Long Term Disability Law Blog
Mr. Scott A. Boles, a former restaurant manager employed by Telesis, Inc., filed a complaint in the Nebraska court against Unum for denial of disability insurance benefits under two separate claims. Boles, employed to manage various Lazlos restaurants, was covered by the Group Long Term Disability Insurance Policy issued by Unum to Telesis, Inc in 2006. Boles had also purchased Disability Income Insurance Policy in 1994, and has paid all the premiums as necessitated by the contract.
Telesis had paid all premiums as required by the policy which also constitutes an employee welfare benefit plan under ERISA. Under the policy, Telesis, Inc. is the named Plan Administrator of the Long Term Disability Plan and enjoyed delegated discretion to make benefits decisions in accordance with policy to UNUM. UNUM denied Boles’s claim, declaring that Boles was not disabled within the meaning of policy issued to Telesis, Inc. Boles appealed this decision but UNUM upheld its initial decision on denying him the disability benefits.
The court took notice that UNUM is conflicted in that it both makes benefits decisions under the policy to discretion delegated by Telesis, Inc, and that it must pay any eligible disability benefits under the policy and that this conflict must be considered while reviewing UNUM’s decision to deny disability benefits.
In a similar vein, a second claim filed by Boles was also denied by UNUM citing reasons that his disabilities are not covered under their Disability Income Insurance Policy that he has been paying premiums for since 1994. This policy, however, is not covered by ERISA as it is not part of an employee welfare benefit plan.
Boles suffers from several disabling medical conditions, including Fibromyalgia, Chronic Fatigue Syndrome and neurally mediated hypotension. These conditions result in symptoms such as incapacitating fatigue, orthostatic intolerance, memory loss, impaired concentration, mental confusion, ataxia, weakness, joint pain and light-headedness. These medical conditions have rendered him unable to work, and Boles has ceased working for Telesis, Inc. since 2007.
Boles has requests the court to rule judgments in his favor for both the claims, requiring UNUM to pay disability benefits due to him and that the court enter judgment in Boles’s favor requiring UNUM to pay disability benefits pursuant to the policy that he had purchased, in the future while he remains disabled. He also requested the court to award Boles a reasonable attorney fee and that the court tax the costs of this action against UNUM.