Before contacting our firm, our client had been out on disability since March of 2005. Prior to 2005, our client worked for Pinelawn Cemetery for 13 years as a Sales Counselor. Unfortunately, he was forced to stop working in March of 2005 due to various medical conditions including Chronic Pain Syndrome, Severe and Progressive Coronary Disease, neck pain, back pain, hip pain, etc. Thankfully, his employer provided a Long Term Disability Insurance Policy with Unum should he be limited from performing the material and substantial duties of his regular occupation.
Immediately after having to stop work in 2005, our client applied for Long Term Disability (LTD) benefits and benefits were initially approved from 2005 through August of 2016. By letter dated August 3, 2016, Unum informed our client that further benefits would not be paid as they had now determined that he was able to perform the duties of his occupation and was not disabled according to the terms of the policy. In support of its decision to deny benefits, Unum indicated it had relied upon information from social media and surveillance footage, in addition to reviews of our client’s medical records by commissioned physician reviewers. These reviews led Unum to conclude that his cardiac condition was stable and that his pain was well managed.
Claimant Contacts Dell & Schaefer
After receiving the denial letter, our client contacted our firm as he could not understand how Unum could have denied his claim. After having a chance to review the denial letter, Attorney Alexander Palamara of Dell and Schaefer also could not understand how Unum could have denied our client’s claim for continued LTD benefits due to the strength of his medical claim.
A review of the denial letter showed that Unum had viewed our now client’s social media accounts, conducted surveillance and came to the conclusion that because “you are able to drive a motorcycle, attend concerts and attend bike week” you are not disabled. Unfortunately for Unum, there is much more to our client’s life than a few pictures on the internet and 12 minutes of surveillance. Because Unum’s decision was clearly wrong, an Administrative Appeal was filed to challenge Unum’s wrongful denial.
The Administrative Appeal
The Appeal filed by Dell and Schaefer was able to show the strengths of the client’s case as well as the weaknesses of Unum’s earlier reviews. For instance, we were able to challenge Unum’s conclusion that our client’s cardiac condition was “stable” by pointing out that he had suffered two heart attacks and has been suffering from ongoing chest pain at rest, chest pain with exertion, and shortness of breath through 2016 with multiple positive EKG tests dating into August of 2016. Furthermore, our appeal also demonstrated that his cervical and lumbar spine degenerating was not stable as Unum claimed. Medical records were able to reveal evidence of radiculopathy including positive straight leg raise testing bilaterally, positive Spurling’s Testing, antalgic gait, the need to use a cane, and impaired reflexes in the bilateral lower extremities. Finally, the Appeal was able to show Unum that its reliance on surveillance and social media held no water as such was limited to a few pictures posted online and 12 minutes of video surveillance. When viewed objectively, this information could not show that our client was untruthful and that he would be able to perform the material and substantial duties of his regular occupation 40 hours a week.
60 days after our appeal was filed, Unum sent a back benefit check for the benefits that had not been paid since the time Unum denied the claim in August 2016. Our client remains on claim to this day and our client knows that our firm will do whatever it takes to keep him on claim until he is able to return to work at his regular occupation or until his policy expires at age 65.
If you have had a claim denied by Unum or any disability insurer, please do not hesitate to call Attorneys Dell and Schaefer for a free consultation to discuss your case.