Daryl King v. Unum Life Insurance Co. of America
Lauren A. Welch and Hilliard “Trey” Kelly won a summary judgment in favor of Unum Life Insurance Company of America (“Unum”) on a long term disability claim governed by the Employee Retirement Income Security Act (“ERISA”). In the suit, Darryl King argued that Unum improperly denied him disability benefits when a back injury prevented him from continuing his employment as a construction supervisor. In its Motion, Unum argued that the medical restrictions issued by King’s treating internist, Dr. Charles Brunell, were overly restrictive. Unum noted, in particular, that despite Dr. Brunell’s repeated assertions of restrictions and limitations, “physical findings [had] not revealed any dermatomal sensory loss, reflexes have been normal, and there has been no specific muscle weakness noted.” Unum also had learned that King, a former special operations soldier, was running an international security consulting business which employed Dr. Brunell as its staff physician. In the end, Judge Tucker Melancon found substantial evidence in the administrative record to support Unum’s decision to discontinue paying Long Term Disability benefits to plaintiff. Accordingly, King’s claims were dismissed in their entirety. Read the decision.
Unum Wins Summary Judgment on Accidental Death Claim
On June 8, 2010, Lauren A. Welch and Hilliard “Trey” Kelly prevailed on a motion for summary judgment on behalf of Unum Life Insurance Company of America (“Unum”) in an ERISA suit in the United States District Court for the Eastern District of Louisiana. Plaintiffs, beneficiaries of decedent Timothy D. Letter, were seeking in excess of $200,000 Accidental Death and Dismemberment (AD&D) benefits under an Employee Life Insurance Plan owned by Pepsi Americas, Inc. and administered by Unum. Prior to his death, Mr. Letter had been declared disabled and was receiving disability benefits under a separate employee benefit plan. In addition to disability benefits, this plan provided that a disabled employee was entitled to have his life insurance premiums waived. Plaintiffs argued that the waiver should have also included the premiums necessary to continue his AD&D coverage. Unum disagreed on the grounds that the AD&D coverage was separate and distinct from the standard life insurance. Furthermore, the terms of the policy did not provide for an AD&D waiver of premium. Judge Carl J. Barbier came down squarely on the side of the insurer noting that “the Life Insurance and the AD&D benefits contain separate and distinct sections relating to eligibility, coverage and payment amounts…. Therefore, it is unclear to the court how Letter to have believed that the clause applied to both the Life insurance and the AD&D provision.” Accordingly, plaintiffs’ case was dismissed with prejudice.
Crystal Williams v. UNUM Life Insurance Company of America
Lauren A. Welch won a victory in favor of UNUM Life Insurance Company of America in the case entitled Crystal Williams v. UNUM Life Insurance Company of America, in the U.S. District Court, Western District of Louisiana.
The long-term disability (LTD) policy issued by UNUM had a definition of “disabled” that was divided into two phases: (1) the first twenty-four months of payments, which considered the insured’s ability to perform the material and substantial duties of her regular occupation; and (2) after the first twenty-four months, which considered the insured’s ability to perform the duties of any gainful occupation for which she was reasonably fitted by education, training or experience. UNUM paid LTD benefits to the plaintiff for the first twenty-fours months of impairment, under the “regular occupation” phase of the policy’s definition of disabled and terminated benefits thereafter, under the “any gainful occupation” phase of the definition. The District Court noted that UNUM’s transferable skills analysis identified sedentary occupations for the plaintiff and that the plaintiff presented no evidence that she was incapable of performing said occupations. The District Court held that, despite the fact that the plaintiff’s treating physicians had indicated that she could not work in any capacity, UNUM’s in-house physicians and vocational rehabilitation staff disagreed and concluded that, based upon the evidence in the administrative record, the plaintiff could perform sedentary work. The District Court granted summary judgment in favor of UNUM and dismissed Plaintiff’s claims, with prejudice.
Gloria Jean Williams v. UNUM Life Insurance Company of America
Lauren A. Welch won a victory (January 2005) in favor of UNUM Life Insurance Company of America in the case entitled Gloria Jean Williams v. UNUM Life Insurance Company of America, in the U.S. District Court, Western District of Louisiana.
The long-term disability (LTD) policy issued by UNUM provided that an insured would be determined disabled if she was limited from performing the material and substantial duties of her regular occupation due to sickness or injury. The LTD Plan defined “Regular Occupation” to be the occupation as it was normally performed in the national economy, instead of how the work tasks were performed for a specific employer or at a specific location. The District Court held that, despite the 50 pound lifting requirement of plaintiff’s occupation with her specific employer, her occupation as performed in the national economy did not require such lifting. The District Court granted summary judgment in favor of UNUM and dismissed Plaintiff’s claims, with prejudice.
Joyce R. Carter v. Fruit of the Loom, d/b/a Vidalia Apparel, et al.
Lauren A. Welch won a victory (August 2004) in favor of Provident Life and Accident Insurance Company in the case entitled Joyce R. Carter v. Fruit of the Loom, d/b/a Vidalia Apparel, et al. in the U.S. District Court, Western District of Louisiana.
