A Utah court found that Unum wrongly terminated a former trial attorney’s ERISA group disability claim based on chronic chest pain post-quadruple bypass surgery. Ralph Dewsnup had been receiving long-term disability benefits for 10 months after undergoing a quadruple bypass and suffering from resulting constant, chronic pain across his chest that would worsen with stress. ERISA limits an insured's ability to seek remedies other than benefits that were denied.
This law firm focuses on ERISA and disability insurance claims. Millions of dollars in disability benefits have been paid to our clients, who were wrongly denied by their disability insurance company.
More About the Case
Dewsnup suffered a heart attack in 2015 and underwent quadruple bypass surgery the very next day. The procedure, while successful, was not without complication and soon after his surgery Dewsnup began experiencing constant pain around the incision site. Dewsnup and his doctors reported that his chest pain caused fatigue and worsened with stress, preventing him from doing much of his past work as a trial attorney. Unum requested four separate paper-based reviews of Dewsnup’s file to determine if he was disabled and provided each reviewer with an occupational description.
Unum’s reviewers claimed Dewsnup’s diagnostic testing showed he had recovered from his cardiac condition and did not support his reports of pain. Based on these reviews, and against the opinions of Dewsnup’s treating physicians,Unum terminated benefits. In response to Unum’s termination of his LTD benefits, Dewsnup submitted his presuit appeal which it rejected. Dewsnup then filed a lawsuit against Unum seeking his disability benefits and attorneys’ fees.
The Court’s De Novo Review
The Utah court reviewed Dewsnup’s case de novo, meaning without regard to Unum’s decision to terminate benefits and deny his appeal. Under ERISA, if the disability insurance policy grants the insurer deference - or the sole authority to make a decision - then the court must defer to its decision. These contractual terms are referred to as discretionary language. When discretionary language exists, the court reviews the case under the lens of whether or not the insurer was unreasonable in denying benefits. Because in Dewsnup’s case the policy did not have this language - and both parties agreed to this fact - he simply needed to show that he was disabled under the insurance policy.
Many disability insurance companies write in discretionary language into their policies, making the case very difficult to win. In short, ERISA is a complex area of the law and not a level playing field for a disabled people going up against a disability insurance company.
Having an Experienced Disability Attorney Matters
Disability insurance law is complicated. If your claim for long term disability benefits was denied or being delayed by an insurance company, it is important to get legal help from a lawyer who focuses on disability law.
As a law firm built to focus disability insurance, all our lawyers spend every day working to get our clients disability benefits from insurance companies.
Because federal law applies to most disability insurance claims, we do not have to be located in your state to help.
Dabdoub Law Firm represents clients nationwide with:
- submitting a disability insurance claim;
- appealing a long-term disability denial;
- negotiating a lump-sum settlement; or
- filing a lawsuit against your disability insurance company.