On August 17, 2001, John H. and his Texas disability attorney filed a lawsuit against UNUM Life Insurance Company of America in Federal Court in an effort to secure John H.’s disability benefits, both short term and long term, under the Employee Retirement Insurance Security Act of 1974 (ERISA).
While employed by ION Geophysical, John H. was covered under a UNUM group disability benefits policy that was effective for John H. as of January 1, 2005. And, since John H. was employed by ION Geophysical at the time of his disability, UNUM is obliged to provide him with disability benefits, but has failed to do so.
UNUM is Accused of an “Inherent Conflict of Interest”
In the complaint, John H. and his disability lawyer allege that since UNUM is the administrator for the ION Geophysical’s group disability plan, the insurer, as the sole authority that grants or denies applicant benefits, has an “inherent conflict of interest” in its role as decision maker for the award of disability benefits. Consequently, John H.’s attorney alleges that UNUM was “arbitrary and capricious” in its denial of his disability benefit claim. Claiming that UNUM’s evaluation of John H.’s disability claim was unfair and failed to use proper discretion and that the insurer’s discretion was vague, the attorney accuses the insurer of rendering a “legally defective” decision per John H.’s claim application.
A technical writer for ION Geophysical, John H. stopped working on February 15, 2010 as a result of “degenerative and traumatic injuries” from “chronic Epstein Barr virus and fibromyalgia.” At the time of his ceasing work, John H. filed for his short term disability benefits and was granted those benefits. (read more about Epstein Barr Virus and the disability claim)
All was going as expected. When his short term disability benefits expired, John H. filed for long term disability benefits, and was denied those disability benefits with the option to appeal that decision within 180 days of the letter of denial dated July 12, 2010. Expecting to receive $2,906.80 per month per the terms of his disability plan, John H. appealed UNUM’s decision by perfecting his appeal on January 7, 2011 and provided the insurer with substantiating medical verification that he was unable to function at his “own occupation” as a result of his medical conditions.
UNUM Continues to Deny Disability Benefits in the Face of Substantial Evidence
UNUM denied John H.’s appeal and notified him that he had exhausted his administrative remedies, thus leading John H. and his disability attorney to file a lawsuit. In their complaint, John H. and his Texas disability attorney catalogue John H.’s medical condition, backed by John H.’s medical records, as causing John H. to suffer from “continued chronic sever pain, fatigue, joint stiffness, insomnia, sleep disturbance, drowsiness, dizziness, slowed reactions, decreased memory and depression”.
Taking multiple medications to curb his symptoms, John H.’s doctors verify that he is unable “to maintain the pace, persistence and concentration required to maintain competitive employment on a full time basis.” Unable to perform his job or any other job on a consistent basis, John H. is fully entitled to his UNUM disability benefits, which the insurer refuses to pay.
As a result of UNUM’s failure to comply with its obligations to provide John H. with disability benefits, John H.’s disability attorney accuses the insurer of “wrongful denial of benefits under ERISA, 29 U.S.C. § 1132” and asks the District Court to award John H. the following.
- Declaratory and injunctive relief;
- Payment of all past due short term and long term disability benefits;
- Reasonable attorney fees and court expenses; and
- Other relief that the Court determines is “just and appropriate.”