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UNUM Denies Accidental Death Benefits Due to Poor Health of Insured

Our client's husband died after falling and hitting his head on their back patio.  The trauma caused a subdural hematoma which became mortal in less than four hours.  The death certificate classified the death as "accidental."  The "immediate cause" of death was listed as "subdural hemorrhaging from blunt force injury to head" and a "contributing condition" was listed as "thrombocytopenia." Client submitted a claim to UNUM Insurance Company for benefits under an accidental death policy.  UNUM denied the claim based on a limitation in the policy that excludes coverage for accidental losses "caused by, contributed to by,  or resulting from diseases [...]

Court Declares That Unum Has A History of Biased Claims Handling

The 9th Circuit Federal Court of Appeals, in the case of Stephan v. Unum Life Insurance Company, 697 F.3d 917 (9th Cir. 2012) overturned a trial court’s finding that the public record did not demonstrate that UNUM had a history of “biased claims administration.”  The Stephen Court specifically stated “Numerous courts, including ours, have commented on Unum’s history “’of erroneous and arbitrary benefits denials, bad faith contract misinterpretations, and other unscrupulous tactics.’”  Indeed, in Saffon, we attributed the trend of state prohibitions on discretionary provisions in insurance contracts to ‘the cupidity of one particular insurer, Unum-Provident Corp., which boosted its [...]

By | 2013-10-09T10:10:10+00:00 October 9th, 2013|Insurance Companies, Legal Updates|0 Comments

UNUM & Paul Revere Life Insurance hit with 4.2 Million Verdict

A Los Angeles Superior Court jury awarded plaintiff Laura Kieffer 4.2 million in damages in her civil lawsuit against Paul Revere Life Insurance Company and Unum Group.  The award represented $600,000 in past and future disability benefits, $600,000 in emotion distress and $3 million in punitive damages. Ms. Kieffer was a dental hygenist in 1988 when she purchased an individual disability policy from Paul Revere.  Beginning in 1996 she developed several disabling medical conditions, including carpel tunnel syndrome and cervical pain radiating into her upper extremities, preventing her from being able to perform the repetitive motions and fine hand manipulations [...]

By | 2011-05-27T08:32:13+00:00 May 27th, 2011|Insurance Companies, Legal Updates|0 Comments

Hartford Insurance Company Found To Have Abused Its Discretion In Termination of Long Term Disability Benefits

Ms. Mennucci underwent spinal fusion surgery for cervical neck pain that radiated into her right arm. Hartford initially paid short term and long term disability benefits to Mennucci. However, when she failed to fully recover from her surgery and complained of continuing neck pain radiating into her right shoulder Hartford Insurance terminated her benefits based on a medical record review by Dr. Richard Kaplan.

By | 2011-01-24T14:49:31+00:00 January 24th, 2011|Insurance Companies, Legal Updates|0 Comments

Life Insurance Company of North America (LINA) Required To Cover Accidental Death of Intoxicated Driver in California

Courts across the country have struggled with whether an accidental death insurance policy covers the death of a drunk driver.  Some courts have ruled that intoxicated drivers knowingly increase the risk of being involved in a fatal accident to the point that their death becomes foreseeable and thus, not accidental.  Other courts disagree, citing the fact that there is less than a 1% chance of an intoxicated driver being involved in a fatal accident. […]

By | 2011-01-07T14:19:31+00:00 January 7th, 2011|Insurance Companies, Legal Updates|Comments Off on Life Insurance Company of North America (LINA) Required To Cover Accidental Death of Intoxicated Driver in California

Metropolitan Life Insurance Company Taken To Task For Ignoring Subjective Evidence of Pain

Ms. Holmstrom suffered from a painful nerve condition in her right arm which did not resolve even after three surgeries.  She was left with an incurable diagnosis of complex regional pain syndrome (CRPS).  MetLife paid benefits until the definition of disability changed from an inability to perform the material duties of one’s own occupation to that of any occupation.  MetLife cited the lack of any objective evidence to support Ms. Holmstrom’s diagnosis of CRPS. […]

By | 2011-01-07T13:10:17+00:00 January 7th, 2011|Insurance Companies, Legal Updates|0 Comments

Blue Cross of California Settles Class Action Lawsuit to Simplify/Clarify Applications

In newer life insurance, disability insurance, and health insurance polices (less than 2 years old) insurers attempt to avoid paying claims by performing what is known as “post claim underwriting.” When you purchase a health, disability or life policy, you fill out an application that asks questions about you and your family’s health, give the insurer a medical authorization, and sometimes undergo a medical exam. Instead of using the authorization to get the applicant’s medical history before wrting the policy, the insurance company waits until a claim is made. At that time, they obtain your medical records to determine if [...]

By | 2007-06-19T16:20:00+00:00 June 19th, 2007|Insurance Companies, Legal Updates|0 Comments

Accidental Death Benefits Denied By MetLife Because Insured Was Drinking and Driving

An accidental death insurance policy will pay benefits when the insured dies as a result of an accident. But when the insured dies in an auto accident with a high blood alcohol rate is that an accident? Metropolitan Life Insurance Company recently denied a widow life insurance benefits when her husband died in a single car accident while driving home from his brother’s house. Met Life claimed that since decedent had been drinking beer before driving that the accident was not an accident under the law. […]

By | 2007-04-09T03:31:00+00:00 April 9th, 2007|Insurance Companies, Legal Updates|0 Comments