In Ralph Dewsnup v. Unum Life Insurance Company of America, the U.S. District Court for the District of Utah, Central Division, held that Plaintiff clearly showed, by a preponderance of the evidence, that he was entitled to long-term disability (LTD) benefits that were incorrectly terminated by Unum.
It all started on March 18, 2015, when Plaintiff, a litigation attorney, had a heart attack. He subsequently underwent open-heart surgery. The surgery corrected his heart condition, but he apparently suffered nerve damage in his chest. He was in continuous chest pain that was eventually determined to be neuropathy. Apparently, a nerve had been damaged during the surgical procedure.
Medication prescribed to alleviate Plaintiff’s pain came with side effects worse than the pain, so Plaintiff stopped them. He also underwent an intercostal nerve block which did not help. He then refused any other medical or surgical intervention that possibly might help reduce his pain.
Plaintiff was covered at his law firm by a disability policy through Unum which defined disability as being unable to work in the person’s “regular occupation” which mean the “specialty in the practice of law which the insured was practicing just prior to the date disability started.” Unum approved his application for LTD benefits beginning on September 24, 2015, but periodically updated its review of his medical condition.
After a review of his medical records by one nurse and three doctors, Unum terminated his benefits effective April 12, 2016. After exhausting his administrative remedies, Plaintiff filed this ERISA lawsuit. The U.S. District Court for the District of Utah, Central Division, held that Plaintiff had proved by a preponderance of the evidence that he was entitled to LTDs for eight more months after the termination date.
Plaintiff’s Disability Claim is Supported by a Preponderance of the Credible Evidence
The Court reviewed the entire administrative record and found the Plaintiff’s claim was supported by a preponderance of the credible evidence.
- Plaintiff’s reports of pain were consistent as to the location and nature of the pain.
- Both his treating physicians found him to be credible and had no reason to doubt he was suffering pain.
- He declined pain medication because of the side effects he suffered from them.
- He refused further intervention after the first intercostal injection failed to help him. The refusal was understandable.
- Helping his wife with household chores and carving a mantel did not mean he could do the exhausting work of a litigation attorney. He never claimed he was disabled “in every facet of his life.”
- There are no diagnostic tests available that can confirm pain due to neuropathy.
- None of Unum’s medical record reviewers examined the Plaintiff. Their conclusions that Plaintiff exaggerated his pain was not supported by a review of the medical records. They could have had him undergo an independent medical exam (IME) but they did not.
The Court concluded by stating “the court finds that Mr. Dewsnup has met his burden of showing disability by a preponderance of the evidence and reverses Unum’s decision to terminate his benefits.”
Court Awards Plaintiff LTD Benefits
The Court determined that the evidence in the record “clearly shows” that Plaintiff was entitled to benefits, therefore, “the court will award him benefits rather than remand the case.”
This case was not handled by or office, but we believe it can be beneficial with those who are faced with their insurance company terminating their LTD benefits. If you have any questions about this case, or any question at all about your disability claim, contact one of our disability attorneys at Dell & Schaefer for a free consultation.