Kantor & Kantor LLP: U.S. District Court Determines Unum Life Insurance Unlawfully Denied Disability Benefits to Policyholder Suffering From Fibromyalgia

Feb 07, 2013, 18:18 ET from Kantor & Kantor LLP

LOS ANGELES, Feb. 7, 2013 /PRNewswire/ -- Kantor & Kantor LLP announced today a victory on behalf of client Tanya Mondolo, who sued Unum Life Insurance Co. in U.S. District Court for the Central District of California for wrongfully denying her disability insurance benefits. The court ruled that Unum, a Fortune 500 company and the largest group and individual disability carrier in the United States, abused its discretion in terminating Mondolo's disability benefits. The court ordered Unum to reinstate benefits, with interest, and that Kantor & Kantor could make a motion for attorneys' fees and costs. 

Mondolo suffers from fibromyalgia and avascular necrosis, often called bone death.  Her physicians believe the bone death is a late developing side effect from the chemotherapy regimen used years ago to treat her leukemia. She has difficulty walking, suffers from uncontrolled pain, and is too weak to tolerate prolonged sitting or typing.

"Like so many group disability insurers, Unum labored under a structural conflict of interest because Unum has both the duty to determine whether claimants qualified for benefits and the responsibility for paying those benefits," said Kantor & Kantor partner Alan E. Kassan, who assisted associate Brent Dorian Brehm on the case. "Unum's bias led the court to review Unum's decision regarding Mondolo's benefits with enhanced skepticism, and the denial could not withstand scrutiny."

In reaching its decision, the court noted Unum's history of biased claims administration and case specific facts that the Kantor lawyers argued aggravated Unum's conflict of interest. The court found the following:

  • Unum failed to properly investigate Mondolo's claim, neglecting to determine how much sitting she could tolerate without significant pain.
  • Unum did not investigate whether the alternative jobs it claimed Mondolo could perform were appropriate for her limited ability.
  • Unum and its reviewing physicians failed to consider psychological evidence, even though the policy expressly stated that such evidence must be considered.

In addition, attorneys Kassan and Brehm argued that Unum's conclusions were unreasonable. For example, Unum insisted Mondolo could sit between one-third and two-thirds of a work day. The Kantor attorneys proved even if Unum's supposition was accurate, Mondolo was still not able to meet the requirements of or perform the sedentary work Unum argued she was capable of. 

The case is Mondolo v. Unum Life Ins. Co. of Amer., CV-11-07435 CAS (MRWx) (C.D. Cal. 2013).

About Kantor & Kantor, LLP
Kantor & Kantor is one of the largest law firms in the country exclusively representing plaintiffs who have been denied insurance benefits from life, health, disability and long-term care policies. The firm has extensive experience with the complex appeals process and federal court litigation of ERISA matters, as well as actions against insurers for acting in bad faith. For more information, log on to www.kantorlaw.net, call (800) 446-7529, or follow Kantor & Kantor at www.californiainsurancelawyerblog.com.

SOURCE Kantor & Kantor LLP