Unum Life Insurance Company Of America Sued By Four Plaintiffs For Alleged ERISA Benefit Violations

Four plaintiffs have sued Unum Life Insurance Company Of America (Unum) in the District Courts of California, Michigan, and Massachusetts for the recovery of long-term disability benefits covered by the Employee Retirement Income Security Act (ERISA). In all four cases that were filed via the respective disability lawyers, Unum is accused of refusing to pay the Plaintiffs’ long-term disability claims under their respective plans.

First Case – Eastern District of California Sacramento Division

In Joseph F. v. Willis North America Long Term Disability Plan (Willis) and Unum Life Insurance Company Of America (Unum), the lawsuit was filed through a California disability attorney. The Plaintiff was employed by Willis as an account executive until January 2, 2009, when pain from neck and back injuries sustained during a fall on December 16, 2008 kept him from working at his own occupation or any other occupation.

Plaintiff filed for long-term disability benefits under the Plan in May 2009. Unum approved the claim via letter on August 3, 2009 and paid benefits through July 2010, but denied further payments via letter on August 23, 2010 based on the “pre-existing condition” exclusion of the Plan.

Plaintiff filed an appeal on February 18, 2011, but after a podiatrist reviewed Plaintiff’s medical records, denied the appeal on June 2, 2011. Plaintiff has exhausted all administrative remedies, leading to the filing of this lawsuit.

Second Case – Central District of California Southern Division (Santa Ana)

In Charles S. v. Unum Life Insurance Company Of America (Unum); Northrop Grumman Corporation Group Benefits Plan (Northrop Grumman), the Plaintiff was employed as a software engineer by Northrop Grumman, which entitled the Plaintiff to its employee benefits plan, which was administered by Unum.

In or around December 2007, Plaintiff became disabled due to peripheral neuropathy, gastroparesis, and congestive heart failure, causing the Plaintiff to cease working after January 7, 2008.

Plaintiff filed for long-term disability benefits, which Unum initially began paying. However, on or around July 30, 2009, Unum denied Plaintiff’s claim for long-term disability benefits based on the claim that the Plaintiff’s conditions separately were not enough to make him “disabled” according to the terms of the Plan.

On or about January 19, 2010, Plaintiff filed an appeal, but Unum denied this appeal on or about April 27, 2010. Plaintiff submitted additional documents to Unum on August 31, 2011 to prove his current medical condition. However, Unum declined to review any more evidence submitted by the Plaintiff as of September 1, 2011, and closed Plaintiff’s file on October 6, 2011. Plaintiff has filed this lawsuit due to exhausting all administrative remedies.

Third Case – Eastern District of Michigan Southern Division

In Carol P. v. Unum Life Insurance Company Of America, the lawsuit was filed through a Michigan disability attorney. Plaintiff worked until December 2, 2009. Plaintiff became eligible to receive short-term disability benefits on December 3, 2009. Plaintiff filed a claim for benefits, to which Unum initially paid.

On or about December 13, 2010, Unum wrote a letter to the Plaintiff stating that it would no longer continue to make monthly payments. Plaintiff has made repeated attempts to have the payments reinstated, including making an administrative appeal on or about April 18, 2011. Unum denied this appeal on May 12, 2011. Due to exhausting administrative appeals, Plaintiff has filed this lawsuit.

Fourth Case – Massachusetts

In Nicole B. v. Unum Life Insurance Company Of America, Unum Group, and The Rivers School Corporation (Rivers), the lawsuit was filed by a Massachusetts disability lawyer. The Plaintiff was employed by The Rivers School Corporation as a teacher, which made her eligible for Rivers’ employee benefits Plan that was administered by Unum.

In early June 2002, Plaintiff suffered a cerebellar hemorrhage that required life-saving brain surgery. This surgery has left the Plaintiff with many complications that have hindered her ability to work at her own occupation. Plaintiff filed a claim for long-term disability benefits, which Unum granted from August 2002 to May 14, 2004.

On May 14, 2004, Unum denied any further benefits to the Plaintiff based on two reports from its in-house neuropsychologist, Dr. Aaron N., conducting one-on-one settings with the Plaintiff, which do not trigger the overstimulation that the Plaintiff has been suffering from.

Plaintiff appealed the denial, and Unum reversed its denial on or about September 11, 2007 based on “updated medical records” that showed an impairment of function. Unum offered a lump sum offer to Plaintiff, showing that the Plaintiff would be permanently disabled. However, due to the lump sum offer being severely discounted, Plaintiff rejected the offer.

Shortly thereafter, Unum put Plaintiff’s case in review. During this time, the Social Security Administration rejected Plaintiff’s case for benefits, stating that she was capable of doing other work. Unum again rejected Plaintiff’s benefits on June 16, 2010. Plaintiff appealed this denial, but Unum again denied Plaintiff’s claim on November 3, 2010. Plaintiff asked Unum to review its denial decision, to which Unum again denied the Plaintiff’s claim on or about January 28, 2011.

Due to the exhaustion of administrative remedies, Plaintiff has filed this lawsuit.

Benefits Sought By The Plaintiffs Against The Defendants

The Plaintiffs request that the Court provide the following relief:

  • All Plaintiffs are reinstated to receive their long-term disability benefits for as long as they remain eligible under the terms of their respective Plans
  • That all past benefits due and applicable interest are paid
  • All attorney fees and court costs are paid
  • All other just and proper relief deemed by the Court is provided by the Defendants