Unum disability appeal results in settlement of Unum long term disability claim
Author: Attorney Cesar Gavidia
Mr. Z had recently graduated with a bachelor’s degree in information technology from a prestigious New Jersey university, and had landed an amazing job working as a software engineer for an international bank in bustling downtown Manhattan. Mr. Z was excited and saw great potential for his career and life. That is until one day in October when Mr. Z was travelling as a passenger in the front passenger seat of his friend’s car, when another vehicle collided directly into the right side of the vehicle. Mr. Z did not lose consciousness, but was dazed and felt sharp pain in his neck. He was immediately transported to the hospital for x-rays and MRI’s. Mr. Z was released from the hospital but unfortunately his pain persisted. The accident left Mr. Z with pain not only in his neck, but pain in his mid and lower back as well. Mr. Z decided to take two weeks off from work to rest, and hope that his pain would go away, but unfortunately it only worsened. MRI’s revealed that his pain was being caused by herniated discs in his spine, as well as bulging discs resulting from degenerative disc disease.
Software engineer unable to continue working following auto accident
Mr. Z attempted to return to work, but soon found that sitting at a desk and working on a computer only made the pain worse. In fact, maintaining any static position for too long caused pain. He requested that his employer provide him the accommodation of working from home, which his employer granted. However, Mr. Z soon discovered that whether he worked from home or worked from the office, the pain persisted. Mr. Z, with the support of his treating physicians, decided that it was time to submit a disability claim under his employer provided group disability insurance policy with Unum.
Disability claim filed with Unum and STD benefits are approved
Unum received medical records from Mr. Z’s treating physicians which supported that his complaints of pain were very credible. Mr. Z had begun developing paresthesias (numbness) in his left hand, and was undergoing intense physical therapy and painful epidural steroid injections to control his pain. Initially, Unum approved Mr. Z’s short-term disability claim, and after twenty-six weeks of short-term disability payments began issuing long-term disability benefits to Mr. Z.
Unum denies LTD benefits and conducts IME and video surveillance
The trouble for Mr. Z started soon after he received his first long-term disability benefit payment. Unum requested that Mr. Z undergo an Independent Medical Evaluation (IME) with a physiatrist selected by them. The IME concluded that Mr. Z was not limited in any way due to the herniated disks in his neck and spine, but that Mr. Z’s left hand pain resulted from carpal tunnel syndrome or peripheral entrapment neuropathy, and that he would indeed have difficulty with repetitive motion activities, such as typing, but that objectively he would be capable of working full time within the physical demands of his occupation as a software engineer. Unum also conducted video surveillance of Mr. Z, which only showed him being transported to his physician’s office for a consult. Nonetheless, Unum terminated Mr. Z’s disability benefits and informed him he that could submit an appeal with Unum within 180 days.
Following the Unum disability claim denial, Mr. Z contacted Attorney Dell & Schaefer. It was clear that Mr. Z’s only option was to file an ERISA appeal that would be reviewed by UNUM. Medical records were gathered, further evidence supporting Mr. Z’s claim for disability was obtained, and finally, Mr. Z’s appeal was timely submitted. Following the submission of the ERISA appeal Attorney Cesar Gavidia was able to reach a confidential settlement with Unum.
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