Unum challenges the long term disability claim of a blind salesman

Our client, a window coverings salesman, began developing significant vision loss in November 2006 and approached Attorneys Dell & Schaefer for assistance in applying for long-term disability benefits with Unum. His policies stated that he would be entitled to benefits for the rest of his life if he were totally disabled prior to his 65th birthday or if he qualified as totally disabled under the “Presumptive Total Disability” provisions of his polices.

The policy defined total disability as “inability to perform the substantial and material duties of your occupation.” Through the efforts of Attorneys Dell & Schaefer, our client will now receive total disability benefits for the rest of his life.

After applying for benefits and struggling with an elusive diagnosis, our client was found to suffer from psuedotumor cerebrii, a condition that can result in degeneration of the optic nerve, leading to blindness. Our client’s treating doctors repeatedly advised Unum that our client was legally blind and he could no longer perform any work. Unum spent nearly two years questioning our client’s vision loss before they finally conceded that he has been legally blind since early 2007. During the disputed period of time, Unum paid benefits on a monthly basis under a reservation of rights. This means that Unum was reserving their right to ask for all the money back if they believe that the claimant has not been eligible for benefits.

Unum first started fighting our client’s disability claim by questioning the “late notice” of his claim, despite providing proof of loss as soon as was reasonably possible. Despite continuing to provide ample evidence of our client’s medical condition and his entitlement to benefits, Unum continued to refuse to pay, citing lack of information. Unum also cited to the medical records of one doctor, who claimed there were inconsistencies with our client’s claim, as a justification for continued evaluation, despite clear medical evidence supporting disability from six other treating physicians.

Our client also was subjected to disability video surveillance during the course of his claim, and Unum insisted on numerous conference calls with a number of our client’s treating physicians. Unum also disputed whether our client was actually totally blind. Throughout this process, Dell & Schaefer continued to closely monitor the status of the claim and provide continuing proof of loss to Unum.

Eventually, Unum scheduled our client for and Independent Medical Exam. Once Dell & Schaefer insisted on having a videographer present at this exam, Unum cancelled this appointment at the last minute. Several months later, Unum re-scheduled this exam with a different doctor who also refused to allow a videographer. Dell & Schaefer managed to have this exam conducted with an investigator present in order to protect our client’s rights.

Finally, in January 2009, Unum accepted liability for the claim, acknowledging that our client had suffered total and irreversible loss of his vision, and had been blind as of April 30, 2007. These two determinations by the insurance company mean that our client will receive total disability benefits under the terms of his three policies for the remainder of his life.