The Plaintiff, suffering from cervical disc herniation and other ailments, has filed this lawsuit against Unum Life Insurance Company of America (Unum) for its abrupt termination of the Plaintiff’s long term disability benefits. Plaintiff was entitled to these benefits based on his employment as an automobile salesperson with John Bleakley Ford, Inc. This lawsuit was filed in the United States District Court Northern District of Georgia Atlanta Division.
In Elmo D Vs Unum Life Insurance Company of America, Plaintiff wants the reinstatement of his long term disability benefits payments as promised under the LTD plan he belongs to.
Plaintiff’s Background
Plaintiff worked for Bleakley as an automobile salesperson up until November 11, 2008. His occupation was classified as a light duty occupation that required 20 pounds of maximum lifting, carrying 10 pounds of articles frequently, and standing with a degree of pushing and pulling. Standing was required for six hours of an eight-hour workday.
Plaintiff suffered from cervical disc herniation, cervical fusion, lumbar herniated discs, lumbar spondylosis, back pain, right leg weakness, right knee pain, osteoarthritis, peripheral neuropathy, migraines, etc. Plaintiff’s condition limits him from performing the material and substantial duties of his regular occupation.
Plaintiff filed for long term disability benefits under the terms of the Plan and was originally granted them.
Unum Denies Further LTD Benefits
Via letter dated January 8, 2010, Plaintiff’s benefits were terminated as of January 7, 2010. Unum stated that the restrictions and limitations provided by the Plaintiff’s attending physician did not preclude the Plaintiff from performing the material and substantial duties of his occupation as a sales associate. The Plaintiff’s physician has maintained during the entire time of this matter that the Plaintiff cannot handle this light duty occupation.
Plaintiff faxed his appeal letter to Unum on February 3, 2010, disputing that Unum’s representative discussed Plaintiff’s condition with Plaintiff’s physician. Plaintiff included a letter from his physician that stated that Plaintiff could not resume his occupation as an automobile salesperson.
On March 26, 2010, Unum denied Plaintiff’s appeal, stating that the claim was terminated on January 8, 2010 when Unum’s reviewing physicians agreed with the Plaintiff’s doctor’s opinion (Dr. Jacob Strong) regarding the Plaintiff’s functional capacity.
Plaintiff has exhausted all administrative remedies, leading to the filing of this lawsuit against Unum.
Why This Lawsuit Was Filed
Plaintiff claims that Unum was untruthful when stating that Plaintiff’s doctors indicated that Plaintiff could perform his duties as an automobile salesperson. At no time did Plaintiff’s doctors ever indicate that the Plaintiff could perform a light duty occupation. His doctors, in October, 2009 indicated that the Plaintiff’s capabilities were that of sedentary work. In November, 2009, his other doctor indicated the same restrictions, and in January 2010, the other doctor also indicated that the Plaintiff was permanently disabled.
Unum failed to provide the Plaintiff with a reasonable opportunity for a full and fair review, as Unum failed to mention or provide the identification of any medical experts whose advice was obtained in connection with the claimant’s adverse benefit determination, as well as misleading the Plaintiff for the reasons for the initial adverse decision.
Unum, as both the insurer and the claims administrator of the Plan, maintained a structural conflict of interest.
Plaintiff’s Relief Request
Plaintiff asks for the following relief to be delivered by the judgment of this Court:
- Past disability benefits that have not been paid
- Accrued interest on all past due benefits
- All future benefit payments so long as Plaintiff remains eligible under the Plan’s terms
- All associated expenses with filing this lawsuit against Unum
- All associated court costs
- All other relief that is granted by this Court