The 4/5/10 issue of Insurance Law & Litigation Week chronicles the case of Dr. Stephen Buck, a dentist and a client of Unum for long-term disability insurance. The predecessor to Unum issued two disability income policies to Dr. Buck: one in 1984 and another in 1986. The two policies would see Dr. Buck receiving disability benefits totaling $10,433 per month.
It is assumed that Dr. Buck paid the premiums and kept the policies in good standing for 23 and 21 years, respectively. Fast forward to June 4, 2007—Dr. Buck submitted a claim for disability benefits to Unum due to an accident that occurred a little under a year prior, on July 7, 2006. According to Dr. Buck's claim, the accident left him unable to perform his professional duties because of resulting "bilateral post traumatic carpal tunnel syndromes."
A provision in Dr. Buck's policy with Unum required that the insured receive "appropriate care" for his condition. However, Unum denied the claim, citing the requirement that the claimant undergo carpal tunnel release surgery, a procedure that Dr. Buck's treating physician was not comfortable recommending. Buck's physician noted that his patient was not a suitable candidate for corrective surgery because of hypertension, hypercholesterolemia and fluctuation of blood pressure.
Buck launched an action against Unum alleging breach of implied covenant of good faith and fair dealing, together with breach of contract. The defendant moved for summary judgment.
The US District Court for the Northern District of California denied Unum's motion for summary judgment. The district court, noting that neither party cited California state court precedent applicable to the issue, observed that the Seventh US Circuit Court of Appeal interpreted similar policy language and concluded that an insurer could not condition eligibility for benefits on the insured's subjecting himself to surgery to alleviate the disability.
Thus, the requirement that the claimant be "receiving medical care from someone other than himself which is appropriate to the injury or sickness" imposed on Buck the obligation to receive "appropriate care" for his condition.
Beyond Unum's insistence that the claimant undergo surgery to qualify for benefits, the district court found that in this case the plaintiff correctly sought and obtained "appropriate care" and that the care did not include corrective surgery.
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The decision comes as Unum aired a new 30-second television creative, titled "Days Fly By." The commercial features a company that has stood by its employee throughout her long career, partly by offering support such as employee benefits from Unum.
"People work hard every day to help their companies succeed, and that's why many employers depend on Unum to offer them the best benefits possible, such as protection from financial uncertainty," said Joe Foley, Unum's senior vice president and chief marketing officer, in comments published in the 5/2/10 issue of Entertainment Business Newsweekly. "Unum has a host of employee benefits to help employers provide the security their workers need."