The long-term disability (LTD) policy issued by Provident provided that after an insured had been disabled from his own occupation for twenty-four months, disability benefits would only continue if the insured was unable to perform any occupation for which he was suited based on education, training, or experience. After paying the plaintiff under the “own occupation” provision, Provident terminated payment of benefits when the medical data submitted on behalf of the plaintiff indicated that she could perform light or sedentary work under the “any occupation” provision. While the plaintiff challenged Provident’s reliance on medical data only, and claimed that Provident abused its discretionary authority when it failed to obtain an opinion from a vocational expert, the District Court specifically held that “it was not necessary to obtain expert testimony as to claimant’s residual functional capacity.” The District Court concluded that “Provident extended every benefit of the doubt to claimant; however, the evidence does not support that Carter is disabled.” Plaintiff’s claims were dismissed, with prejudice.
Rayford Racca v. UNUM Life Insurance Company of America
A motion for summary judgment was granted in Unum’s favor in a case handled by Lauren Welch entitled Rayford Racca v. Unum Life in the Western District of Louisiana before Judge Trimble. The disability policy issued by Unum provided that after an insured had been disabled from his own occupation for 24 months, disability benefits would only continue if the insured was unable to perform any occupation for which he was he was reasonably suited based on education, training and experience. Unum identified several alternate gainful occupations that plaintiff could perform and the plaintiff presented no evidence to dispute the existence of these other gainful occupations, thus entitling Unum to summary judgment.
Provident Life & Accident Insurance Company v. Sharpless
Lauren Welch obtained a favorable opinion from the federal Fifth Circuit Court of Appeal in a case involving a number of previously unresolved issues in the Circuit. The Court held that multiple, non-married shareholders can be considered “employees” for purposes of establishing the existence of an ERISA plan. The Court also found that the purchase of multiple individual disability policies at a discounted rate by physicians in a professional medical corporation, when considered with other circumstances, was sufficient to establish the intent to establish an employee welfare benefit plan subject to ERISA. The Court upheld the trial court’s judgment in favor of Provident rescinding a disability insurance policy based on material misrepresentations contained in the application for the policy. Finally, under a new more restrictive test recently adopted by the United States Supreme Court for determining whether state law claims are preempted by ERISA, the Court found that the Louisiana statute governing misrepresentations in applications, as well as all of the physician’s state law claims asserted in a counterclaim, were preempted by ERISA.
Kevin Chauvin v. UNUM Life Insurance Company of America
On a motion for reconsideration, Lauren Welch obtained a summary judgment in Unum’s favor from Judge Ginger Berrigan in the Eastern District of Louisiana where the court found that plaintiff was not entitled to “partial disability” benefits under an ERISA plan where he failed to actually obtain any type of employment once he had been determined to no longer be totally disabled. Unum had previously prevailed on a motion for summary judgment finding that plaintiff was not entitled to “total disability” benefits. The Court rejected plaintiff’s argument that Unum did not provide him with adequate notice that he actually had to be employed in order to be entitled to total disability benefits. The case is presently pending in the Fifth Circuit Court of Appeal.
Stephen Valdetero v. UNUMPROVIDENT Corporation
Lauren Welch obtained a summary judgment in Unum’s favor in the case entitled Stephen Valdetero v. UnumProvident Corporation before Judge Minaldi in the Western District of Louisiana. Unum had paid disability benefits for 24 months while plaintiff was unable to perform the duties of his own occupation. The Court upheld Unum’s determination that he was not entitled to benefits after 24 months because he was capable of other gainful employment.
Elliott Bushnell v. UNUM Life Insurance Company of America
On a motion for reconsideration, Lauren Welch obtained a summary judgment in Unum’s favor upholding Unum’s determination that the insured was able to perform the duties of his occupation as a casino gaming supervisor. In deciding that plaintiff was not entitled to benefits, Unum relied on a vocational specialist’s assessment of plaintiff’s job duties based on the occupational definition contained in the Labor Department’s Dictionary of Occupational Titles. The Court originally denied Unum’s motion,and had accepted plaintiff’s contention that a factual issue existed as to whether Unum had utilized the occupational definition which most closely resembled plaintiff’s job duties. However, on reconsideration the Court agreed with Unum’s contention that the Court could not properly consider any alternate job descriptions because the plaintiff did not challenge Unum’s assessment of plaintiff’s occupation during the administrative review and the Court could not look beyond the administrative record to determine whether Unum had abused its discretion in determining that plaintiff was not entitled to benefits.
Steve Loria v. UNUM Life Insurance Company of America
A summary judgment was granted in Unum’s favor in a case handled by Lauren Welch which was brought under ERISA for intentional interference with the receipt of benefits under an employer-sponsored long term disability plan, as well as a state law claim for intentional infliction of emotional distress. The plaintiff contended that Unum had misled him into believing he could still be covered under his employer’s policy if he left to go to work for another employer. Utilizing a de novo standard of review, Judge Lance Africk of the Eastern District of Louisiana found that the terms of the policy as a whole plainly evidenced an intent that coverage under the policy would terminate when employment or disability payments terminate.