UNUM Plan Participant's Short-Term Disability Benefits Prope

Copyright 2009 Strafford Publications, Inc.All Rights Reserved Texas Insurance Law & Litigation Alert

February 28, 2009

Pg. 8

452 words


UNUM plan participant's short-term disability benefits properly terminated; Demand v. UNUM Life Ins. Co. of Am., No. 07- 1785 (N.D. Tex. Jan. 13, 2009)

The U.S. District Court for the Northern District of Texas affirmed an insurer's decision to terminate a plan participant's short-term disability benefits. The court held that the insurer presented substantial evidence that the participant was able to perform the essential functions of his position.

Verizon Communications Inc. established an employee welfare benefit plan under which employees were eligible for short and long-term disability. Martin Demand participated in the plan as a Verizon employee. UNUM Life Insurance Co. of America administered disability benefits under the plan.

In March 2005, Demand contacted UNUM to make a claim for short-term disability benefits. Demand advised UNUM that he had a stroke several years ago and recently had some of the same symptoms. According to Demand, his doctor told him to stop working and scheduled surgery. UNUM requested Demand's medical records.

In May 2005, UNUM contacted Demand and advised him that his medical records did not reflect that his doctor told him to stop working. Later that month, Demand's doctor notified UNUM that he had told Demand that he thought it was reasonable that he go on short-term disability. Accordingly, UNUM approved Demand's claim for benefits through June 2005.

In June 2005, UNUM extended Demand's benefits through August 2005. In September 2005, Demand advised UNUM that he was planning to return to work on Sept. 19, 2005. Demand's physician released him to return to work with no restrictions. Based on Demand's return to work, UNUM terminated his short-term disability benefits.

On Sept. 21, 2005, Verizon advised Demand that he would be included in a reduction in force effective Oct. 21, 2005. On Sept. 23, 2005, Demand advised UNUM that his doctor had reversed his decision to release Demand to work. Demand claimed that he was entitled to disability benefits effective Sept. 21, 2005. UNUM denied Demand's claim.

Ultimately, Demand sued UNUM, and UNUM filed a motion for summary judgment. The court held that UNUM presented substantial evidence that Demand was able to perform the essential functions of his position at the time of his disability. Accordingly, the court held that the record supported UNUM's decision and found that the denial of benefits was not arbitrary or capricious.

Counsel for Demand : Greg Fitzgerald, 817-281-0044, Bedford, Tex.

Counsel for UNUM : Bill E. Davidoff, Doug K. Butler, Figari & Davenport, 214-939-2000, Dallas.

Source: Texas Insurance Law and Litigation Alert, 02/28/2009

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March 3, 2009

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