Insurance Companies

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 [...]

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 [...]

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.

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. […]

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 [...]