Disability Insurance Law Group Files Appeal and Wins Long-Term Disability Benefits for Claimant Denied by UnumOn Behalf of Disability Insurance Law Group | | Appealing A Claim Denial
Sandra A. was an executive in a large multi-national corporation. Her job required frequent travel and onsite inspections. When new products were about to launch, Sandra would give presentations to her team who would then demonstrate the products to vendors. Sandra enjoyed her career and working with her staff. She started noticing significant fatigue. Given her fast paced schedule, she assumed she was just rundown. However, her fatigue did not go away during her down time.
She also began to have headaches and occasionally double vision, which she described as a wobbly feeling in her eyes. At first, she dismissed this as being overly tired from work. Unfortunately, her symptoms only progressed. She started to experience muscle stiffness and minor spasms, numbness and tingling of her skin, and pain in her nerves. Sandra went to her primary care physician who referred her to a neurologist. After a long process, which included brain MRIs, CSF tests, and blood tests, Sandra was eventually diagnosed with Multiple Sclerosis. The news was devastating.
Challenges in Disability Claims: A Case Study of Sandra A.
Sandra continued to work, which she asserts was a welcome distraction. However, over time, her symptoms increased in intensity. She also began to develop hand tremors, which made presentations difficult. Her fatigue and pain became almost unbearable at times. When boarding a plane for a business trip, Sandra became dizzy and lost her balance. She took her seat and slept on the plane. The dizziness remained. Sandra had to cut her work trip short and return home. Ultimately, she came to the realization that she simply could no longer do her job in her condition and had to take a medical leave of absence.
She hoped that with rest, she would be able to return. However, her symptoms just got worse. Through her employment, Sandra was covered by a short-term and long-term disability insurance policy, insured by Unum. Sandra applied and was awarded Short-Term Disability benefits. She was relieved that she would not have to worry about paying her bills. She just entered a clinical trial for MS and at this point had to focus on her health. Unum required Sandra to apply fir Social Security Disability benefits (“SSDI”) with the Social Security Administration, which Sandra did. After six months, Sandra’s short-term disability ended.
She assumed that long-term disability would automatically start since both policies had the same definition of Total Disability – “the inability to perform the material and substantial duties of your Regular Occupation.” However, Sandra received a letter from Unum stating that it was “investigating” her claim for Long-Term Disability benefits. Her physicians sent Unum Sandra’s records and completed Unum’s forms certifying that Sandra met the definition of “Totally Disabled. However, Unum kept insisting that it needed additional information. Also, Unum took multiple extensions, asserting that it did not receive requested information from Sandra’s physicians.
Despite proof that it was received, Unum required her physicians to send the same information time and time again. Unum required Sandra to attend a physical examination by a neurologist hired by Unum. Sandra eagerly complied, hoping that this would establish her disability. The physicians performed a basic physical examination and asked her a seres of questions regarding her symptoms.
Sandra received an approval from the Social Security Administration for SSDI benefits, as it determined that she was unable to maintain gainful employment. She quickly sent this to Unum, assuming her claim would be immediately approved. It was not. Instead, 12 days later, Sandra received a letter denying her claim. Unum’s denial letter asserted that its hired physician did not find “objective evidence” of her restrictions and all of her alleged symptoms were “subjective.” Unum further asserted that it placed Sandra under surveillance and since she could drive and run errands, she did not appear disabled. Sandra was confused and terrified. Without her benefits she had no ability to pay her bills.
Her savings was being drained by her medical expenses and she would run out of money in months. That is when she contacted our Firm. We took Sandra’s case and agreed to appeal the claim denial. We obtained the claim file, which revealed that one of Unum’s in house physicians determined that Sandra was indeed Totally Disabled.
The surveillance video showed Sandra driving approximately 3 miles to her doctor’s appointment and then stopping at a pharmacy after her treatment. There was no other activity seen despite the Unum hired private investigator stalking her house for 5 days. We sent Sandra to an Independent Functional Capacity Evaluation (“FCE”), who documented Sandra’s hand tremors and her loss of balance. We also took detailed testimonial statements from her physicians. We prepared a lengthy appeal letter outlining Sandra’s Total Disability and Unum’s unreasonable behavior. Unum promptly overturned its claim decision and immediately awarded Sandra Long-Term Disability benefits and paid all back benefits it wrongfully withheld.