After Denying Benefits, UNUM sued for disability benefits in California

A California claimant and his California disability lawyer filed a lawsuit against UNUM Life Insurance Company of America in the United States District Court for the Northern District of California on July 7, 2011 in an effort to force the insurer to pay his entitled disability benefits.

A beneficiary of a UNUM Life Insurance policy through the Electrical Workers Health and Welfare Trust for San Mateo County, Frances Q. became disabled on September 10, 2009. Frances returned to work in April 2010 and worked until he again became disabled in February 2011.

Claimant’s Disabling Condition

As the result of an accident, Frances sustained injuries that required shoulder and knee surgery. Afterwards, Frances was unable to continue work and applied for his UNUM disability benefits. The insurer refused to provide Frances’ disability benefits and supported its denial by alleging that Frances had a pre-existing arthritis condition which caused his disability as opposed to the accident injuries. And, while Frances did have arthritis, it did not prevent him from functioning in his job until after the surgeries, indicating that the accident is the event that precipitated Frances’ disabling condition.

Details of Claimant’s and California Disability Attorney’s Complaint against UNUM

In an effort to gain his entitled disability benefits, Frances was forced to hire a California disability attorney to file his lawsuit to retrieve his disability benefits. In their complaint, Frances and his California disability lawyer outline three claims against UNUM.

  • First Claim – Frances and his California disability attorney allege that UNUM acted in bad faith in denying Frances his disability benefits
  • Second Claim – Frances and his California disability attorney allege that UNUM intentionally inflicted emotional distress and grave financial distress on Frances by arbitrarily denying Frances his disability benefits
  • Third Claim – Frances and his California disability attorney allege that UNUM breached is contractual obligations to Frances by “failing to pay benefits due” and “failing to process claims properly under the policy”

In the subject complaint, Frances and his disability attorney as the District Court to award Frances:

  • Past and future long term disability benefits;
  • General damages of $150,000.00;
  • Attorney’s fees of $150,000.00;
  • Punitive damages of $300,000.00;
  • Suit costs; and
  • Other relief as the Court “deems just and proper.”