Many insurance companies simply refuse to find that an insured is disabled and entitled to the monthly disability benefits the insured deserves, even after losing in Court. Thankfully, for clients of Donahue & Horrow, Michael Horrow and his team are willing to keep fighting for as long as it takes.
Recently, Michael Horrow and the entire Donahue & Horrow ERISA disability denials team won another court case on behalf of their client in his years-long fight with Unum Life Insurance Company of America for the long-term disability benefits to which he was rightfully entitled.
Our client was a Maintenance Specialist for a large oil company who suffered a lumbar fracture in a motor vehicle accident. However, he loved his job, and with some accommodations offered by his employer, he returned to work as soon as he was able. Unfortunately, the pain in his back proved unrelenting, and eventually he had to admit to himself that he was simply no longer able to continue working. Thankfully, his employer offered long-term disability coverage as a benefit of his employment. Our client submitted a claim for disability benefits from Unum. However, as insurance companies too often do, Unum refused to acknowledge the full extent of our client’s injury and pain and refused to approve his claim.
Following a mandatory appeal of that decision right back to the same insurance company that denied his claim in the first instance (an unfortunate requirement of ERISA law), Unum, unsurprisingly, upheld its initial decision. Donahue & Horrow then filed a Complaint in the Sacramento Federal Courthouse in January 2019. Following trial briefing and a bench trial (and after a long delay caused by the COVID pandemic and the fact that the Eastern District of California is the busiest District Court in the country), in February 2022 the Court agreed that our client’s injuries and pain prevented him from working as a Maintenance Specialist and awarded him past due disability benefits. (The parties then reached a confidential agreement regarding the amount of attorneys’ fees and costs to which our client was entitled, which allowed him to receive every dollar that he should have received from the start of his claim.)
The only downside of the trial victory was that, pursuant to the rules of ERISA, the Court was prevented from assessing our client’s potential entitlement to benefits for more than 24 months after his disability, due to a change in the definition of disability in the Policy. Accordingly, his claim was remanded back to Unum for an assessment of whether his conditions prevented him from performing the duties of “any occupation.”
After winning at trial, our client was hopeful that Unum would not deny his claim a second time. However, after reviewing his claim, Unum again denied his claim, alleging that the change in the definition of disability meant that the company was no longer liable for the long-term disability benefits that were promised and granted by the court. We, of course, disagreed with Unum’s determination. Donahue & Horrow continued to represent him with the appeal. Unfortunately, Unum still refused to reverse its denial decision.
Accordingly, Donahue & Horrow initiated another lawsuit in Federal Court, arguing that Unum’s denial decision was improper and a violation of both the insurance policy and ERISA. In the trial briefing, Donahue & Horrow argued that the medical evidence established that our client was unable to perform the duties required for the occupations that Unum said he could do. After comparing the evidence and arguments made by both parties, Chief United States District Judge Troy Nunley once again agreed with the arguments Michael Horrow made on our client’s behalf. Judge Nunley ruled that our client was disabled under the Policy’s new “any occupation” definition of disability and was therefore entitled to long-term disability benefits.
As a result of the trial victory, our client will receive all of the benefits he was due under the policy – including six years of past due benefits, with interest – and the insurance company will likely again be required to pay the attorneys’ fees and costs our client was forced to incur in order to fight for his benefits.
If you believe your disability insurance claim was improperly denied, call Donahue & Horrow LLP at (877) 664-5407 for a free consultation. We are ready to help you get the benefits you deserve.