UNUM Life Insurance Company sued by California Disability Lawyer after denial of benefits for a school custodian

The UNUM Life Insurance Company of America (UNUM) is one of the largest providers of long term disability insurance in the United States; however, UNUM is not only well known for its size. This disability insurance company has a checkered history with regard to its handling of Unum disability Claims. In 2004, Unum was the subject of an investigation by state regulators which resulted in a reassessment of 200,000 claims and a fine in excess of $15 million. Unum entered into a regulatory settlement agreement that was a joint effort with 46 different states. Despite Unum’s regulatory settlement agreement, there have been subsequent cases around the country in which Unum has been accused of unfair denials, delayed payments of benefits and reliance on flimsy evidences to either deny or terminate a legitimate claimant’s disability benefits.

The case of Domingo Gopez v UNUM Life Insurance Company of America filed recently at the District Court for the Central District of California by a disability attorney is an example of a Unum claim denial.

The Nature of the Complaint

The plaintiff Domingo Gopez was a custodian employed by the Capistrano School District. Gopez, on January 1st 1995, was issued a disability insurance policy by UNUM which was part of an employee benefit plan that was offered by the Capistrano School District. This case is not governed by ERISA as the plaintiff worked for a government entity. Under the terms of the policy, the insured was to receive monthly disability income protection worth 60% of the insured’s monthly income up to a maximum of $2000 per month in the event the insured became totally disabled as a result of injury or sickness. The benefit was payable for five years provided the disability began prior to the insured’s age of 64 years.

In order to receive disability benefits under the policy, the insured had to be “unable to perform with reasonable continuity the substantial and material acts necessary to pursue your occupation in the usual customary way”. And to continue receiving disability benefits after the initial 24 months of payable benefits, the insured had to demonstrate that he is also “unable to engage with reasonable continuity in another occupation in which you could reasonably be expected to perform satisfactorily”¦”

The nature of the plaintiff’s job required him to have sufficient physical ability that included lifting, carrying, pushing pulling, walking long distance around the campus, bending, squatting and reaching. All these activities can range from medium to heavy intensity. The plaintiff last day of work was on January 15th 2008. Prior to becoming disabled, the plaintiff had a history of shoulder pain due to work related injuries. This resulted in surgeries on both his shoulders with the latest surgery occurring on January 17th 2008. Consequently, the plaintiff wasn’t able to return to work after this surgery.

Because of his disability, the plaintiff filed a claim for disability benefits with UNUM. As required under the terms of the policy, the plaintiff filed his claim in a timely manner supported with a magnitude of medical records documenting his shoulder pain and surgeries that resulted from this condition. These supporting documents also included agreed medical examination reports from the plaintiff’s Worker’s Compensation case with the most recent dated September 10th 2008. The report stipulated that the plaintiff was not permitted to do “heavy lifting over 25 pounds on a repetitive basis, 50 pounds on an occasional basis and overhead work with the right and left shoulder.” In addition to the supporting medical documents, the plaintiff also included in his claim a statement from his employer that it could not accommodate the plaintiff’s work restrictions.

Despite the overwhelming medical evidences supporting the plaintiff’s disability, UNUM rejected the plaintiff’s claim on August 15th 2009. UNUM based its unreasonable denial by categorically selecting certain evidences taken out of context and at the same time ignoring the mountain of evidences of the plaintiff’s disability. Although the plaintiff was approved for the much stricter and narrower standard of disability used by Social Security Administration (SSA), UNUM also choose to disregard this information. In addition, in the plaintiff’s worker compensation claim and independent doctor determined that the plaintiff was totally disabled.

Legal Redress Sought through the Lawsuit

As the result of UNUM’s breach of its contractual obligations, the plaintiff had suffered monetary damages, mental and emotional distress leaving the plaintiff no choice but to seek relief through the Court with this legal action against UNUM. In the lawsuit, the reliefs sought by the plaintiff included:

We encourage you to contact any of our disability insurance lawyers to discuss some strategies for a possible resolution of your Unum disability denial.

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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

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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.

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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.

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Amy W.

My disability claim had reached the 10 year “any occupation” point. The appointed insurance claims representation began calling and asking several questions and requiring that I answer, while indirectly threatening that my claim would be canceled if I did not answer immediately. It was very unkind and stressful to be threatened in this manner.

My claim was then set for cancellation after my medical records identified a temporary period of remission. They used one sentence of ten years of records that was based upon how I felt that day during that appointment. I contacted Dell & Schaefer and Attorney Gregory Dell responded to my e-mail within hours and on a Sunday. I was assigned to Rachel Alters. The insurance company asked me to do some pretty unsettling things, a physical capacity test that was being requested by LTD carrier to confirm their cancellation. Rachel was honest, direct and comprehensive while being timely and efficient. That is a hard find in any business to client relationship.

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