An addendum to the
ORDER
of 01/28/99.
UNITED STATES FEDERAL COURT
DISTRICT OF MASSACHUSETTS
JUDY E. MORRIS, MD )
)
Plaintiff ) Civil Action No. CA 98-30204 FHF
)
v. )
)
UNUM CORPORATION OF AMERICA, )
et al. )
Defendants
ADDENDUM TO ORDER TO SHOW CAUSE TO ENJOIN UNUM INSURANCE TO SPECIFIC
PERFORMANCE OF CONTRACTS AND TEMPORARY RESTRAINING ORDER PURSUANT TO
FED.RUL. CIV. P. RULE 65
1. This is an addendum to supplement and clarify issues in
plaintiff's previously submitted Order to Show Cause and Temporary
Restraining Order to Enjoin UNUM Insurance to specific performance of
contracts in order to prevent permanent and irreparable harm to
plaintiff.
2. This addendum is also meant to clarify issues concerning ERISA and
fiduciary duties and the Conflict of Interest review standard related to
my group disability insurance contract and the contractual obligations
and fiduciary duties of my ex-employer Harrington Memorial Hospital,
Inc., UNUM, Richard Mangion (ERISA Defendants).
3. This addendum hereby incorporates and reiterates my previously
submitted Order to Show Cause and Temporary Restraining Order as if set
forth here in full, and is for purposes of supplementing the record. It
does not diminish in any way the statements and evidence in previous
Order to Show Cause and incorporates same documents as attachments.
4. First I would like the court to be aware of defendant UNUM's
response, through their attorney Patricia Peard to my telephone
notification of the impending filing of the Order to Show Cause and
Temporary Restraining order as well as my simultaneously filed Motion to
Disqualify Pat Peard. See Attachment (a).
Based on this and previous letters, it certainly appears that UNUM
and Ms. Peard have made absolutely no effort to justify their fraudulent
denial of my disability claims nor justify UNUM's oppressive and
dangerous claims tactics. They apparently expect this Court and me to
believe they are innocent simply because they say they are. They have
neither Common Law, Case Law or Precedent, Medical Justification, ERISA
law, or common sense justifications for any of their actions.
5. As stated previously, I have presented medical evidence that
constituted proof in the eyes of my doctors, my insurance agent and
independent broker and my employer that I am disabled by policy
definition. "'Totally disabled' meaning injury or sickness restricts the
Insured's ability to perform the material and substantial duties of his
regular occupation to an extent that prevents him from engaging in his
regular occupation." (Individual Policy) and "'Disability' and
'disabled' mean that because of injury or sickness:
1. you cannot perform each of the material duties of your regular
occupation; or
2. you, while unable to perform all of the material duties of your
regular occupation on a full-time basis, are;
a. performing at least one of the material duties of your occupation on
a part-time basis or full-time basis; and
b. earning currently at least 20% less per month than your indexed
pre-disability earnings due to that same sickness or injury." (Group
Policy).
Although I have limited my question of disability to whether or not
I can perform as an Emergency Room Doctor, there is still a great
question remaining as to how employable I would be in any field given
the uncertain nature and unpredictability of Chronic Fatigue Syndrome.
However, there is no provision in my policies that states I must attempt
to return to work, against my doctor's advice, in any capacity.
However, if the question is limited to Emergency Medicine, I have
clearly met the burden of proof that "Insured is 'wholly unable to
perform any work' within total and permanent provisions of life
insurance policy, if he can do no work without seriously endangering his
health or risking his life." M.G.L.175 § 24,Note 2. In my occupation
the lives of others might also be endangered. This type of work is
clearly contraindicated by the recommendations of the National
Institutes of Health that "It is important for people with CFS to slow
the pace of their lives, and avoid or reduce their exposure to
situations that are physically or psychologically stressful." Attachment
(b). The only provision in either policy granting UNUM discretion are
the following statements (Individual Policy) "How and When we pay
benefits. We will pay benefits due under this policy in United States
dollars. We will not pay any benefit until we have sufficient Proof of
Loss. When we have determined that the claim is payable we will pay
according to the Benefits provision." (Group Policy) "When are claims
paid. When we receive proof of claim, benefits payable under the policy
will be paid monthly during any period for which we are liable."
