Edmundo Romberio v. UnumProvident Corporation

385 F. App'x 423
CourtCourt of Appeals for the Sixth Circuit
DecidedJanuary 12, 2009
Docket07-6404
StatusUnpublished
Cited by37 cases

This text of 385 F. App'x 423 (Edmundo Romberio v. UnumProvident Corporation) is published on Counsel Stack Legal Research, covering Court of Appeals for the Sixth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Edmundo Romberio v. UnumProvident Corporation, 385 F. App'x 423 (6th Cir. 2009).

Opinions

STAFFORD, District Judge.

With leave of this court, the defendant-appellant, UnumProvident Corporation (“Unum”), appeals from the district court’s interlocutory order certifying the plaintiffs’ breach-of-fiduciary-duty action as a class action. We now REVERSE.

BACKGROUND

The case was begun when fifteen individual claimants filed seven class actions in six federal district courts1 located in six different circuits.2 The plaintiffs sued Unum, six of Unum’s insuring subsidiaries,3 and two of Unum’s corporate officers, asserting breach-of-fiduciary-duty claims under section 503(a)(3) of the Employment Retirement Security Act of 1974 (“ERISA”). 29 U.S.C. § 1132(a)(3). With one exception, the plaintiffs were covered by group long-term disability insurance policies purchased by their individual employers either from Unum or one of its subsidiaries.4 Some of the plaintiffs [425]*425claimed that they were wrongfully denied long-term disability benefits; others claimed that their long-term disability benefits were wrongfully terminated.

In 2003, the cases were consolidated in the Eastern District of Tennessee by the Judicial Panel on Multidistrict Litigation. Seven of the plaintiffs thereafter settled their claims, and an eighth plaintiff ultimately received the benefits she was seeking. Those eight plaintiffs have been dismissed from the action, leaving seven plaintiffs who seek to proceed with this consolidated action.

A. The Allegations:

The plaintiffs allege that Unum5 devised and implemented a corporate-wide scheme to illegally deny or terminate the long-term disability claims of thousands of disabled Americans, all in violation of ERISA. Specifically, in their Consolidated Amended Class Action Complaint, the plaintiffs allege that Unum engages in the following practices:

a. Instituting targets, budgets, or goals for cost-savings to be attained through the denial and termination of claims; the claims do not receive a proper review by a fiduciary and are denied or terminated based upon UnumProvi-dent’s financial targets rather than the medical and vocational evidence concerning claimants’ disabilities;
b. Providing financial incentives to in-house physicians who will “rubber stamp” previously made business decisions; the physicians thus ignore their appropriate ethical obligations and overlook strong medical evidence that would ordinarily require a disability claim to be approved.
c. Implementing of compensation and/or bonus plans that reward Company management for denying or terminating as many claims as possible to meet special financial goals set by the Company.
d. Authorizing more senior in-house doctors to alter the written reports of other “uncooperative” in-house doctors in order to justify a claim denial or termination;
e. Creating secret documents for each claim, at the time that claims are filed, that, upon information and belief, sets [sic] a target date for cutting off future disability payments; these “Duration Management” documents reflect business decisions made by non-medical claims personnel as to when the company believes claim payments should stop in the future; physicians are not involved in creating these secret documents which are kept outside of the claims file and withheld from claimants, their attorneys, and reviewing courts, and are not produced in discovery during litigation;
f. Encouraging a game among the in-house physicians called the practice of “insurance medicine;” these in-house physicians are prompted, encouraged, and pressured into (1) changing their valid medical opinions as to a claimant’s disability in order to justify a business-driven claim denial; (2) closing their eyes to numerous sources of medical evidence that support a claimant’s disability; (3) remaining quiet about their personal medical opinions that require further analysis, review, testing, and follow up that would reveal the claimant’s obvious disability; and (4) putting “canned” statements into their written reports that, on the surface, appear to validate a previous decision by claims [426]*426personnel to terminate ongoing disability payments to a claimant or to deny a claim in the first instance.
g. Recruiting claims personnel who have a reputation for “closing claims” (cutting off the ongoing monthly benefits of disabled individuals);
h. Designing a system in which claimants who have multiple disabling conditions will never receive an integrated overview as to how all of the disabling conditions combine to disable the claimant; by deliberately fragmenting the claim into a number of pieces and preventing a comprehensive review of individuals with “co-morbid” conditions, the Company ensures that the claimant will not receive a comprehensive and fair review of the claim; and
i. Employing numerous other practices that pressure claims handling personnel into causing claims to be denied or terminated without receiving a proper review.

Allegations regarding the seven plaintiffs who remain in the case include the following:

Theresa Keir worked as a financial systems analyst for a real estate company when she became insured under a group long-term disability policy issued by Unum to her employer. In March of 2000, Keir claimed disability arising out of breast cancer surgeries in her left and right breasts, spinal fusions in her low back, removal of a precancerous ovarian cyst, dermatomyoci-tis, two herniated discs in her neck, and fibromyalgia. Based on an in-house review of her medical records, Unum denied Keir’s claim to disability benefits in December of 2000. On appeal, Unum upheld the adverse benefits decision.

Michelle Lynn Washington was employed as an attorney when she became insured under a group long-term disability policy issued by Unum. On May 29, 1998, Washington claimed disability arising from mitral valve prolapse, iron deficiency, anemia, hypothyroidism, cervical discogenic disease, cervical myofascial pain, L-5 radi-culopathy, fibromyalgia, and depression. Unum paid Washington disability benefits for almost three years before terminating those benefits in 2001 based upon an in-house medical review that purportedly revealed that Washington could resume her full-time employment as an attorney. On Washington’s appeal, Unum upheld the termination of benefits.

Karen Gately was employed as a registered nurse when she became insured under a group long-term disability policy issued by Unum. Gately claimed disability on or about August 1, 1995, arising from fatigue, loss of balance, joint pain and swelling, short term memory loss, and confusion, all arising from lyme disease. After paying disability benefits to Gately for seventy months, Unum terminated her benefits in November of 2001, allegedly because her file contained no objective data regarding her “Epstein Barr virus, lyme disease, chronic fatigue, and cognitive dysfunction.” On review, Unum upheld its decision to terminated Gately’s benefits.

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385 F. App'x 423, Counsel Stack Legal Research, https://law.counselstack.com/opinion/edmundo-romberio-v-unumprovident-corporation-ca6-2009.