In Erskine Williams v First UNUM Insurance Company and M&T Bank Long Term Disability Plan, filed by a New York disability attorney at the District Court for the Western District of New York, the plaintiff was a former employee of the M & T Bank working as a collector. While employed with the M & T Bank, the plaintiff participated in a group long term disability (LTD) insurance that was issued to M & T Bank and which the policy was used to fund the M & T Bank LTD plan. The First UNUM Insurance Company (First UNUM) was the Claims administrator for the LTD plan while the M & T Bank was the Plan Administrator for the LTD plan.
On May 14th 2009, the plaintiff became disabled but was denied his claim for LTD benefits. In the lawsuit, the plaintiff alleged that First UNUM as a Claims Administrator was operating under a conflict of interest in making benefits claims decisions. Prior to being denied his claim for LTD benefits, the plaintiff was determined by two independent agencies to be disabled. The first agency that determined the plaintiff to be disabled was the Social Security Administration (SSA) while the second was a determination by a New York Administrative Law Judge at a hearing.
The SSA concluded that the plaintiff’s impairment disabled him from all substantial, gainful activity. In the second instance, the plaintiff was determined by a New York Administrative Law Judge at the hearing at which the plan administrator was present that the plaintiff was disabled for the first 26 weeks of his disability. The New York Administrative Law Judge determined that the plaintiff was entitled to the maximum 26 weeks of disability benefits pursuant to the New York State Disability Benefits Law. Despite the determinations by these two separate agencies, First UNUM continued to deny payment of disability benefits to the plaintiff.
Relief Sought by the Plaintiff in the Lawsuit Against Unum
In the lawsuit, the plaintiff petitioned the court to enter judgment against First UNUM for:
- A declaration of the plaintiff’s rights under the policy and plan according to the provisions of ERISA;
- LTD benefits past due from May 14th 2009 and for LTD benefits payments continuing into the future inclusive of interest;
- For an Award of Attorney’s fees and costs according to the provisions of ERISA;
- Any other relief deem fitting and proper by the Court.