The plaintiff, Tracy Mondolo, was reported to have been previously diagnosed with leukemia and underwent the rigors of chemotherapy in an attempt to eradicate the disease. That necessary regimen of chemo, according to Mondolo’s doctors, may have resulted in the so-called bone death that left Mondolo with uncontrolled pain and weakness, together with difficulty in walking and a limited capacity for sitting or typing for prolonged periods.
And yet, Unum insurance denied Mondolo her disability benefits. Mondolo sued. The US District Court for the Central District of California ruled in favor of Mondolo, finding that Unum had abused its discretion in terminating the plaintiff’s benefits.
The denial on the part of Unum in the Mondolo case appears to mirror denials of other Unum disability claims historically, going back several years. To that end, the Court noted Unum’s history of biased claims administration.
Among other findings, the Court determined that Unum Group failed to properly determine just how much sitting the plaintiff could tolerate in association with carrying on regular administrative tasks, without incurring significant pain in the process.
The Court also took Unum Disability Insurance to task for failing to determine if alternative jobs the insurer claimed Mondolo was capable of undertaking were indeed appropriate for the claimant given her limited ability and mobility.
Unum, formerly operating as First Unum and Unum Provident before that, had insisted in defending its denial of Mondolo’s disability benefits that the plaintiff could sit between one-third and two-thirds of a work day. However, Unum was not able to prove beyond a reasonable doubt that Mondolo could perform the work the insurer insisted she was capable of performing.
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The Court ordered the insurer to immediately reinstate Mondolo’s Unum long-term disability insurance benefits, with interest. The Court also ruled that Mondolo’s attorneys could make a motion for costs and attorney’s fees.
Unum is one of the largest providers of insurance in the world. A Fortune 500 Company, Unum prides itself on contributing to charitable causes and not-for-profit initiatives. However, the insurer continues to suffer from a years-long reputation of unfair practices and accusations of bad faith insurance.
Such accusations are often tested in the courts with a Unum lawsuit. The Mondolo action is Mondolo v. Unum Life Ins. Co. of Amer., CV-11-07435 CAS (MRWx) (C.D. Cal. 2013).
READER COMMENTS
employee
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Michael Kaplan
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Even though I had a copy of the contract and a letter in writing from them, I called once a year for four years to make sure I would continue to receive my full amount and not have Social Security Payments deducted from my benefit which amounted to something over $1800. I was always assure that was true. So based on the contract, the letter and their verbal assurances, my wife and I decided to refinance our house and take enough money to remodel our 1949 house. Mostly is was used to convert the long one car garage that abutted our Master bedroom to a Bathroom, Laundry room and closet and install a Jacuzzi bath for me to soak in for my back pain, plus a new garage in the rear of the property. Had they not given their word both in writing and multiple times verbally, we would have never refinanced. Well about a year after the refinance, I received a small settlement from Workers comp for the temporary Disability for a surgery I had after I stopped working. According to my UNUM contract, I am supposed to report any settlements so they can get their cut. So, being an honest person I sent them a copy of the check and gave them the money they requested from the settlement. Instead of being rewarded for being an honest person, they told me that the Contract, the letter and all the verbal assurances that Social Security would not be deducted was a mistake, and they would start deducting for it from then on. This lowered by benefit from over $1800 a month to $645 a month. That was a $1200 cut in our income! That was in 2008. I of course appealed the decision and again sent copies of the contract and letter. But the appeals process is no handled by an impartial third party, but by UNUM Lawyers, so of course it was denied.
Even though both my pain Management Doctor and my Neurosurgeon have both sent them multiple reports saying I am 100% Permanently Disabled, ever two years they harass me by sending a pile of forms for me and my Doctors to fill out to prove I am still disabled. I just received the latest last week. So I called and spoke with he person that sent the package, who is like the sixth or seventh person that has handled my claim since 2003 and reminded him of my eight surgeries and that my doctors had already told them over and over that I am 100% percent disabled and will never be able to return to work. The agent threatened to stop my checks if I did not comply and was a disrespectful thug and bully. So I filled out his forms and included the report from the latest of the eight AME Doctors the Workers Comp Insurance Company has sent me to, all of which agreed that I am 100% permanently disabled. Then I brought up the Social Security issue again. He became even ruder and told me I was wasting his time as it had already been appealed. I told him it was not a fair appeal if it was made solely by his companies lawyers. I of course got nowhere. He also changed the story from the one I got in 2008. He said the contract had been renegotiated several times between my enrolment date and my claim, and that is was not a mistake like his predecessor told me in 2008. So now the story is completely different. I told him since I was paying the entire payment for the insurance, the contract that I signed should be the one in force and not any other. Especially since I never received any other copies of the contract other than the original one I got when I enrolled.
Since the $1200 decrease in my benefit, we have had to take the difference out of our savings just to pay the higher mortgage. I added up the amount I have lost since they lowered the amount in 2008 and it is over $54,000, and is rapidly depleting our savings. My life now consists of lying in bed 99% of the time, with the other 1% soaking in the bath or going to Doctors. With my secondary medical insurance, dental and prescription drug plan having just jumped to an 800% increase in monthly payments since the national budget passed and water going up 40%, it is becoming harder and harder to pay our bills, due to the lies and despicable business practices of UNUM Insurance.
Do you think I have a case,
Former Employee
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ELaine Wilhelm
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