LAW OFFICES
JAMES P KOCH
Representative Insurance Law Cases:
Valerie Watson v. UnumProvident Corp., 185 F. Supp.2d 579 (D. Md. 2002)
Plaintiff was a 56-year old woman with end stage congestive heart failure. Her treating cardiologist had repeatedly certified that she was totally disabled, even that she was at risk of sudden death on the job if she attempted to work. Prior to terminating her benefits, the insurer, UnumProvident Corp., asked the cardiologist to send all of plaintiff's medical records for review. After legal proceedings had commenced, James P. Koch, plaintiff's attorney, discovered that her cardiologist had mistakenly sent the insurer the records of another patient. When deciding to terminate plaintiff's disability benefits, the insurer apparently failed to notice that plaintiff's file contained the wrong patient's medical records.
The court ruled that the UnumProvident Corp., the country's largest provider of long term disability insurance, had acted in an "unprincipled, if not fraudulent" manner when it terminated our client's long term disability insurance benefits. The court ordered the insurer to reinstate plaintiff's benefits immediately, retroactive to the date that benefits had been terminated.
This case was decided under the Employee Retirement Income Security Act (ERISA). .
Kenneth Lanham v. UnumProvident Corp., in the U.S. District Court for the District of Maryland (2005)
In this case, UnumProvident Corp. terminated a client's long term disability benefits, even though the client's doctors had repeatedly certified that he was totally disabled as the result of chronic pain syndrome caused by a spinal cord injury. The client's doctors further certified that his condition had steadily deteriorated since the onset of disability. UnumProvident based its decision to terminate benefits on the results of a functional capacity examination. According to the insurer, the FCE concluded that the client was capable of performing sedentary work.
After litigation commenced, it was discovered that UnumProvident had seriously misconstrued the results of the functional capacity exam. Although the client was capable of performing some sedentary work, the FCE had actually concluded that the client was capable of sustained work for no more than a couple of hours each day. When UnumProvident's erroneous interpretation of the FCE was brought to the court's attention, the insurer agreed to reinstate the client's disability benefits in full.