None of these statements gives UNUM the right to interpret plan or
policy, medical evidence, case precedent or the law contrary to State
law, ERISA law, Criminal law and accepted medical practice. I asked
UNUM repeatedly to tell how I could prove my claim, if they needed
further proof prior to the time of claim denial, and what they wanted.
I would have been willing, at that time, to get tested or attend an
IME. I was never advised to do such.
6. Despite the fact I did experience depression as part of the
manifestation of my Chronic Fatigue Syndrome, and that both policies
contain limitations or restrictions for mental illness, Brian Dorsk v.
UNUM, No 97-97-P-C(Me.D.Apr. 10, 1998) clearly states that the doctrine
of contra preferentum would dictate a finding in favor of coverage for
me for a physical disorder, and negate these limitations and exclusions.
7. Because Black's Law Dictionary includes in its definition of Good
Faith "An honest intention to abstain from taking any unconscientious
advantage of another, even through technicalities of law ..." the efforts
not only of UNUM but of all the defendants in Morris v. UNUM to attempt
to have this lawsuit dismissed, not on its merits, but on legal
technicalities is Prima Facie evidence of bad faith on the part of all
these defendants and their attorneys.
8. Issues relating to ERISA and Fiduciary Duties to myself and other
Plan Beneficiaries by UNUM and Harrington Memorial Hospital, Mr. Mangion
and Jack Taylor.
The Harrington Hospital ERISA Long Term Disability Plan long ago found
me disabled under the plan terms and entitled to benefits.
However instead of paying me the benefits and seeking indemni-fication
from UNUM, or otherwise enforcing their direction to UNUM to pay me,
they have sat on the sidelines without the courage of their convictions
or the decency to pay their obli-gations. I ask that the court require
that UNUM and/or the other ERISA defendants, Harrington Memorial
Hospital, Mr. Mangion and its agent Jack Taylor be ordered to pay the
monthly benefits owed to me and to which I became entitled when I became
disabled from my occupation as an ER physician. They have not honored
these obligations despite their admission that I am totally disabled.
They have instead, as they have done before, chosen to ignore the terms
of their contracts, the ERISA plan and the dictates of multiple state
and federal laws. These abuses of fiduciary duty and of contractual law
by ERISA De-fendants have at times been so egregious as to amount to
cri-minal activity. I ask this court to enforce those agreements that
UNUM, Harrington, and Jack Taylor so cavalierly disregard and order them
to pay my monthly benefits under the group po-licy. UNUM should be
ordered to pay the benefits under the Individual policy, or if not UNUM,
than it's agent, Betty Rae Poppo.
9. As stated in the previous Order to Show Cause, I am being
irreparably harmed with each day that goes by that UNUM and the other
defendants are allowed to defy the law by depriving me of benefits to
which I am entitled and further attempting to deprive me of Due Process
and keep me ignorant and confused as to my legal rights. I am (1) in
immediate and real jeopardy of suffering even greater and more
irrevocable losses of health, mental and physical, as well as, fiscal,
and (2) as demonstrated numerous times, I will prevail on the merits of
these claims for benefits. Harrington and the ERISA defendants admit I
am entitled to the benefits claimed, but while admitting the plan's
liability contend that the UNUM should pay all benefits and (3) the
balance of hardships is clearly in my favor. UNUM and Harrington can
fiscally afford to pay their obligations to me whereas it is becoming
increasingly very difficult for me to meet my debts and living expenses
and (4) the public interest mitigates in favor or requiring insurance
companies and ERISA plans to honor their legal obligations to their
policy holders and/or plan beneficiaries including treating them in
accordance with state and federal laws. There is no reason why these
benefits, now over $280,000 should not have been paid in the past and
should not be paid now. I am harmed now by past benefits unpaid. I
will be harmed irreparably if it continues. There is no legal or
adequate remedy for what I suffered and continue to suffer.
