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