A New Jersey disability attorney, on behalf of a disability claimant, recently filed a lawsuit at the District Court for the District Of New Jersey against the Provident Life and Accident Insurance Company (Provident) and Unum Group (Unum) under the Employee Retirement Income Security Act (ERISA) for allegedly adopting unreasonable claims procedure in denying the plaintiff’s claim for disability benefits.
The Nature Of The Complaint Against Unum As Stated By The New Jersey Disability Lawyer
In the case of Gemma L. Abernovich Vs Provident Life and Accident Insurance Company. Unum Life Insurance Company of America, Unum Group, Abc Co. 1-5 (Fictitious Names, Z Names, True Names Being Unknown), the plaintiff Gemma L. Abernovich being disabled is suing for the recovery of long term disability benefits and waiver of premium under an individual and group long term disability benefits insurance plan issued by Provident and Unum to the plaintiff and Wilenz. Goldman & Spitzer. P.C respectively.
The plaintiff was formerly employed as an attorney with Wilenz. Goldman & Spitzer. P.C. she alleged that she became disabled within the terms of the group long term disability benefits insurance plan on June 23rd 2008. Subsequently, she submitted an application for long term disability benefits on December 12th 2008 to Provident and Unum. The plaintiff was claiming on the grounds of being disabled due to her physical conditions of fibromyalgia and chronic fatigue syndrome.
Claim For Long Term Disability Benefits under Fibromyalgia And Chronic Fatigue Syndrome
Nevertheless, the plaintiff was informed on March 31st 2009 by Provident her claim under her long term disability benefits plan was successful. She was further notified by Unum on April 2nd 2009 that her claim for long term disability benefits under her group long term disability benefits plan was denied. An appeal was submitted by the plaintiff on October 2009. She was however informed by Provident and Unum that her claim for long term disability benefits and waiver of life insurance premiums based on her conditions of fibromyalgia and chronic fatigue syndrome was unsuccessful on January 29th 2010.
Approval Of Unum Claim Under Anxiety Disorder
Provident and Unum however, approved the plaintiff’s claim for “anxiety disorder” with a policy limit benefits of 24 months. The plaintiff stated in the lawsuit that she never had an anxiety disorder and never made a claim for disability benefits based on an anxiety disorder. The plaintiff was further informed by Provident and Unum in the January 29th 2010 notification that if she disagreed with Provident and Unum decision regarding a claim for disability benefits based on an anxiety disorder, she can file a lawsuit under section 502(a) of ERISA against them.
The plaintiff informed Provident and Unum that she disagreed with their decision on her claim for long term disability benefits and waiver of life insurance premiums. The plaintiff alleged that Provident and Unum also denied her the availability of a second appeal and instead stated that she can bring a lawsuit against them.
Despite attempts by the plaintiff to straighten out her claim for long term disability benefits and waiver of insurance premiums by filing a new claim on December 27th 2010 and rendering all cooperation to Provident and Unum, Provident and Unum persisted in evaluating her claim for disability unreasonably and not in accordance with the terms of the plan.
On June 2nd 2011, the plaintiff informed Provident and Unum that unless they withdrew their denial of her claim for disability benefits by June 9th 2011, she would filed a lawsuit to comply with the statue of limitations set forth in the Plan.
Relief Sought Under the Lawsuit
To date, having received no response from Provident and Unum regarding the plaintiff’s demand for withdrawal of claim denial or removal of the Reservation of Rights and after exhausting all her administrative remedies, the plaintiff is filing a civil suit against Provident and Unum to seek the following relief from the Court:
- To compel Provident and Unum to pay the plaintiff the accrued long term disability benefits and future long term disability benefits.
- An award of attorney fees and cost of the suit.
- Equitable and appropriate relief provided for under ERISA.
- Other such relief the Court deems equitable, just and proper.