10. At the time of the start of my employment with Harrington Hospital,
I was given, as a benefit of employment, a policy for disability
benefits. Although I was diagnosed with Chronic Fatigue Syndrome in
April 1995, I was able to continue to work, despite increasingly severe
symptoms and hardships, and sometimes at great risk to myself and my
patients, until I became incapacitated in October 1996. When I applied
for disability benefits through the Harrington Plan, I was assured, and
continue to be assured by the hospital's insurance agent Jack Taylor
that the hospital's ERISA plan and UNUM Policies should pay me as I met
the definition of disability in the policy. The plans, both the
individual and group policies state that they promised to pay benefits
if I was disabled by a sickness that impaired my ability to be an
Emergency Doctor. The plan fiduciaries at Harrington Hospital and my
insurance agents never faltered from that opinion. In fact that plan's
fiduciaries have determined I am owed its benefits, but contends that
the entity primarily responsible for their payment, UNUM, will not
comply with the trustees direction. They in essence, offered me a
useless and dangerous "benefit" as part of an inducement to work at
Harrington and have all but abandoned me to the mercies of UNUM when I
rightfully tried to claim my benefit.
Charlene Richard, head of Employee Resources at Harrington Hospital
acted as a plan fiduciary by helping me fill out forms and acknowledging
the validity of my claims. She has not yet been named as a defendant in
this lawsuit but I reserve the right to name her at a later time. At the
present time I believe she was merely following the orders of Mr.
Richard Mangion. She was in contact with the hospital's insurance agent
Jack Taylor and ratified his writing of a letter to UNUM telling them
they must pay this claim. Despite the contentions of all the ERISA plan
fiduciaries and the incontrovertible evidence in this case that I should
be paid benefits under this plan, Charlene Richard, Richard Mangion,
Harrington Hospital and Jack Taylor have all consistently declined my
invitations to them to either honor their fiduciary obligations by suing
UNUM with me, or by simply paying the benefits admittedly owed by UNUM,
or in fact helping me in any way. While Harrington's and the ERISA
defendants clearly do not wish to have UNUM's breach of its fiduciary
obligations to the Harrington's LTD plan be theirs, they fail to realize
their obligations. Even now, the ERISA plan defendants seek to avoid
their obligations through legal technicalities and by merely saying
"UNUM did it, not us." While true, it is a failure they have known of
and could have been corrected by them. Instead they simply disagreed
with UNUM and to their credit protested UNUM's failure, although clearly
not enough. However their knowledge of wrongdoing required them to act
further to protect me and the plan and themselves. They didn't. UNUM's
failure is their responsibility to correct. It should be corrected now.
With regards to my Individual policy the broker, Betty Rae Poppo
assured me that she saw no problem with my claim for benefits for
Chronic Fatigue Syndrome and Fibromyalgia and that it was not considered
a mental disorder. She took a week to investigate this question at my
request before I filed my claim. She predicted prompt payment. In fact
even after UNUM fraudulently denied my claims under this policy UNUM
insisted I had to continue to pay the policy premiums, premiums upon
which Betty Rae Poppo continued to collect commissions. The statement
that I must continue to pay premiums was fraudulently backed up by the
Massachusetts Department of Insurance, much to my dismay.
Betty Rae Poppo refused to even so much as write a letter to UNUM
despite her offers to help me, yet did not object to collecting
commissions on my premiums that I paid even after UNUM fraudulently
denied my claim.
11. UNUM's Conflict of Interest. It boggles the mind that even when a
medical doctor, her employer, a hospital and her treating medical
doctors, some of whom are experts in the field are united in their
opinion, that they can all be ignored by an insurance company intent on
keeping its money. It operates at its pleasure and treats the law as
something to be ignored. It is certainly obvious to myself and others.
Hopefully the court will soon see what we see - A company run amuck.
This situation is clearly explained by UNUM's Conflict of Interest. I
am only 40 years old, my disability is probably incurable, and UNUM
would be required to pay me benefits until the age of 65 which would be
a very substantial amount of money.
