY INFORMATION
Videos, Questions, Resolved Cases, Lawsuit Summaries & Company Reviews

disability insurance companies complaints

FAQ

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   *****

Vincent A. (Florida)

It was a pleasure working with attorneys that return your calls in a timely manner. Alex Palamara was great. He listened to me and heard what I was saying. Either he or Danielle Lauria kept me in the loop at all times. I would definitely use Dell and Schaefer again and ABSOLUTELY recommend their services to anyone who needs excellent competent attorneys.

Read 424 reviews

Speak With An Attorney Now

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