A California federal judge gave a complete win to a severely disabled woman in a case governed by the Employee Retirement Income Security Act (“ERISA”). The disabled insured suffering from a myriad of conditions, including fibromyalgia, argued that the Court should take into consideration the fact that Unum operates under a conflict of interest as shown by its history of unfair tactics against insureds. Unum countered by submitting a sworn statement by one of its loyal employees stating that she was fair in her appeal review, and Unum’s finances did not play a role in her decision-making process.
The court rejected Unum’s attempt to feign fairness and, citing to U.S. Supreme Court precedent, ruled that Unum’s claim of innocence fell far short of the Supreme Court’s requirements to defeat a documented conflict of interest. The court stated that at a minimum, Unum should have a corporate policy statement showing Unum’s commitment by its top brass that claims must be administered fairly regardless of the impact on its finances. Unum presented no such evidence. I wonder….does such a policy even exist?
Mondolo v. Unum Life Insurance Company of America – Central Dist. Calif., Western Div. 1/16/13
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