Unum Disability Beneft Denial Overturned for Pre-textual Investigation

Insurance companies hire physicians to comb through medical files to look for a reason to deny an ERISA disability benefit claim. In a Texas case, Unum was criticized for not making relevant medical records available and for not basing its decisions on concrete medical evidence. Unfortunately, it is impossible to know what information is provided for those independent medical record evaluations without challenging those disability benefits denials.

In a case against Unum Life Insurance Company of America, the claimant worked as a carpenter for eleven years. In the summer of 2003, he suffered a work-related back injury. Even though doctors performed six surgeries on the plaintiff’s back over the next three years, the claimant continued to have severe pain. Before the fourth operation, his doctors found that he was disabled and was unable to perform the duties of any gainful employment. He couldn’t lift any object of more than 30 pounds. He couldn’t frequently carry objects greater than 15 pounds. He couldn’t sit or stand for longer than one hour without rests. As a result, he made an ERISA claim for long-term disability benefits under a Group Disability Policy his former employer maintained with Unum Life Insurance Company of America (“Unum”).

After paying benefits for several years, Unum denied the claim. Unum based its decision to deny disability benefits on an internal investigation of the claim. Specifically, Unum relied on a report from an independent medical record evaluation performed by one of its internal physicians, Dr. Tsourmas. But he issued two reports that were irreconcilable. Dr. Tsourmas initially determined in July 2006 that the claimant should qualify for disability benefits, but, before he would form a definitive opinion, he would like to review an earlier MRI of the claimant’s back. Two months later, Unum advised Dr. Tsourmas that the requested MRIs were unavailable – though the MRIs were already in Unum’s file – and asked that he promptly assess the claimant’s then functioning level. Without seeing the claimant or receiving new medical evidence, Dr. Tsourmas issued an addendum to his original report, opining that the claimant was employable and re-trainable.

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Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

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Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

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In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

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No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

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When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

Reviews

Bruce R. (Arizona)

Steve Dell has done an exceptional job with my disability application process. The firm is extremely well managed. They have acquired an incredible amount of experience over many years. I recommend them for disability insurance claims without reservation. 

Don (Florida)

I called this firm a few months ago completely disparaged due to a company cutting off disability benefits at a time that nearly caused me to lose everything.

Attorney Alex Palmera and Danielle worked hard to reach an amicable settlement and my case was settled a few months later. This is a good firm and the specific expertise in disability claims saved me countless hours of hassle at a time when an already fragile state existed.

Thank you Mr. Palamara and Danielle.

Sandra B. (Arkansas)

I have nothing but good things to say about how my buyout was handled with my disability claim. The level of professionalism was amazing. All of my questions and concerns were answered either by Danielle L. or Alex P. in such a timely manner and with such care I would recommend them in a heartbeat to anyone needing to approach their provider with buyout options.

They did a fantastic job communicating between the provider and me, always keeping my best interest at heart and always answering my many many questions. They really did take most of the stress out of this whole situation. I would give them a 10 out of 10 for every step of this crazy journey. Thank you so much for helping me through this.

Brenda R. (New York)

I needed assistance with an appeal for a LTD claim that was initially denied. Stephen understood what needed to happen to win the appeal and he did win the appeal for me.

Michael C. (Virginia)

Greg Dell and his assistant Anneli have been extremely responsive and helpful, not only our initial consultations, but in follow-ups 1 and 2 years later with the insurance company to ensure that they comply with their agreements (which they did), as well as a separate and only slightly-related inquiry about our health insurance. I always hear back from them very quickly, which is rare and greatly appreciated.

Jeff P. (Oklahoma)

After a very long and frustrating ordeal to keep my LTD payments coming I decided to seek assistance from and attorney. After much research and asking those in the legal profession Dell & Schaefer seemed to be the top choice. I reached out and Alex Palamara was the attorney assigned to my case. All I can say is the experience was outstanding. Both Alex and his Paralegal, Danielle Lauria were excellent to work with. They were very kind, concerned, understanding of my frustrations and treated me with the utmost respect. Communication was excellent with regular updates and telling me what I could expect in each stage of the process.

Alex was also very straight forward with what to expect and no pie in the sky promises or expectations were made. In the end we won our case and I believe it was solely due to their experience and knowledge of not only the laws but the insurance companies as a whole. I would highly recommend them and am very grateful for the help they afforded to me.

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