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July 25, 2011 at 08:00 PM
A federal court has ruled against an insurance company and in favor of a disability claimant in a case involving interpretation of a summary plan description.
A 3-member panel at the 7th U.S. Circuit Court of Appeals agreed 3-0 to reverse a lower court ruling that favored Unum Life Insurance Company of America, a unit of Unum Group Corp., Chattanooga, Tenn. (NYSE: UNM).
The lower court ruling awarded summary judgment in favor of Unum and against Susie Weitzenkamp, a former sales representative for Time Warner Cable Inc., New York, who filed a claim for long-term disability (LTD) insurance benefits.
In 2006, Weitzenkamp started receiving LTD benefits after she was diagnosed with fibromyalgia, chronic pain, anxiety and depression.
Unum stopped paying benefits 24 months later citing a policy provision limiting payments to individuals whose injuries were based on self-reported symptoms.
A district court denied Weitzenkamp’s argument that her plan’s SPD referred only to a limitation on payments for either mental illness or substance abuse and contained no mention of the self-reported symptoms limitation.
