In January of this year, Kantor & Kantor secured a judgment against Unum Life Insurance Co. http://www.unum.com/, a Fortune 500 company and the largest group and individual disability carrier in the United States. (click here for a copy of the ruling Mondolo v. Unum Life Ins. Co. of Amer., C-11-07435 CAS (MRWx) (C.D. Cal., order filed January 16, 2013). http://www.kantorlaw.net/documents/59-Mondolo-13-01-17-Findings-of-Fact-Order.pdf
Our client, a resident of Los Angeles County, was suffering from fibromyalgia and avascular necrosis (aka bone death, believed to be a result of leukemia treatment). She had been treating for these conditions at U.S.C.’s Keck School of Medicine and had been on disability since July 2009. After paying long term disability benefits for over a year, Unum terminated our client’s disability benefits. Unum’s Gilberto Del Real determined that our client was not disabled because she was capable of working in a sedentary occupation. After our client appealed, Unum’s Stephanie LeSieur also erroneously concluded that our client was capable of sedentary work.
“Like so many group disability insurers, Unum labored under a structural conflict of interest because Unum has both the duty to determine whether claimants qualified for benefits and the responsibility for paying those benefits,” said Kantor & Kantor partner Alan E. Kassan
, who assisted associate Brent Dorian Brehm on the case. “Unum’s bias led the court to review Unum’s decision regarding our client’s benefits with enhanced skepticism and the denial could not withstand scrutiny.”
Kantor & Kantor was able to prove that Unum’s structural conflict of interest had contributed to its decision to terminate his client’s disability insurance benefits. In reaching its decision, the court noted Unum’s history of biased claims administration and case specific facts that the Kantor lawyers argued aggravated Unum’s conflict of interest. The court found the following:
•Unum failed to properly investigate the client’s claim, neglecting to determine how much sitting she could tolerate without significant pain.
•Unum did not investigate whether the alternative jobs it claimed our client could perform were appropriate for her limited ability.
•Unum and its reviewing physicians failed to consider psychological evidence, even though the policy expressly stated that such evidence must be considered.
In addition, attorneys Kassan and Brehm argued that Unum’s conclusions were unreasonable. For example, Unum insisted our client could sit between one-third and two-thirds of a work day. The Kantor attorneys proved even if Unum’s supposition was accurate, our client was still not able to meet the requirements of, or perform the sedentary work for which Unum argued she was capable.
Click here http://www.kantorlaw.net/Cases_Resources/Document_Library.aspx to learn more about this case.
At Kantor & Kantor, we spend every working day doing one thing: helping people resolve disputes with their insurance companies. Life is difficult enough for people living with chronic illness, and we understand that being denied disability coverage by your insurance company or employer only exacerbates the situation. If you are in need of the services we provide, please call us at (800) 446-7529 for a no-cost consultation or go to www.kantorlaw.net for more information.