Disabled Doctor wins fight against Unum Life

June 11, 2010

Disabled Doctor wins fight against Unum Life

Plaintiff Albert David Matthew, M.D. has taken on Unum Life Insurance Company of America concerning the
Disability Insurance Policy which he claimed Unum had breached.  This case dealing with denied disability
and the responsibility of Unum Life Insurance Company brings to light the red tape and bureaucracy that
is rampant in the world of insurance policies.

The trial involved both parties submitting their information, and the jury was left with the decision of
whether the defendant had breached the Disability Insurance Policy by failing to pay the Plaintiff
disability benefits to which he was entitled or whether the Plaintiff breached the Disability Insurance
Policy to receive benefits to which he was not entitled.

The Plaintiff Dr. Albert David Matthew M.D. submitted a Notice of Claim to Unum Life Insurance Company
in August of 1996. Within this document the Plaintiff indicated that his profession as a Urologic
Surgeon-Urologist was impeded and that he was no longer able to perform open urological surgeries because
of pain in his ankle that made him unable to stand to perform surgeries. Later, the plaintiff informed
Unum that he would be submitting a claim for total disability due to his inability to perform major
surgical procedures.

Because Unum Life Insurance Company of America refused to pay long-term disability benefits a simple case
of denied disability and responsibility. Dr. Matthew eventually sued Unum for breach of contract. Unum
Life Insurance Company disputed the assertions of the Plaintiff, claiming that he had failed to meet the
requirements to receive certain disability benefits and denied that Unum had breached the policy.

Attorney Greg Jones speaks about this commonly applied tactic “Unum has shown a long standing pattern of denying occupation specific policies focusing on denying high earning professionals such as doctors, lawyers, chiropractors and the like. UNUM uses it’s own appeal process to unjustly prejudice and deny valid and deserving claims.”

In 2009 the court denied both cross-motions for a summary judgment on the Plaintiffs claim of total disability, finding genuine issues of material fact existed about whether performing major surgeries was
a substantial duty of the Plaintiff’s occupation.At the end of the trial, the jury returned with a verdict in favor of the Plaintiff. Finding that the Plaintiff met the definition of total disability as stated in the policy, that he met that definition from December 1, 2004 until the present time, and that the plaintiff was entitled to residual disability benefits under the policy for the period between October of 1996 when he submitted his Notice of Claim to Unum until December 1, 2004. The jury also awarded the Plaintiff $892,380 as well as finding that the Plaintiff received no disability benefits to which he was not entitled; therefore bringing closure to the case of Unum and their attempt to deny disability.

Publisher: Salient News

1 comment on “Disabled Doctor wins fight against Unum Life”


The author really isn’t being fair to UNUM. With all do respect, because you do not have all of the facts of the case. UNUM was already paying total disability until his death or maybe it was a certain age like 72 or 75. Also the benefits could transfer to his wife as well if he died before that age, until he would have been that age. This award was in excess of 1,000,000, from Dec 1, 2004 forward. As a matter of fact, a claim representative didn’t dispute that claim of total disability in court from Dec 2004 forward. The jury was asked to re-establish that fact in court, and they did (Dec 2004 forward). The years in question were years from August 1996 until 2004, while the doctor was doing 95% of his job. The jury collectively agreed that the portion of the duties the doctor couldn’t do contributed to merely 5% of his responsibilities. He could still do numerous surgeries where he sat. The Doctor did not meet the terms of “total disability” laid out by the policy from August 1996 to Dec 2004. The jury agreed to partial disability. However, the jury instructions forced the jury into making a claim for the Doctor based on the doctor’s calculations, because they had no other way to calculate an award based on evidence presented. The doctor’s numbers were not necessarily trustworthy; therefore his numbers added an accelerator to the award, as if he was totally disabled many of those years except two. The true award should have been maybe $200,000 at most. This is the reality. UNUM got screwed on this one. Justice was not served, and instead UNUM was robbed of at least $692,000.

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