How Unum Got Lit Up by the Court in an ERISA Disability Denial: A Breakdown of Mundrati v. Unum
In the latest slapdown of insurance shenanigans, the Western District of Pennsylvania dropped a detailed, point-by-point takedown of Unum’s denial of long-term disability (LTD) benefits in Mundrati v. Unum Life Ins. Co. of Am., 2025 U.S. Dist. LEXIS 53449 Let’s dig into why Unum lost — and lost hard. Background: Dr. Pooja Mundrati and a 3-Year Medical Odyssey Dr. Pooja Mundrati, a highly specialized interventional spine physiatrist, suffered serious injuries from a 2018 car accident. Her symptoms ranged from persistent migraines and fatigue to cervical spinal stenosis requiring surgery. For years, she pushed through part-time work with documented restrictions from [...]
Is a Heroin Overdose an “Accidental” Death
What Happened: Terri Yates filed a claim for accidental death benefits under her employer’s group life insurance policy after her husband, Johnny Yates, died from a heroin overdose. His death occurred unexpectedly. Symetra’s Reason for Denial: Symetra, the insurance company, denied the claim by arguing that Johnny’s death wasn’t an “accident” because he voluntarily used heroin. They also believed his actions were intentional enough to trigger a policy exclusion for “intentionally self-inflicted injuries.” The Court’s Key Questions: Was the Death Accidental? The court looked at whether Johnny’s overdose was truly unexpected. It used a test (known as the Wickman test) [...]
Navigating Disability Benefits: Understanding Your Options
Life can take unexpected turns, and if you suddenly find yourself unable to work due to a disability, it’s important to know your options for financial support. Depending on your circumstances, you may be eligible for multiple forms of disability benefits. Understanding these programs can help you secure the income you need while focusing on your recovery. State Disability Benefits (EDD – California) If you work in California, you may qualify for State Disability Insurance (SDI) through the Employment Development Department (EDD). This program provides wage replacement benefits equal to 70%–90% of your earnings for up to one year, helping you maintain [...]
Are Drug Overdose Deaths Covered Under an Accidental Death & Disability Policy?
In today's complex world of insurance, one frequently asked question is whether a death caused by a drug overdose is covered under an Accidental Death & Disability (AD&D) policy. The answer, as with many insurance matters, is not a simple yes or no. Instead, it depends on various factors, including the specific circumstances of the overdose and the terms of the insurance policy. In this post, we'll explore this topic and shed light on some general considerations. Accidental vs. Intentional Overdose First and foremost, to be covered under an AD&D policy, a death must result from an accident. This means [...]
Navigating Disability Claims Amidst Lingering Post-COVID Symptoms
In the wake of the global COVID-19 pandemic, a new and complex health challenge has emerged: the enduring effects of the virus on some individuals, known as "long COVID" or "post-acute sequelae of SARS-CoV-2 infection" (PASC). As we delve into the intersection of health and disability insurance claims, it becomes evident that the range of persistent symptoms associated with long-term post-COVID can play a pivotal role in supporting disability claims. Understanding The Impact The spectrum of long-term post-COVID symptoms is broad, encompassing a myriad of challenges that can disrupt both personal lives and professional pursuits. Let's explore how these symptoms [...]
Can An Employer Be Held to Its Word?
We have handled many cases where an employer has advised an employee, either directly or indirectly, that they were entitled to certain benefits even when the Benefit Plan did not provide the benefits promised. Examples would be false promises that a pension would vest or life insurance would continue after leaving employment when in fact the Plan did not provide the continuing coverage promised. What are your remedies when the Benefit Plan does not provide coverage but the employer erroneously advises that there is coverage? When you adversely rely on this erroneous advice the remedy is a claim for [...]
Accidental Death Insurance Policy Covers Heroin Overdose Death
A widow, whose husband died of an accidental overdose of heroin, sought benefits under an accidental death insurance policy sponsored by her former husband’s employer. The plan was governed by the Employee Retirement Income Security Act (ERISA). The insurer denied the widow’s claim asserting an exclusion in the policy for “loss caused wholly or partly, directly or indirectly, by… intentionally self-inflicted injury.” The insurer argued that decedent intentionally used in illegal substance that directly resulted in his death. The widow filed suit and the case eventually went before the 8th Circuit Court of Appeals. The court drew a correlation [...]
Insured Does Not Need a Proper Diagnosis Or Supporting Objective Tests To Prove Disability
The recent case of Abrams v. Unum life Ins. Co. of America, 2022 US Dist. LEXIS 23195T0 highlights that a claimant may prevail on his/her disability claim without supporting objective medical evidence or even a proper diagnosis. In April 2020 Mr. Abrams, who was a trial and appellate lawyer, began to experience frequent, almost daily, fevers. He also experienced severe fatigue and mental fogginess. He saw seven medical doctors with different specialties. He complained of the same symptoms of brain fog, fatigue, decreased attention and concentration and fevers. Three of his doctors diagnosed him with Long-Covid and four with [...]
Life Insurance Company Collects Premiums From Ineligible Employee
Stennett & Casino filed suit against our client’s life insurance company for not paying benefits following his wife’s death. Sally taught the hearing-impaired at the public school. She herself was deaf and communicated mostly by sign language. Her speech is called deaf speech which is difficult to understand until one becomes accustomed to it. Sally’s benefit package as a teacher included life insurance and disability insurance. The premiums for those insurances were deducted from her paycheck. Both policies were written by the same Insurance Company. Sally received a cancer diagnosis in early 2020. She stopped working as a teacher in [...]
Death from Drug Overdose Was an Accident – Not Suicide
Client’s husband died from an overdose of a combination of prescribed drugs, including [drug* and drug*] Decedent had suffered from a very painful condition that required long-term use of the prescribed narcotics. Over the last year before his death, he had been unable to work but had hidden that from his wife by pretending to go to work each day. He had been depressed and was in severe financial debt at the time of his death. In order to avoid liability under an accidental death policy, MetLife claimed that the death was not “accidental”, but rather the result of suicide. [...]