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Court Finds UNUM Abused Its Discretion in LTD Termination

Friday, August 30th, 2013

Another Federal Judge has determined that UNUM abused its discretion in terminating benefits to a physician with a group long term disability insurance policy. The Court, applying its 4th Circuit review procedures, determined that UNUM unreasonably determined that the claimant had not worked the minimum hours for coverage, and that it was “willfully blind” to the most relevant information in the record and drew unwarranted conclusions unfavorable to the claimant.

The Court determined that the records was “replete with reliable, objective evidence” yet UNUM failed to give proper credit to such evidence. The concept of willful blindness is common, as too often, insurers fail or refuse to properly undertake an investigation to secure the most appropriate evidence, choosing instead to isolate records or evidence favorable to its position.

The Court also considered evidence of UNUM’s conflict of interest, noting that the substantial amount of the monthly benefit was a factor, and rejecting UNUM’s argument that it took steps to reduce any perceived bias or conflict of interest. Finally, the Court also took notice of UNUM’s history of biased claim administration in its consideration of the conflict.

The Court ultimately decided that the claimant was entitled to his back benefits rather than a remand of the case.

Schindler v. UNUM Life

Justin C Frankel

Written By:

Justin C. Frankel - Disability Insurance Attorney

Justin Frankel is a founding partner of the disability insurance law firm Frankel & Newfield and is a highly skilled litigator and advocate. He has published numerous articles on the challenges facing clients with private or individual disability insurance policies and those who own group or ERISA disability insurance policies.

Learn more about Justin | See Justin’s Publications



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