How a Recent ERISA Case Against Unum Could Impact Your Long-Term Disability Claim
If you’ve been denied long-term disability (LTD) benefits by your insurance company, you’re not alone. Navigating the complex world of disability insurance can be overwhelming, especially when you’re dealing with serious health conditions that prevent you from working. This is where understanding your rights under the Employee Retirement Income Security Act (ERISA) and having an experienced ERISA lawyer on your side can make all the difference. A recent case against Unum Life Insurance Company provides a great example.
A Recent Victory for ERISA Participants: Maureen Downes vs. Unum
A recent court decision demonstrates that there is hope for individuals struggling to obtain the long-term disability benefits they deserve. In the case of Maureen Downes v. Unum Life Insurance Company of America, the court ruled in favor of a plaintiff who was denied LTD benefits by Unum, one of the largest disability insurance providers in the country. This case sheds light on the importance of understanding your rights under ERISA and the need for expert legal representation when dealing with a denial of benefits.
Background of the Case
Maureen Downes, a 70-year-old pediatric physician, had been in practice for over forty years when she was forced to stop working in early 2020 due to a combination of serious health issues. Her medical problems were so severe that her doctors advised her not to return to work, especially as the COVID-19 pandemic was rapidly escalating.
Downes applied for long-term disability benefits under her employer’s ERISA-regulated insurance plan, which was administered by Unum. Despite her significant health risks and the advice of her doctors, Unum denied her claim. They argued that while she was at high risk for severe COVID-19 complications, her condition didn’t prevent her from performing her job, especially if she used personal protective equipment (PPE) and followed other preventive measures.
The Court’s Decision: What It Means for You
The court disagreed with Unum’s assessment. After reviewing the case, the judge ruled that Downes was indeed disabled under the terms of her insurance policy. The court recognized that her underlying health conditions, combined with the risks posed by the COVID-19 pandemic, constituted a legitimate disability. The judge also highlighted that, as a pediatric physician, Downes was regularly exposed to patients who might have been infected with COVID-19, further increasing her risk of severe illness or death.
This ruling is significant because it is persuasive authority for other long-term disability claims, particularly for those who face heightened health risks due to their occupation or who face a serious “risk of relapse” of a previously-disabling condition if they were to return to work. It shows that courts are willing to consider the unique circumstances of each case, including the specific dangers posed by working during a global pandemic.
Why This Case Matters to You
If you’re dealing with a long-term disability and your claim has been denied by your insurance company, this case demonstrates that you have options. Insurance companies like Unum often deny claims, arguing that policyholders are not sufficiently disabled to qualify for benefits. However, the Downes case illustrates that courts can and do overrule these decisions when the evidence shows that a disability exists under the policy’s terms.
This decision also underscores the importance of having a knowledgeable ERISA lawyer on your side. ERISA is a complex area of law, and insurance companies often rely on this complexity to justify denying valid claims. An experienced ERISA attorney can help you understand your rights, gather the necessary medical evidence, and present a compelling case that maximizes your chances of receiving the benefits you deserve.
The Importance of Seeking Legal Help
If you’ve been denied long-term disability benefits, it’s crucial to act quickly. Under ERISA, there are strict deadlines for filing an appeal, and missing these deadlines can mean losing your right to challenge the denial. For LTD claims, you typically have 180 days from the date you receive your adverse claim determination to submit your ERISA appeal. Under ERISA, you generally must appeal an adverse claim determination before you are able to pursue it under Section 502(a) of ERISA in court. At The Garner Firm, Ltd., we devote the majority of our practice to representing individuals in ERISA claims, generally, and ERISA long-term disability claims, specifically. Our attorneys have decades of experience litigating ERISA claims. We understand the tactics insurance companies use to deny claims, and we know how to fight back.
Contact The Garner Firm, Ltd. Today
Don’t let an insurance company like Unum deny you the benefits you deserve. If you’ve been denied long-term disability benefits or are struggling with an ongoing LTD claim, contact The Garner Firm, Ltd. today at (215) 645-5955. Our experienced ERISA lawyers are here to help you navigate the claims process, fight denials, and secure the benefits you’re entitled to.
Your health and your future are too important to leave to chance. Reach out to us for a free consultation, and let us help you get the financial support you need to move forward with your life.