Lawsuit Says Unum Unfairly Terminated Disability Benefits

At the time of the accident, Sosinski was insured by Unum under a policy through his employer welfare benefit plan governed by ERISA. ERISA is the federal law that dictates employee benefit plans.

“A civil action may be brought by a participant of beneficiary to recover benefits due to him under the terms of his plan, to enforce his rights under terms of the plan, or to clarify his rights to future benefits under the terms of the plan,” the law states.

Sosinski received $941.23 in benefits per month from Unum until June 19, 2013. However, the Unum lawsuit claims that the Michigan resident’s disability benefits should continue, according to language in the policy.

The Unum lawsuit claims that the insurance company cannot agree to pay Sosinski under the terms of the policy for four years and have a different interpretation of the same policy four years later, when nothing has changed.

Sosinski was intoxicated at the time of the car accident and he disclosed this information to Unum when he applied for his benefits, and Unum decided that he qualified for accidental disability benefits with that knowledge. In the letter the Michigan man received on June 19, in which his benefits were terminated, Unum explained that it changed its interpretation of the language in the policy that talks about what would exclude someone from receiving their benefits, the “commission of a crime for which you have been convicted.”

However, Sosinski was never convicted of a crime. Because he was incapacitated due to his injuries and unable to participate in his misdemeanor proceedings, Sosinksi pleaded “no contest” to the allegation that he operated his vehicle “while impaired” and followed the punishment that was given to him by the court, with the understanding that it was not a conviction.

The Unum lawsuit explains that Unum does not define what it means by “commission of a crime for which you have been convicted” in the way it did when it used the language to deny Sosinski his benefits in June.

According to Michigan law, unclear or poorly defined language in insurance policies are supposed to be interpreted in the favor of the insured and against the insurer, in this case Unum.

Also, “exclusionary clauses in insurance policies are strictly construed against the insurer.”

In addition, Michigan law does not allow evidence of conviction or a civil infraction to be used in the way that Unum tries to use it in this case.

According to Sosinksi’s Unum policy, he should receive disability benefits until he turns 65 on April 8, 2051

Sosinksi tried to appeal Unum’s decision through the administrative process, arguing that Unum did not define the exclusionary clause, before pursuing litigation.

“Even assuming defendant’s plan exclusion encompassed plaintiff’s alcohol intoxication and no contest plea as a ‘conviction,’ it cannot be legally used to deny his long term disability benefits,” the lawsuit states.

Because “an offer to plead guilty or [no contest] to the crime charged or any other crime, or of statements made in connection with, and relevant to, any of the foregoing pleas or offers, is not admissible in any civil or criminal proceeding against the person who made the plea or offer.”

Sosinski is asking for his benefits to be reinstated and to be awarded damages, interest, costs and attorney fees.

Sosinski filed his Unum lawsuit in the U.S. District Court in the Eastern District of Michigan, Southern Division on August 20, 2013.

If you or someone you now had insurance benefits run out prior to when they should have as a customer of Unum Life Insurance Co. of America, legal options are available. Learn more and get a free legal consultation regarding a claim’s eligibility at the Unum/UnumProvident Disability Insurance Claim Denial Class Action Lawsuit Investigation. Experienced legal professionals are available to determine if you have case, so act now.