In the past several months our office has been hired by two separate clients who had individual disability policies purchased privately through insurance agents; that had received benefits for an extended period of time; and that were denied by Unum, in part, on the basis that their ability to travel was indicative of the ability to work. The first client, a doctor had coverage with Paul Revere Life Insurance Company, and the other client, a Court Reporter had coverage through New York Life Insurance Company- both of which are administered by Unum.
The Ability to Travel Does Not Mean the Ability to Work
When purchasing a disability policy through an agent one of the most common riders selected is an “Own Occupation” rider in which “disability” is determined based on the inability to perform your actual job duties. More often than not this “own occupation” definition of disability is for the term of the policy. Both our clients had such language in their respective policies.
In the case of the doctor, he had been receiving disability benefits for nearly 15 years when Unum terminated his claim due in large part to online investigations conducted which indicated that he had traveled extensively while on claim and had written about it on a personal blog.
As Attorney Stephen Jessup would come to find out our client took extended trips with his spouse in order to have additional days to rest as he would inevitably experience a great deal of pain from any physical activity; that the travel was usually in business or first class so he would be able to lay down through the flight (a position he spends most of his day in regardless); and given his love of writing he embellished the trips to make the blog posts more appealing to readers and often recounted the stories of friends he vacationed with an passed off as his own. To that and he provided Attorney Jessup with documentation to verify everything. However, prior to terminating his claim Unum made no inquiry whatsoever regarding the travel, nor did they seek any additional clarification as to what the travel entailed. Without verification, the claims manager found the blog posts on the internet and saw it as a “smoking gun” justification to deny benefits.
Administrative Appeal Challenges the Definition of Total Disability
Attorney Stephen Jessup prepared and submitted an appeal with Unum on our client’s behalf. Although an individual disability policy does not require an administrative appeal be filed it was agreed that given the horrible misrepresentations made by Unum in the denial letter it would be appropriate to clarify our client’s travel and provide additional medical information in support of continued benefits prior to filing a lawsuit. It is our position that our client’s travel does not have bearing on his ability to practice medicine or how Unum must review policy language to determine disability. The applicable portions of the definition of total disability contained in his policy read:
- You are unable to perform each of the important duties of Your Occupation; and
- You are not engaged in any other gainful occupation
There is nothing in that definition that defines disability to mean that one is disabled if they are unable to perform activities of daily living, or if you are unable to perform at the physical demand level your job requires as determined by the Department of Labor (ex: Sedentary, Light, Medium, Heavy, Very Heavy). Policies are written to mean that due to injury or sickness one is unable to perform one’s occupational duties.
So how is that Unum will justify the argument that the ability to travel is indicative of the ability to practice medicine? It essentially comes down to is the appearance of impropriety. Unum is more concerned with how something appears rather than the reality of the situation.
This was also the case with the second client who worked as a Court Reporter. Her policy contained substantially similar language regarding “disability” in that she would be deemed disabled if she was unable to perform her pre-disability occupation. Similar to our doctor, she had been on claim receiving disability benefits for a period of time, and Unum’s initial review of her continued eligibility was predicated on information that she had taken a once in a life time trip overseas. Unum argued in its denial letter that her ability to take an extended trip was indicative of physical ability to perform the “light” duty physical demands of her prior occupation.
In both cases Unum’s reviewing doctors paid more credence to the “travel” than they did the actual medical records. No matter what information was provided Unum had blinders on and focused so heavily on the ability to travel as some great wrong that I believe they saw our clients more as frauds trying to “pull one” over on Unum.
Despite detailed clarification and strong additional evidence of disability, Unum denied the doctor’s appeal and Attorney Jessup is pursuing legal remedies on his behalf. The appeal for our Court Reporter client is still pending, but given Unum’s actions during the claims and appeal review of our doctor client it would not be unreasonable to expect Unum to continue with such behavior.
In a world of social media and online postings insurance companies are now, more than ever, scouring the internet to obtain information about their insureds. The digital footprint you leave, no matter how seeming innocuous, can have lasting ramifications. Without a doubt disability policies do not define disability to mean you are unable to perform activities of daily living, but insurance companies will review your abilities to travel or perform normal activities as evidence that your symptoms may not truly be impacting your ability to work.
If you have concerns with your disability insurance carrier due to inquiries into travel, requests for interviews, or over video surveillance that may have been shown to you or sent to your doctors please contact our office to speak with Attorney Jessup or one of our other disability insurance attorneys to discuss your claim in detail.