Patricia E. Patrick v. UNUM Life Insurance Company of America, and American Rock and Asphalt Long Term Disability Income Plan
Published: Oct. 9, 1999 | Result Date: Aug. 10, 1999 | Filing Date: Jan. 1, 1900 |Case number: 388506 Bench Decision – $1,456,070
Judge
Court
San Mateo Superior
Attorneys
Plaintiff
Terrence J. Coleman
(Pillsbury & Coleman LLP)
Defendant
Anna M. Martin
(Meserve, Mumper & Hughes LLP)
Facts
ACCORDING TO THE PLAINTIFF: Plaintiff worked as a weighmaster at a rock quarry for 13 years. In 1989, she developed severe noise induced hearing loss on the job and tinnitus. Her treating doctors recommended that she leave her employment which she did in April 1989. The plaintiff was insured under an own-occupation disability policy issued by defendant UNUM Life Insurance Company of America. The plaintiff submitted her claim for benefits in July 1989. UNUM approved the claim and paid benefits to her for the next five years. During the five years of disability payments, the claim was transferred several times to different claims representatives. In 1993, her claim was transferred a new representative in UNUMÆs special risk unit. The new representative was 23 years old and been handling long-term disability claims for six months. The new representative had complete authority to deny plaintiffÆs claim without supervision or consultation with anyone at UNUM. The representative terminated the plaintiffÆs benefits in January 1994. The representative reasoned that there may be other weighmaster jobs she could perform for other employers which did not require working in noisy areas or verbal communication. In April 1999, the case proceeded to court trial only on plaintiffÆs claim under the federal Employee Retirement Income Security Act (ERISA). At trial, UNUM, among other things claimed that plaintiff was never disabled from her prior weighmaster job based on noise readings it collected at the job site in 1995 and in 1999. FACTS ACCORDING TO THE DEFENDANT: In 1989, plaintiff, a 56-year-old woman, had been a weighmaster at a rock quarry for 13 years. The plaintiff developed a hearing loss for which she sought medical treatment. Several physicians opined that she had developed a noise induced hearing loss based on plaintiff's statements that she worked around extremely loud truck engines. None of her physicians visited the plaintiff's job site, or reviewed noise testing from her job site. The plaintiff left her job because of her complaints that noise from the trucks was hurting her ears. The plaintiff submitted her claim for disability benefits in July of 1989. Benefits were paid on the belief that her hearing loss was caused by truck noise at work and that exposure to the trucks would further damage her hearing. In 1993, UNUM received a report from plaintiff's then treating physician Dr. Roger Smith advising that plaintiff could be safely exposed to noise up to 80 decibels on a time weighted average. UNUM investigated whether the noise exposure to a weighmaster exceeded Dr. Smith's recommendation. UNUM determined that it did not and denied further benefits. The plaintiff appealed UNUM's decision and it was upheld on appeal by a separate department of UNUM.
Injuries
Hearing loss and tinnitus.
Result
Judgment for plaintiff in the amount of $1,456,070, plus an injunction ordering defendants to commence paying monthly disability benefits and prohibiting defendants from discontinuing benefits until either upon the death of plaintiff or July 15, 2007, the end of the maximum benefit period under the policy.
Other Information
ACCORDING TO PLAINTIFF: The trial court issued an 11-page Statement of Decision in which it characterized UNUMÆs decision to terminate benefits as unprincipled and ruled that under de novo review under ERISA, that plaintiff has been continuously disabled since 1989 and that her condition is permanent. In its order granting plaintiffÆs motion for prejudgment interest, attorney fees and costs, the court stated the UNUMÆs conduct could only be termed bad faith under state law including its actions of making extended payments under disability policies followed by referral to a special unit of the company followed by an offer to settle for significantly less than the contractual obligation to the insured followed by spying on the insured and precipitous denial of benefits on inadequate grounds. In its order, the court stated that "For reasons best known to Congress, ERISA insulated the insurance carriers from financial punishment for even the most egregious conduct." In awarding attorney fees in the amount of $1,249,038, the court multiplied the lodestar amount by a factor of 2 reasoning that without such a multiplier no rational attorney would accept a case of this nature which was the end defendants sought to achieve.
Poll
____-___ (Nos. pls.)
Length
12 days
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