Alabama Disability Attorney Files Lawsuit Against UNUM Following Disability Application Denial

Recently, in the case of Felicia Fielder Vs Unum Life Insurance Company Of America, Administrator Of The Flex-N-Gate Corporation Long Term Disability Plan in The United States, the plaintiff through an Alabama disability attorney filed a lawsuit at the District Court for the Northern District of Alabama. In the lawsuit, the plaintiff Felicia Fielder alleged that the Unum Life Insurance Company Of America (Unum Life) had denied disability benefits to her in violation of an employee welfare benefit Plan’s provisions and the Employee Retirement Income Security Act (ERISA).

The Nature of the Complaint

The plaintiff was a former employee of the FLEX-N-GATE Corporation. She worked as a “Production Associate/Welding & Assembly” which is considered to be unskilled work and classified under the Dictionary of Occupational Titles as Medium with a Specific Vocational Preparation (SVP) of 2. While employed at the FLEX-N-GATE Corporation, the plaintiff was accorded coverage in the FLEX-N-GATE Corporation Long Term Disability Plan (the “Plan”) which was underwritten and administered by Unum Life.

The plaintiff suffers from lumbar radiculopathy, sciatica and as a result of the symptoms of chronic back pain, the plaintiff stopped working and submitted a disability application on May 5th 2008. The multiple medical conditions that the plaintiff suffers from resulted in both exertional and nonexertional impairments. Accordingly, the plaintiff alleged that she became “disabled” on May 6th 2008. On May 13th 2008, the plaintiff filed for short term disability (STD) benefits with Unum Life. It was stated in the lawsuit that STD benefits were granted on May 13th 2008.

The Claim for LTD Benefits

On January 6th 2009, the plaintiff filed for long term disability (LTD) benefits under the above mentioned Plan. She was duly informed by Unum Life on May 11th 2009 that her claim for LTD benefits was unsuccessful. The plaintiff was also informed that she had 180 days to appeal Unum Life’s decision to deny her claim for LTD benefits. Had the claim for LTD benefits turned out successful, the plaintiff would have received a monthly benefit of $1456.00. According to the lawsuit, the standard of disability applicable during this stage was disability under the “Own Occupation” standard.

The Appeals to Unum Life’s Decision to Deny LTD Benefits

The plaintiff made an appeal to Unum Life’s decision to deny her claim for LTD benefits on June 17th 2009. To support her appeal, she submitted additional information and medical records to show that she is totally disabled from the performance of both her own and any other occupation as defined by the Plan.

On December 30th 2009, Unum Life informed the Plaintiff that her appeal was again unsuccessful and Unum Life was reaffirming its prior decision to deny the plaintiff‘s claim for LTD benefits. The notice also included the notification that the plaintiff had exhausted her all administrative remedies.

Alleged wrongful Actions by Unum Life

In the lawsuit, the plaintiff maintained that at all times; she was totally disabled under the definition of “Disabled” under the plan. Her attending physicians had documented continued chronic back pain, radicular symptoms, as well as decreased range of motion and weakness which impaired her ability to engage in any work related activities.

Wrongful Denial of Benefits under ERISA

The plaintiff argued that Unum Life had wrongfully denied disability benefits to the plaintiff in violation of the ERISA and the Plan provisions because;

  • The plaintiff is totally disabled and she cannot perform the material duties of her own occupation, as well as any other occupation which her medical condition, education, training, or experience would reasonably allow.
  • Unum Life failed to properly consider the evidence in the administrative record showing that the plaintiff is totally disabled.
  • Unum Life’s interpretation of the definition of disability contained in the policy is contrary to the plain language of the policy and is unreasonable, arbitrary, and capricious.
  • Unum Life had violated its contractual obligation to furnish disability benefits to the plaintiff.

Contractual and Fiduciary Relationship

According to the lawsuit, Unum Life administered the Plan and retained the sole authority to grant or deny benefits to applicants. Unum Life also funds the Plan benefits.

The plaintiff argued that because Unum Life funded the plan benefits and retained the sole authority to grant or deny benefits, it had an inherent conflict of interest. As such, Unum Life’s decision to deny disability benefits to the plaintiff should be reviewed by the Court under a de novo (afresh) standard of review. The plaintiff contended that Unum Life owned a fiduciary duty to the plaintiff to administer the Plan fairly and to furnish disability benefits according to the terms of the Plan.

Relief Sought by the Plaintiff in the Lawsuit

Having exhausted all her administrative remedies, the plaintiff is seeking a judicial review of her case and seeks the following relief from the Court:

  • A declaration 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 to Unum Life to compel Unum Life 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 award of reasonable attorney fees and expenses incurred.
  • An award of any other relief deemed just and proper by the Court.