U.S. Chief District Judge William Young of the U.S. District Court for the District of Massachusetts ruled that the plaintiff, only identified in court documents as “John Doe,” should have received disability benefits
According to Young’s ruling, First Unum maintained that Doe could not be considered disabled due to the schizophrenia before June 1999, but that his coverage ended in April 1999 when he stopped working at law firm Hawkins, Delafield & Wood. For his part, Doe asserted that he was, in fact, disabled before April and that his employment with the firm continued until June 30, 1999.
First Unum ultimately denied Doe’s disability claim – a decision Doe appealed four times, the ruling said.
Young quoted First Unum documents as saying that Doe was fired because of “inability to handle the workload, poor attention, poor concentration, and diminished social interactions.” Those issues, Young asserted in the ruling, were “a list of failings that bore a striking resemblance to the outward manifestations of schizophrenia.” Young decided that Doe had become disabled while a firm employee and, therefore, was entitled to benefits.
“First Unum acted in bad faith in denying benefits to Doe, and while First Unum’s position was entirely without merit, (Doe) was essentially correct. The company can well afford to pay a fee award, and the awarding of fees against insurers acting in bad faith would deter similar conduct by other insurers in the future,” Young wrote. “… to the extent that other participants and beneficiaries exist, the decision that has resulted from the bringing of this case ought certainly change First Unum’s practice of denying valid claims based on an erroneous and highly restrictive interpretation of the policy.”
The decision is at http://pacer.mad.uscourts.gov/dc/opinions/young/pdf/radfordtrustmemo.pdf
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