Pennsylvania Disability Lawyer sues Unum following Unum Disability Application Denial

Recently, a Pennsylvania disability attorney filed a lawsuit at the District Court for the Middle District of Pennsylvania against the Unum Life Insurance Company of America (Unum) for violation of the provisions under the Employee Retirement Income Security Act (ERISA). The legal action was to secure disability benefits under the Mercy Hospital Long Term Disability Plan which Unum was alleged to have wrongfully denied to a former nurse working at the Mercy Hospital. In Christine Leuthe vs Unum Life Insurance Company of America, the Administrator of Mercy Hospital long term disability plan, the plaintiff claimed that she is entitled to disability benefits under a disability insurance policy underwritten and administered by Unum.

The Alleged Facts Of The Case

The plaintiff was employed as a “Licensed Practical Nurse (LPN)” by Mercy Hospital. According to the Dictionary of Occupational Titles, Licensed Practical Nurse (LPN) is considered to be unskilled/semi skilled/skilled work, a medium level work and with a Specific Vocational Preparation (SVP) of 6. The plaintiff stated in the lawsuit that at all relevant time by virtue of her employment with Mercy Hospital, she was a covered beneficiary under a group disability benefits policy issued by Unum. The plan was funded and administered by Unum who retained the sole authority to grant or deny benefits to claimants.

The plaintiff alleged that she suffers from lumbrosacral disc disease, degenerative disc disease, depression, anxiety, left foot pain, chronic and severe low back pain, incontinence, cognitive difficulty and a decreased range of motion. Accordingly, due to her degenerative and traumatic injuries, the plaintiff stopped working on September 8th 2007. She alleged that she was disabled on September 11th 2007.

Claimant submits a Disability Application to Unum

Subsequently, the plaintiff filed a disability application for long term disability (LTD) benefits with Unum on February 26th 2008. However, her claim was denied by Unum on July 11th 2008. She was further denied in her claim for Long term disability benefits by Unum on February 9th 2009. In this denial, the plaintiff was informed that she had 180 days to appeal this denial. The standard of disability operating on the plaintiff at that time was that she had to be considered unable to carry out the duties of her “Own Occupation“.

The plaintiff submitted an ERISA appeal to Unum’s decision to deny her claim for LTD benefits on June 15th 2009. She also submitted documentations to support her appeal. One of the documentation provided was the Social Security Administrations finding that the plaintiff was found to be totally disabled under Title II and Title XVI of the Social Security Act.

Nevertheless, Unum informed the plaintiff on December 3rd 2009 that it was upholding its prior decision to deny her claim for LTD benefits. With this denial, the plaintiff was also informed by Unum that she had exhausted her administrative remedies.

The plaintiff argued that Unum, among other things, had ignored the medical opinions of her treating physicians, the documented limitations and impairments that the plaintiff was suffering from and also which hampered the plaintiff’s ability to engage in work activities.

The Alleged Wrongful Denial Of Benefits Under ERISA

The plaintiff alleged in the lawsuit that Unum’s wrongful denial of her claim for LTD benefits was in violation of the Plan provisions and ERISA due to the following reasons:

  • The plaintiff alleged that she is totally disabled and cannot perform the material duties of her own occupation or any other occupation which her medical condition, education, training, or experience would reasonably allow.
  • Unum had failed to give proper consideration to the evidence in the administrative record that indicated the plaintiff was/is totally disabled.
  • Unum’s interpretation of the definition of disability is contrary to the plain language of the policy and is unreasonable, arbitrary, and capricious.
  • Unum’s was in violation of its contractual obligation to the plaintiff by refusing to provide disability benefits payments.

Request for Relief

Having exhausted all her administrative remedies, the plaintiff is now seeking from the Court the following relief:

  • A finding that the plaintiff is entitled to all past due short term and long term disability benefits yet unpaid under the terms of the Plan.
  • An order for Unum to pay all future short term and long term disability benefits according to the terms of the Plan until such time as the plaintiff is no longer disabled or reaches the benefit termination age of the Plan.
  • An order awarding the plaintiff all reasonable attorney fees and expenses incurred.
  • An award for such other relief as may be just and appropriate.