University of Cincinnati Employee Suffering From Knee Osteoarthritis Sues Unum For Termination Her Disability Benefits

A Kentucky disability attorney recently filed a federal lawsuit against the Unum Life Insurance Company Of America (Unum). The Plaintiff, Patricia S., worked as an employee for the University of Cincinnati, which contracted with Unum to provide long-term disability insurance benefits to its employees. Plaintiff, due to being employed at the University of Cincinnati, was eligible and covered under this group policy.

After being denied benefits, like so many others, Patricia was forced to file a lawsuit against Unum.

Facts of the Case Against Unum Life Insurance Company Of America

Plaintiff worked full-time at the University of Cincinnati. Due to bilateral knee osteoarthritis in conjunction with hypothyroidism and morbid obesity, she experienced difficulty in her ability to engage in sustained standing and walking and experiencing knee pain while sitting.

Unum approved Plaintiff’s application for long-term disability benefits beginning on September 27, 2007.

Plaintiff was to receive long-term disability benefits for the first 24 months of disability if she was unable to perform the material duties of her regular occupation, as defined by the terms of the disability Policy.

After the 24-month period, the disability definition changed. For disability benefits to continue, the participant must submit medical evidence documenting participant’s condition that supports being unable to perform the duties of any gainful occupation to which the participant was able to perform based on education, training, and provided experience and that were available in the relevant community at a wage rate that was dictated by the terms of the Policy.

Unum’s Termination Of Plaintiff’s Long-Term Disability Benefits

On or about July 7, 2009, via a prepared letter to the Plaintiff, Unum Life Insurance Policy denied Plaintiff’s claim for continuing disability benefits due to the disability definition change within the Policy. The letter also identified jobs that the Plaintiff could allegedly perform. However, the letter was NOT sent to the Plaintiff because Unum learned that the Plaintiff was undergoing new treatment for her condition.

On October 28, 2009, Unum advised Plaintiff that it was terminating her long-term disability benefits. Unum advised Plaintiff that she could perform the following jobs:

  • Director of Home Health Care
  • Director of Volunteer Services
  • Head of Admitting

Unum’s declaration that Plaintiff could perform the aforementioned jobs contradicted the medical evidence submitted to Unum by Dr. Stern, Plaintiff’s treating physician. In addition, Plaintiff did not have the necessary skills, training, and education required to perform those jobs at an adequate level.

Plaintiff appealed Unum’s decision to terminate her long-term disability benefits. Dr. Stern submitted a disability statement and office notes dated March 10, 2010 and March 16, 2010, respectively, that confirmed that Plaintiff could not be gainfully employed due to the restrictions caused by her condition. Dr. Stern recommended the continuation of her regimen of warm water aerobic exercises on as many days as possible and the exclusion of driving during rush hour traffic.

Dr. Roebker submitted a Vocational Evaluation dated March 29, 2010 that stated that Plaintiff was not qualified to perform the aforementioned jobs that Unum declared the Plaintiff could perform. Dr. Roebker also claimed that Plaintiff could not perform any position of gainful employment on a full-time basis.

Unum conducted an internal review of Plaintiff’s claims file dated April 29, 2010. The report excluded Dr. Stern’s recommendation of warm water aerobics and home physical therapy. The examiner stated that the eligibility of Plaintiff’s claim was based upon the Plaintiff’s ability to lose weight, suggesting that the Plaintiff needed to eat healthier and that no formal weight loss program was included in the administrative record.

Unum had Dr. Yablon conduct an Appeal Physician Review of the administrative record; Dr. Yablon concluded that Plaintiff could work full-time in a sedentary position.

Unum had a vocational assessment conducted on May 31, 2010. The individual conducting this assessment concluded that Plaintiff could perform the duties of Clinical Nurse Specialist and telephonic Nurse Case Manager.

Via letter dated June 23, 2010, Unum notified Plaintiff that it was denying her appeal of their original denial of LTD benefits.

Plaintiff has exhausted all administrative remedies, leading to the filing of this lawsuit.

Unum Lawsuit Filed

The lawsuit claims that Unum did the following wrongs against the plaintiff:

  • Relied on a partial and incomplete review of Plaintiff’s administrative record to determine what occupations Plaintiff could reasonably fulfill to deny her LTD benefits
  • Never stated what qualifications Plaintiff had to adequately do the jobs that Unum claimed Plaintiff could do
  • Relied on medical opinions that were based on incomplete reviews of her medical records
  • Never gave proper weight to the medical opinions and reports of Plaintiff’s treating physicians
  • Caused mental and financial hardship to the Plaintiff

Plaintiff Seeks Following Relief From The Unum Lawsuit

Unum’s actions have caused the Plaintiff to ask for the following relief from the Court:

  • To have all long-term disability benefits retroactive to the date of original termination
  • To have all long-term disability benefits paid in the future to the Plaintiff provided she meets the definition of disability as listed in the Policy
  • All pre-judgment and post-judgment interest
  • All attorney fees and court costs
  • All other relief that the Court decides to be appropriate and just