Close Close

Life Health > Health Insurance > Health Insurance

5th Circuit rules on disability investigation

Your article was successfully shared with the contacts you provided.

A group disability plan administrator may have no legal duty to investigate the source of reports of malingering.

A three-judge panel at the 5th U.S. Circuit Court of Appeals has come to that conclusion in a ruling on Truitt vs. Unum Life Insurance Company of America (No. 12-50142).

The plaintiff in the case, Terri Truitt, said back, leg and foot pain kept her from working as a lawyer.

Her disability insurer, a unit of Unum Group Corp. (NYSE:UNM), awarded her benefits in May 2003. When the insurer had professionals review her case, some found that she really was disabled, and some concluded that she was exaggerating her pain and had little or no physical impairment.

In 2007, a former boyfriend called the insurer and sent the insurer an e-mail. The former boyfriend said Truitt had gotten him “deported to the United Kingdom,” and that “as a result, he wanted to ‘see the b**** locked up,’” Circuit Judge Stephen Higginson wrote in an opinion explaining the decision.

The former boyfriend asked the insurer to pay him an amount equal to six times Truitt’s monthly benefit for evidence that she was getting disability payments under false pretenses.

The former provided more information about Truitt, including flight itineraries and eTicket records, without compensation, Higginson wrote.

Truitt also provided evidence that Truitt had resumed practicing law, Higginson said.

When Unum terminated benefits payments and asked for $1 million in reimbursements, Truitt challenged the evidence Unum had used to terminate her benefits.

A district court in Texas ruled in favor of Truitt, saying the weight Unum had placed on the former boyfriend’s e-mails made the Unum decision “arbitrary and capricious.”

The 5th Circuit panel notes that Unum conducted a thorough investigation and used many medical and vocational experts, many of whom were unaware of the ex-boyfriend’s communications.

Unum also had other evidence that Truitt was not disabled, Higginson wrote.

“In sum,” Higginson wrote, “we hold: that Unum did not have an affirmative duty either to investigate the accuracy of the e-mails or to investigate and further consider their source…. Unum did not abuse its discretion.”

Truitt’s lawyer was not immediately available for comment.

A Unum representative said the company believes the ruling speaks for itself and has no further comments.

See also: