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Unum Approves Long Term Disability Application to a Program Manager

Attorney Stephen JessupAuthor: Attorney Stephen Jessup

Our client, a high level Program Manager for a large international aeronautics company, was involved in an automobile accident that resulted in physical and emotional injuries, which impacted her ability to meet the demands of her job. Prior to hiring our office she filed her application for short term disability benefits under her employer’s disability insurance plan with Unum. From the onset of her short term disability claim she felt attacked, belittled and scrutinized by Unum on a constant basis. It was the rude behavior exhibited by her claims manager and her mistrust of Unum that lead her to Attorneys Dell & Schaefer.

When she first contacted our office she spoke with Attorney Stephen Jessup and discussed her concerns with how Unum was behaving as it related to her short term disability claim. Despite the fact that Unum had issued benefit checks our client relayed to Attorney Jessup how every communication seemed adversarial and veiled with threats of a claim denial, and how her benefit checks were continually late. The stress caused by Unum was overwhelming and for our client it was hard enough for her to deal with the injuries she sustained from the accident, let alone this added stress from Unum. In order to ensure her claim was paid properly and to avoid having to deal with Unum directly, she hired our office to handle her claim on a monthly basis.

When Attorney Jessup first took over the monthly claim handling he realized that Unum did not have all of the applicable medical information with which to assess our client’s claim for disability benefits. To address these concerns Attorney Jessup obtained records from all of our client’s doctors in order to present as clear a picture of her restrictions and limitations. Additionally, Attorney Jessup reached out to our client’s main treatment providers to obtain medical condition specific questionnaires prepared by Attorney Jessup to further strengthen restrictions and limitations. Concerned about the transition to long term disability and the fact that Unum was ignoring our client’s physical medical problems Attorney Jessup sent her for a functional capacity examination in order to obtain objective evidence of our client’s functional restrictions and limitations as they would relate to her ability to perform in a workplace.

Armed with all of our client’s records and properly documented evidence of impairment Attorney Jessup was able to secure all of our client’s short term disability benefit through the end of her short term disability term.

Long Term Disability

Prior to the end of our client’s short term disability period Unum began its review of her entitlement to long term disability benefits. Historically, short term disability benefits are easier to secure than long term disability benefits, due in large part to the underwriting and funding of the respective disability policies. However, given Unum’s aggressive requests for information and constant threats of claim denials and deadlines to provide information throughout the period of short term disability it was clear that a fight was to be expected from Unum as they processed her claim for long term disability benefits.

Despite the information provided in support of the short term disability claim Unum’s long term disability department was focusing its attention on the mental health aspects of our client’s claim in an attempt to limit payment of benefits to a maximum of 24 months of benefits due to Mental Health conditions. Despite documented proof of physical restrictions and limitations by way of diagnostic tests and the FCE, after delaying as much as legally possible Unum advised Attorney Jessup that it was approving our client’s claim for long term disability benefits but in doing so determined that the only condition preventing her from working was her mental health condition.

Unum intends to limit our client’s claim to 24 month of benefits. This decision is all the more frustrating considering that under the terms of the policy our client is only entitled to 36 months of benefits! The claim determination goes to show the lengths Unum will go to in an attempt to avoid paying a claim.

For Attorney Jessup and our client, the first battle for long term disability benefits was won – our client was receiving benefits, but the fight is by no means over as Attorney Jessup continues to attack Unum’s position that her disability is only the result of a mental health condition.

Is Unum Fighting Your Claim?

Unum’s actions, as set forth above, are unfortunately very common. If you have a claim for disability benefits with Unum and are experiencing any of the above problems, or you have any questions about your claim please do not hesitate to contact our office and speak to one of our disability insurance attorneys.