However that does not absolve them of their contractual and fiduciary
responsibilities, from which they profited for years by my willingly
paying them substantial premiums. Their behavior can only be explained
from the context that UNUM in its dual role as both funding source and
plan administrator has an inherent conflict of interest. UNUM is a
stock company and the financial analysis done of UNUM by Roy E. Gill, as
a companion piece to John O'Connell's "Evil Mind" document clearly
demonstrates that UNUM's profits were in jeopardy by increased claims
during the years shortly before plaintiff filed her claims. Attachment O
of previous Order to Show Cause. And if that isn't enough, we have the
statements and boasts of UNUM's Executive James F. Orr that the company
focuses first on "double-digit top and bottom line growth" and building
"shareholder value" in it's Annual Reports. UNUM's advertising boasts
of "Financial strength and long term stability" and its performance in
the stock market. Also notable is the salary and stock awards paid to
executives. Attachments (c) and (d). As demonstrated by their behavior
to plaintiff and others similarly situated, UNUM's claims of caring
about customer service extend only until a claim is filed. At that
point they clearly mistake etiquette for ethics with their phony
apologies in every letter. In fact, they even go so far to boast in
newspaper articles that their "success sharing" program rewards
employees based solely on UNUM's "bottom line." Attachment (e).
Unfortunately, although some costs can be lessened in any organization
and clearly some disabled claimants can be rehabilitated and resume part
or full time work, in situations such as mine and thousands of others,
not only is the chance of rehabilitation slim based on current medical
knowledge and job requirements, but UNUM made no effort to even work
with the me in any way and clearly conducted an investigation geared
only towards finding or fabricating a pretense (as unbelievable as it
is) to deny my claims and force me to try to sue them. In their own
document the "Chronic Fatigue Syndrome Management Program" Dr. Carolyn
Jackson states that "UNUM stands to lose millions if we do not move
quickly to address this increasing problem." Attachment (f). Paying my
claim and the claims of thousands of others similarly situated would
clearly affect UNUM's profitability. Unfortunately UNUM's response to
this problem was to set up or beef up Units (Complex Claims Units,
Special Investigations, so call Anti-Fraud Units) for purposes of
dealing with claimants in the same criminal manner as I have been dealt
with. I was subjected to criminal fraud, invasions of privacy,
intimidation, harassment, pervasive deceptions and stonewalling, forced
litigation, and more all in the hopes that I will settle for less than
my contractual benefits or be forced to give up my claims entirely due
to inability to find and/or afford adequate and competent legal
representation.
What is incredibly mindboggling to me is that these same insurance
company tactics have been revealed in countless cases in countless
courts across the country by countless insurance companies, and yet
these criminal activities of fraud and extortion continue to be
portrayed by lawyers and judges as merely "abuses of discretion" or
"aggressive business tactics."
U.S. v. Dischner, 974 F.2d 1502 (9th Cir.) states that when the evidence
presented in a court is that criminal activity is occurring and that
when that evidence surpasses a "preponderance" and approaches "beyond a
reasonable doubt," the judge is duty bound to turn it over for criminal
prosecution by the DOJ. Ordinary citizens are routinely indicted and
found guilty of criminal fraud and extortion for single incidents of
what insurance companies engage in as a matter of company policy.
(Aside: Witness the simple lies that have gotten our president in such
hot water.)
Continual denial of claims by the same insurance company that lists
(or doesn't exclude) CFS as a covered illness when the Courts have
adjudicated against the company (or other similar companies) in favor of
the CFIDS patients clearly violates the Federal Racketeering act (RICO
18 U.S.C.).
12. All of these facts were known to the ERISA plan defendants when
they submitted the group claim to UNUM, or were made known to them by me
as they occurred. That claim, supported by the hospital and its
administration was also supported by treating physician statements from
three doctors saying that I was disabled from CFS and FMS was not to be
good enough for UNUM. Instead UNUM fraudulently denied my disability
benefits under both policies. UNUM did make a $4000 payment to me on my
group policy under the pretense that I was depressed. I'm the first to
admit that suffering from a confusing, debilitating disease while trying
to continue to work at a stressful job with long hours and high risks,
which I hesitated to quit because I found it so rewarding emotionally;
then being sued, losing my job and then finding out that, contrary to
its representations, I was betrayed, mislead and defamed by my
supposedly "reputable" insurance company, my employer, my insurance
broker, the Massachusetts Department of Insurance, and finally my
government, has left me, at times emotionally devastated, and prone to
mood swings and suicidal thoughts; the fact remains that all of my
doctors concur that my primary problem is not psychological but
physical.
