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Major Litigation Victory: Riemer Hess Prevails in Chung v. Provident

Riemer Hess is proud to announce a major litigation victory in the case of Chung v. Provident Life and Casualty Insurance Company.  The Honorable Alvin Hellerstein, an esteemed District Judge in the Southern District of New York, ruled in favor of Plaintiff, awarding him $818,865.98 in total disability benefits dating back to his date of disability, along with interest in the amount of $114,332.90, costs of $681.63, and approximately $375,000 in attorneys鈥� fees.  The outcome represents a total win for our client.

Plaintiff鈥檚 Long Term Disability Claim Background

The Plaintiff had a career as a high-profile mergers & acquisitions partner at one of the most prestigious law firms in the country.  After nearly three decades of service, his career came to an early end due to progressive spinal difficulties.

Crucially, the Plaintiff held two insurance policies through his firm, both subject to ERISA regulations:

• • Group Long Term Disability (鈥淟TD鈥�) Policy:  This policy, provided through his employer, offered essential coverage for the Plaintiff鈥檚 long term disability needs.
  • Supplemental Individual Disability Insurance (鈥淚DI鈥�) Policy:  Exclusively offered to partners at the firm, this supplemental policy added an extra layer of protection.

The policies were administered by Provident, a subsidiary of UNUM, the country's largest provider of disability insurance.  Initially, the Plaintiff鈥檚 claims under both policies were approved by UNUM, and he received benefits for approximately two years.  However, the situation took a turn when UNUM sent a letter threatening to terminate benefits under both policies.  UNUM鈥檚 rationale was based on their so-called Independent Medical Examination (鈥淚ME鈥�), which suggested that the Plaintiff could work part-time, even though no such requirement existed in his policies.

UNUM eventually backed down on the threat to terminate benefits under the group policy, but they ceased payment benefits under the supplemental IDI policy, even though both policies had nearly identical definitions of disability.

During the appeal, UNUM relied on the reports of non-examining medical reviewers and one 12-minute-long Defensive Medical Examination.  The Plaintiff provided mountainous evidence with his appeal, including a fully favorable decision from the SSA for Social Security Disability benefits, an expert vocational assessment, and opinion letters from his treating specialists supporting his disability and refuting UNUM鈥檚 defensive examiner.  Despite this, UNUM refused to overturn its adverse decision, thus leading to the initiation of the lawsuit.

The Court鈥檚 Decision to Award Long Term Disability Benefits

In litigation, Riemer Hess successfully established that the Plaintiff could not even work part-time, let alone perform at full capacity, as UNUM alleged.

Key takeaways from this victory include:

• • Challenging Outdated Vocational Guidelines: The Dictionary of Occupational Titles (鈥淒OT鈥�) is a tool used by insurance companies to evaluate occupational demands.  It often is criticized as outdated and limited in its ability to assess what functions are required for different occupations.  The Court鈥檚 criticism of the outdated DOT in this decision serves as a reminder that plaintiffs should challenge an insurer鈥檚 use of the DOT in the future.  Riemer Hess utilized a vocational expert whose analysis identified job duties not specified in the DOT, which played a pivotal role in the case.
  • Judgment and Attorney Fees: The Court awarded benefits through the date of judgment and attorney fees under ERISA鈥檚 fee-shifting provision.  This was the best possible outcome.  Otherwise, the Plaintiff might have dealt with a remand that would have further delayed the payment of his benefits and/or a dispute about whether he is entitled to attorney fees.
  • Validation of Subjective Complaints: The Court鈥檚 decision reaffirms the legitimacy of relying on subjective complaints to establish disability, provided they are credible.  This recognition offers hope to individuals whose disabilities can be difficult to demonstrate via objective evidence.
  • Weighing Credibility of Treating Doctors: The Court鈥檚 finding that the opinions of the treating doctors were more reliable than the reviewing or one-time examining doctor emphasizes the importance of consistent medical care and documentation. 
  • Critical Examination of Defensive Medical Examinations: The Court鈥檚 criticism of UNUM鈥檚 defensive examination process, including its reliance on MRI impression reports rather than the actual MRI films, a brief 12-minute examination, and a lack of goniometer-based range of motion testing, acknowledges that insurers do not always provide thorough 鈥� let alone impartial 鈥� assessments.
  • Focus on Evidence: The Court鈥檚 decision highlights that the diagnosis itself may not be the determining factor; instead, the focus should be on the evidence demonstrating the presence of a disabling medical condition.

The Court鈥檚 Decision on Attorney Fees 

The Court awarded Riemer Hess $374,754.13 in attorneys' fees, fully reflecting the requested amount, along with prejudgment interest at a beneficial 9% interest rate.  This award is crucial in making the Plaintiff financially whole, as ERISA's fee-shifting provision ensures that plaintiffs are not burdened by legal costs when wrongfully denied benefits.  This outcome not only aids in rectifying the Plaintiff's financial losses but also highlights the protective intent of ERISA regulations regarding legal expenses.

Conclusion

The favorable decision in Chung v. Provident demonstrates the importance of challenging outdated tools insurance companies use to justify unfair claim denials and providing strong, objective evidence of your condition.  The outcome reflects Riemer Hess鈥� commitment to excellence and advocacy in representing individuals in need of assistance with their group and individual long term disability claims.  It is also a testament to our reputation as the most aggressive long term disability litigators NYC has to offer.