Doctor Awarded Disability Benefits and Attorneys’ Fees After Three-and-a-Half-Year Battle – Victory at the Ninth Circuit

In October 2019, Donahue and Horrow LLP sued the nation’s biggest insurance company—Unum Life Insurance Company—on behalf of a doctor whose claim for disability benefits was unfairly denied. While there was no dispute that the doctor suffered from Chronic Migraine Disorder and other conditions that rendered her unable to perform the duties of her job, the insurance company still denied her claim arguing that she was not eligible for benefits because she did not work enough hours each week to qualify for benefits.

Unum asserted that our client was not an eligible employee in “active employment” because the ERISA Plan required both that she be a “full-time employee” and be working at least 30 hours per week prior to her disability. Donahue & Horrow LLP pointed out that the Plan did not specifically require a claimant be a “full-time employee,” nor did it define the term “full-time.” Michael Horrow and his team also argued that Unum improperly failed to account for all of the hours our client worked—both from home and when she was on call—such that the doctor easily worked more than 40 hours a week. 

Following a bench trial in Oakland, California before United States District Judge Yvonne Gonzalez Rogers, the Court found in favor of our client, agreeing that Unum’s claim decision was contrary to the terms of its own Plan—awarding our client full disability benefits. In addition, Unum was ordered to pay the attorneys’ fees and costs that our client was forced to incur in bringing the lawsuit. With this favorable award on attorney’s fees, our client was set to receive 100% of the benefits to which she was entitled.

But, of course, Unum again failed to do the right thing and pay our client. Instead, it appealed the matter to the Ninth Circuit Court of Appeals, again arguing that its interpretation of the Plan was correct and—even if it wasn’t—it should not have been ordered to pay our client’s attorneys’ fees. After more briefing and oral argument before a three-judge panel, the Ninth Circuit agreed with Judge Rogers’ conclusions that (1) Unum improperly interpreted the terms of its own Plan in order to erroneously deny our client’s claim for benefits and (2) Unum is responsible for the attorneys’ fees and costs she was forced to incur. The Ninth Circuit further concluded that Unum is also responsible for fees and costs incurred for the appeal.

So finally, after about three-and-a-half years of fighting for our client in two different Courts, Unum will be forced pay our client all of the benefits she should have received years ago, with interest, and pay for the time Donahue & Horrow LLP spent fighting on her behalf.

This case is just one of many showing that Michael Horrow and the Donahue & Horrow team will not stop fighting for you. With decades of experience fighting insurance companies, they will take on the biggest insurers for however long is necessary to obtain a favorable result.  

If your claim for disability benefits or any other ERISA claim was improperly denied, call Donahue & Horrow LLP at (877) 664-5407 for a free consultation.