Posted on Mon, Nov 22, 2010 @ 03:14 PM
Unum life insurance Company of America, and its subsidiaries Provident Life & Accident insurance Company and Paul Revere life insurance company, are among the most aggressive long-term disability carriers in the country. As Austin long term disability denial lawyers, we have litigated against Unum many time. If you have employer-provided long-term disability insurance with Unum, there’s a good chance you’re going to be denied, if you have not been already.
Most UNUM policies contain a change in the definition of disability after 24 months of benefits have been paid. For the first 24 months, a claimant typically qualifies for benefits so long as he is unable to perform the material duties of his own occupation. After 24 months, a claimant qualifies for benefits only if he is unable to perform the material duties of any occupation for which he is reasonably fit. Most claimants are denied at the 24 month own occupation/any occupation transition.
In a practice that is almost unique among major long-term disability insurance carriers, Unum uses, almost exclusively, in-house medical professionals to conduct appellate reviews of denied claims. This means the “doctor” conducting a claimant’s appellate review is, in actuality, an employee of Unum itself. It is not surprising that many times these appellate reviews conducted by in-house medical personnel contain numerous mistakes.
In a recent case I argued before the Fifth Circuit Court of Appeals, the court found that multiple mistakes committed by Unum reviewing doctors affected those appellate reviews to the extent that they could not be considered substantial evidence in support of Unum’s decision to deny benefits. If your claim and appeal have been denied by Unum, it is therefore crucial to go through the entire administrative record carefully in order to locate any mistakes committed by Unum review personnel. These mistakes can often be used to overturn a wrongful denial of benefits. View that decision, Scheurmann v Unum.
| Have you been denied LTD Benefits by Unum?Visit Lonnie Roach’s page to arrange your free legal consultation today. |
Posted on Sun, Mar 21, 2010 @ 05:54 PM
Negligence, as it relates to the law, is generally defined as conduct which a reasonably prudent person would not do, or the failure to do something which a reasonably prudent person would do under like circumstances, resulting in an unintended injury to another party. For a plaintiff to recover damages, this action or failure must be the “proximate cause” of an injury, and actual loss must occur. It is usually the function of a jury to determine whether negligence occurred, and the obligation of the plaintiff to demonstrate the defendant’s negligence by a preponderance of the evidence. Negligence claims are a leading source of modern civil litigation. Common negligence cases include car accidents, truck accidents, DUI accidents, manslaughter, product liability, and medical malpractice lawsuits.
For example, an individual who drives under the influence of alcohol or drugs is acting negligent. They are aware of the effect of alcohol or drugs on their behavior and yet they still choose to get behind the wheel, intentionally putting others at risk with their impaired driving capacity. For drunk driving victims, a DUI attorney can often prove negligence if the person was under the influence behind the wheel.
The concept of negligence was developed under English law. Although English common law imposed liability for the wrongful acts of others, negligence did not emerge as an independent cause of action until the eighteenth century. Another important concept which emerged at that time: legal liability for a failure to act. The concept of negligence passed from Great Britain to the United States as each state (except Louisiana) adopted the common law of Great Britain (Louisiana adopted the civil law of France). While there have been notable developments in negligence law, the basic concepts have remained the same since the eighteenth century.
The law considers a variety of factors in ascertaining whether an individual or manufacturer has acted as a ‘reasonable person’ would have acted in a similar situation. These factors include the knowledge, experience, and perception of the person, the activity the person is engaging in, the physical characteristics of the person, and the circumstances surrounding the person’s actions.
For instance, if a person engages in an activity requiring special skills, education, or training, such as driving a semi truck, their conduct is measured against the conduct of a reasonably skilled, competent, and experienced person who is a qualified member of the group authorized to engage in that activity. The law also takes a person’s physical characteristics into account in determining whether that person’s conduct is negligent. Children may be negligent, but they are not held to the same standard of conduct as adults. A child’s conduct is measured against the conduct expected of a child of similar age, intelligence, and experience.
Most states have now adopted the concept of comparative negligence in place of pure, contributory negligence. With comparative negligence, also referred to as comparative fault, a plaintiff’s damages are reduced by a percentage his/her own fault. This requires the jury to determine, by percentage, the fault of the plaintiff and the defendant as the cause of the plaintiff’s injury.
Although it might seem obvious whether a defendant’s negligence has caused injury to the plaintiff, issues of causation are often very difficult to establish. Each Texas board certified personal injury attorney at Austin Law Firm Bemis, Roach and Reed understands the laws that can affect the outcome of a personal injury claim relating to negligence. To schedule a free consultation with a qualified Austin attorney, call toll free (866) 433-4979.