A lawyer denied disability benefits from his policy with Unum has filed a lawsuit under ERISA.

ERISA stands for Employee Retirement Income Security Act, a federal law enacted in 1974.

ERISA’s purpose was to protect money placed in retirement plans so employees had sufficient income upon their retirement.

It does so by setting minimum standards for retirement and other welfare benefit plans offered by employers in private industry.

Plaintiff Robert O. has filed this lawsuit believing that Unum, in denying the disability claim, has breached its obligations and duties under ERISA.

Factual Information About the Lawyer Denied Disability Benefits

Robert was employed full time as a lawyer since May 1984. As part of the employee benefits offered to him by the law firm which he worked, Robert was covered with Unum for short-term disability, long-term disability and group life insurance. At all relevant times, Robert was covered under the plan.

In late 2011, Robert suffered from chest discomfort radiating to his back. Early the next year, Robert underwent imaging studies which found that he had a “degenerative disease, mild to lower thoracic spine with prominent bridging and osteophytes involving the lower thoracic spine.”

Robert’s back condition continued to worsen despite seeking conservative treatment and working within the job restrictions placed on him by his primary care physician.

Robert was subsequently diagnosed with all of the following: lumbosacral spondylosis, thoracic spondylosis, facet hypertrophy, central canal stenosis, disc bulge T12-S1, mild-moderate bilateral hip osteoarthritis, chronic lipidemia and chronic hypertension.

“As a result of the above-described medical conditions, the Plaintiff experiences persistent and chronic low back pain, hip pain, pain in back radiating into ribs on the right, back and chest pain aggravated by standing,  [and] left lower extremity numbness,” the lawsuit states.

Robert has been taking Norco, a narcotic pain medication. Previously, he was prescribed Vicodin, another narcotic pain medication. He also takes Flexeril as a muscle relaxant. When Robert is taking narcotic medication he is not legally able to operate a motor vehicle due to safety.

As a result of his continued pain and need to treat it with narcotic pain medications, Robert’s last day of work with his firm was in February 2015. At that time, he had been with the law firm for 31 years, and was a “Principal” of the firm.

Robert applied for disability benefits and was granted short-term disability benefits from the last day that he worked through March 2015.

In May 2015, he received a letter saying that his short-term disability benefits would be terminated. He appealed the denial of benefits but his appeal was denied. He was also told by Unum that his group life insurance benefits had also been denied.

Following his denial, Robert applied for disability benefits through the Social Security Administration, and his application was pending a decision at the time the lawsuit was filed. Robert filed his Unum lawsuit after exhausting all of his appeals with the company.

Allegations from the Lawyer Denied Disability Benefits

Robert has only brought forth a single count against Unum for a claim of benefits pursuant to ERISA. He alleges that Unum’s failure to pay full disability benefits are a direct violation of the term of his plan with Unum, and that Unum breached the terms and provisions of his plan.

Robert also states that his claim was not properly and thoroughly investigated as it should have been.

The lawyer denied disability benefits is seeking a declaration that he is entitled the benefits to under his plan, with a full and accurate accounting for him to review, and order for Unum to pay the full amount of Robert’s employees benefits due, attorneys’ fees and costs and any additional relief deemed just and appropriate.

Filing a Lawsuit against Unum over Denied Disability Benefits

If you are a lawyer denied disability benefits from Unum, or work in any capacity in which you are covered by Unum disability insurance and were denied your coverage, you may be eligible to take legal action against the insurance company.

The Unum Lawsuit is Case No. 1:16-cv-01437, in the U.S. District Court for the Western District of Michigan, Southern Division.