Disability Insurance Law Research

Unum Denies Disability Benefits to 53 Year Old Woman After Paying for 16 years

Unum is obviously scraping the bottom of the barrel and making attempts to reduce the number of claimants that are currently receiving long term disability benefits. We recently reviewed a Unum denial letter for a woman that has been deemed disabled by Unum since September 18, 1998. This woman was approved for social security disability benefits in 2000 and she has been receiving $488 a month from Unum. She is currently 53 years old. Her disabling medical conditions include Systemic Lupus Erythematosus (SLE), Pericarditis(cardiac), chronic headaches, joint pain, blurred vision, osteoarthritis, vertigo, and cognitive dysfunction.

Unum’s Method for Denial of Benefits

Her Unum disability policy defined disability as the inability to perform any gainful occupation and Unum previously agreed that between September 1998 and May 12, 2014 she has been unable to perform any occupation. Unum began to scrutinize her claim in early 2014 and relied upon the file review conducted by a family medicine doctor to deny the claim. The claimant was never examined. Unum cherry picked the medical records of the claimant and determined that she did not have restrictions or limitation that would prevent her from performing a sedentary job. Unum did a vocational review and said she could do a job earning $12.50 an hour.

A Classic Unum Claim Denial

This denial is a classic “bullshit” denial that we see on a daily basis from Unum. A claimant can never let their guard down when dealing with Unum or any other disability insurance company. No one should ever think that an approval means you will continue to get paid as these companies reevaluate the claimant’s eligibility on a monthly basis. A claimant must always continue to treat with their doctors and make sure that the doctor is documenting their medical chart appropriately. Our lawyers help hundreds of disability insurance claimants every year to do everything possible to protect their disability benefits. It is extremely sad that Unum would deny benefits to a chronically ill woman that is only receiving $488 monthly. Our law firm will do everything possible for this woman to secure long term disability benefits for her.

Comments (4)

Johnna,
How long ago was the claim denied? Did you ever file an appeal of the denial? Please contact our office to discuss what rights may still be available to you.
Stephen Jessup Oct 9, 2015 #4
It’s very easy to tell disabled people to continue treatment with a doctor, except frequently we can’t afford it. And when doctors abandon chronic pain patients because of the drug war, and we can’t find another doctor to treat us, what are we supposed to do? Especially when all of the treatments offered by the medical industry can do more harm than good. For a long-term chronic pain patient, a home treatment program is the only option left. Yes, Unum terminated my coverage (after 7 years) because I haven’t been able to afford seeing a doctor on a regular basis, but also because Unum demanded an updated Functional Capacity Examination and wouldn’t pay for it. Unum knew that I couldn’t afford to pay for this expensive report, so I am in violation of the contract and Unum wins again. Poverty is the reason I no longer have long term disability benefits. Ironic, isn’t it?
Johnna S. Oct 8, 2015 #3
Lynda,
Unfortunately, if you do not give timely notice of a claim for benefits, or you try to pursue benefits after coverage has ended, or you are outside the scope of a Statute of Limitations your legal ability to pursue a claim is extremely limited.
Stephen Jessup Oct 1, 2015 #2
Mr. Dell and Staff:
My story is exactly the same as the woman you described above. Your office referred me to an attorney in Tennessee. Unfortunately, this attorney informed me that it was too late for me to make a claim against UNUM. UNUM indicated to the Texas Department of Insurance that I was now too old to receive benefits even though I might have had a valid claim in the past. After no contact for years, UNUM sent a representative to my home as I was leaving for the hospital. He attempted to intimidate me and he kept telling me to stop harassing UNUM. He told me to remember that I’m too old to receive disability benefits. Is it a UNUM tactic to ignore claims until the patient can’t file? Feel free to share my story with your clients. Thank you.
Lynda S. Sep 30, 2015 #1

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