13. UNUM conducted its claims investigation with one goal in mind,
that being, not paying these benefits. To that end they fraudulently
diagnosed me with mental illness, and then even with a mental illness
diagnosis refused to pay benefits on the group policy. As UNUM's funds
come out of its own pockets, its greed caused it to ensure that neither
policy would be paid. It would rather breach its own duty to the
Harrington Plan and its beneficiaries than pay these benefits, even if
that breach results in danger or death to beneficiaries. They collected
only information they needed to attempt to prejudice my record (although
I believe they were largely unsuccessful at doing that) and protested
when I sent them unbidden information. They went through an elaborate
charade of pretending to be interested in the details of this case when
all they were interested in was prejudicing the record with defamatory
statements and innuendos, even going so far as to fraudulently attribute
some of them to my treating physicians. The best UNUM can come up with
to claim I haven't proved my disability is that I was videotaped doing a
lot of driving. Even then, Dr. Pringle's assertions that I was able to
engage in activities for greater than 12-14 hours is grossly exaggerated
and indicates that she didn't even read the PI reports, as inaccurate as
they were. My policies have no requirement that I "look sick" in order
to collect my benefits.
And the activities I was engaged in while under investigation are no
measure whatsoever of the physical and mental requirements of regular ER
work. Not only that, but even the reports of these investigations show
impairment (the ones that were accurately reported anyway). And I'm
sure UNUM will try to claim that my typing this lawsuit and doing the
research involved proves I'm not disabled from ER work. Once again, as
I've stated before, this statement is ludicrous, medically baseless, and
has no scientific or common sense rationale to back it up. It is pure
defamatory conjecture. As I've stated before, if UNUM knows of some
objective scientifically proven method of proving conclusively that I am
not disabled from performing my occupation on a regular basis, than they
should have told me to have this test done.
14. Attachment (g) is yet another compilation of case law and precedent
that UNUM knew existed, and if they didn't I had informed them of much
of it, at the time that they were and still are claiming they have the
right to torment me by denying my benefits, claiming I haven't proven my
claim, and yet continuing to refuse to tell me how anyone could prove
any claim to their satisfaction. Your Honor, by UNUM's perverse logic,
should you ever file a disability claim for any reason, UNUM would find
you not disabled if you were able to sit in a comfortable chair for 3
hours at a stretch.
15. Although I hope that suicide is no longer an option for me, the
reality of Chronic Fatigue Syndrome is that sufferers are prone to
exaggerated and unpredictable mood swings. Because of my strongly
independent character, it is certainly possible that faced with a life
of dependency on others, especially when I had taken great pains and
paid good money to insure that would not happen, I could become
suicidal, especially as a result of sudden or unexpected shocks,
betrayals or setbacks on top of the ongoing stress and uncertainty of
this litigation. As mentioned elsewhere, several UNUM claimants have
succumbed to suicide. Based on plaintiff's knowledge and experience,
both personal and medical, these suicides would not have occurred but
for UNUM's despicable actions. Every day that goes by without justice,
without relief from the tension and stress of waiting for my wrongs to
be righted by the courts, increases the risks that sudden shock,
betrayal or setback will induce me to commit suicide. I have recently
had to start taking tranquilizers on a daily basis, something I have
never had to do before. Suicide is, of course, irreparable injury.
16. With my financial cushion rapidly dwindling, mounting bills,
new expenses related to this litigation and unforeseen costs, the
tension also rises and the risks of irreparable harm to my credit,
comfort, and even my ability to earn a living as a doctor, if I cannot
afford to keep up my medical licensure.
My home is threatened, my profession is threatened, my health is
threatened, my ability to prosecute this case is threatened, even my
life is threatened by UNUM's continued defiance of the law by refusing
to pay me and deal with me in good faith. Each of these harms is real
and imminent.
