It can be very frustrating when you have a disability policy through your employer–or even on your own–and still have to engage in legal action in order to receive the payments that are rightfully yours. This is especially frustrating for those who find themselves unemployed because of the disability and relied on receiving the disability payments to carry them through until they can go back to work–or at least until they are able to collect Social Security.
Facts of the Case
The plaintiff, Teresa Buchan, worked as an administrative assistant for CBL & Associates Management from early in 2008 until May 2010 when she was besieged by back problems and had to leave her job to have surgery. Following her surgery the doctors placed numerous restrictions on her that prevented her from returning to her job as an administrative assistant. This was based on her job duties that required her to sit for long periods of time, fine motor skills and concentration, the latter of which can be altered due to pain and other types of medications. At that time she submitted a disability application for both short-term and long-term disability until October 2010 when Unum determined the plaintiff was not disabled from performing her normal job. They made this decision even though CBL had documentation in the files stating the plaintiff was unable to perform her duties as an administrative assistant.
The terms of the Plan indicate participants are entitled to disability if they are unable to perform their regular jobs and after 24 months if they are unable to perform any job. In this case the claimant was denied during the own occupation period. The plaintiff has exhausted all ERISA appeals in this case, but she claims she did not receive a full and fair evaluation during the Appeal process.
Terms of the Lawsuit Against Unum
The plaintiff’s attorney filed a lawsuit in the United States District Court, Eastern District of Tennessee in Chattanooga. The basis of the lawsuit is that the defendants have breached their obligation until the terms of the agreement by failing to approve the plaintiff for disability benefits. The plaintiff is asking the court for the following Prayer for Relief as a result of this breach of contract:
- The defendants be properly served and required to answer the time prescribed by law
- The defendant award the plaintiff benefits under the terms of her usual occupation including payments retroactive to the first day the plaintiff was eligible to receive disability payments
- Defendant will award the plaintiff disability payments under the terms of the “any occupation” clause of the policy or the Court shall remand the defendants to properly perform an administration evaluation of the plaintiff’s eligibility for continued long-term disability payments under the terms of the policy and ERISA
- Defendant shall compensate plaintiff for all attorney’s fees and court cost that she incurred as a result of this lawsuit