17. As before, I beg this court to attempt to right these wrongs. Your
honor, you have in your power, the ability to stand up for justice, to
help me finish what I have started, namely hold people accountable for
their words, their deeds, their promises, and their obligations as
Citizens of (what should be) the most just country in the world, the
United States of America. Please, your honor, I am asking you not to
wait to issue this Order and TRO. Not to wait an extra three weeks,
that because of the multiplicity of defendants could easily turn into
three months. You've seen the evidence, the case precedents, my medical
records, my contracts, and UNUM excuses. What could they possibly say
in Oral arguments that would refute all this? Please don't keep me in
limbo and increase my stress. And if, even with all this, you feel I
haven't proved my claims for benefits, please advise me so I can
rectify, if possible the situation.
18. In this and the previous Order to Show Cause I have clearly met
the elements of the Fed. Rul. Civ P 65 to demonstrate 1) a likelihood of
success on its merits, 2) irreparable harm, 3) harm to plaintiff that
outweighs harm to defendants, and 4) lack of damage to any public
interest. Classic equitable principles would make the immediate granting
of this order mandatory. Moore's Federal Practice, Section 62.22[5];
Planned Parenthood League v Bellotti, 641 F.2d 1006, 1009(1st Cir.
1981), Ciriton-Garcia v. Barcelo, 671 F.2d 1,3(1st Cir. 1987),
Vargas-Figueroa v. soldano 826 F.2d 247 (1st Cir. 1987), Cohen v. Brown,
991 F.2d 888, 905-906 (1st cir. 1993), Hinkley v. Kelsey, 866 F. supp
1034, 1044-45 (E.D. Mich. 1994), "In considering requests for equitable
relief against fidu-ciaries the court will grant relief where abuse is
shown to exist." W.F. Fratcher, Scott on Trusts (4th ed. 1987), Section
197 et seq. Although I will not go homeless tomorrow, delays or weeks or
months could certainly affect my physical and emotional health adversely
as continued psychological stress is known to have negative effects on
the immune system. Merrill, Lynch, Pierce, Fenner and Smith v. Bishop,
839 (D. ME 1993), Cirelli v. Town of Johnston Schl Dist., 288 F. supp.
141 (DRI. 1995). Although the above case precedents dealt with
different issues they clearly show that courts can order immediate
Temporary Restraining orders when the four elements of Rule 65 have been
clearly met. In my case, the issue is not merely my financial well
being but my life and sanity which may be in danger.
The conclusion and inevitable outcome of this Order to Show Cause and
Temporary Restraining Order to Enjoin UNUM, the ERISA defendants and
Betty Rae Poppo, from continuing their egregious breach of contracts
must be an immediate decision to Order UNUM or the other defendants to
pay the plaintiff the money and benefits owed as detailed in preceeding
Order to Show Cause (Attachment R of previous Order to Show Cause).
This will at least give plaintiff some peace of mind, some relief from
financial stresses, and some resources to maintain herself until a trial
on the merits of these claims and the Racketeering charges can occur.
19. Since UNUM has based their denials of plaintiff's claims in her
supposed failure to prove her claim, plaintiff also prays this court
enjoin UNUM from now or in the future asserting new pretenses, defenses
or excuses to deny her claims.
20. Signed under the penalties of perjury this 4th day of February,
1999.
Judy E. Morris, MD
PRO SE
CERTIFICATE OF SERVICE
I hereby certify that a true copy of the above document was
delivered in person February 4th, 1999 to US District Court, District
of Massachusetts, Springfield and served by United States Postal Mail,
postage prepaid upon the following attorneys representing all defendants
in Morris v. UNUM, et al. Mailed on February 4, 1999.
Judy E. Morris, MD
PRO SE
Patricia A. Peard, Esq., Katherine A. Robertson, Esq., William J.
Kayatta, Esq., H. Gregory Williams,Tracy L. Devlin, Esq., Michael
Sloman, Esq., Thomas H. Hayman, Esq.,Robert Pierce, Esq., Christopher N.
Jones, Carolyn G. Sullivan.
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Created: February 5, 1999
Last Updated: May 28, 2000