Cummins Service Supervisor With Coronary Artery Disease Wins Virginia Unum Long-Term Disability Insurance Appeal After Benefits Terminated at 24 Months

Unum terminated our client’s long-term disability benefits after paying them for nearly three years — not because his medical condition improved, but because the definition of disability in his policy changed. That decision was wrong, and we proved it.

Our client, a Virginia service supervisor for Cummins, had been out of work since suffering a heart attack and undergoing triple coronary artery bypass graft surgery. His conditions — spanning cardiac disease, degenerative spinal disorders, COPD, chronic kidney disease, and diabetes — were not getting better. They were getting worse. We have handled hundreds of heart disease disability claims against Unum and know this pattern well: pay benefits under the own-occupation standard, then use the 24-month definition change as an excuse to terminate — regardless of the medical evidence.

Attorney Cesar Gavidia assembled a comprehensive appeal backed by updated treating physician records and an independent vocational evaluation, and Unum reversed its decision in full. Below, we break down exactly how Unum built its denial, how we dismantled it, and what every Unum claimant approaching the 24-month mark should understand. If Unum or any other disability insurance company has denied or terminated your benefits, speak with one of our long-term disability insurance lawyers for a free consultation — we represent claimants nationwide, and there is no fee unless your benefits are paid.

Table of contents

• Why this case matters for every Unum claimant
• Unum’s denial: a paper review, a flawed vocational analysis, and a foregone conclusion
• The medical evidence Unum chose to ignore
• The independent vocational evaluation that dismantled Unum’s alternative occupation
• Social Security found our client disabled — Unum disagreed
• Unum reverses its decision in full
• If Unum has denied your disability benefits

Why This Case Matters for Every Unum Claimant

The 24-month definition change is a trigger for termination — not proof you can work. Under most Unum group policies, the definition of disability shifts from “own occupation” to “any gainful occupation” after 24 months of benefit payments. A 24-month definition change in a disability insurance policy means the standard of proof increases: the claimant must now show they cannot perform any occupation for which they are reasonably qualified by education, training, or experience. Unum routinely uses this contractual milestone to terminate benefits — but the definition change alone does not establish that the claimant can actually perform alternative work. Unum must still prove it with reliable evidence, and in this case, it could not.

A paper review is not a substitute for an independent medical examination. If your disability benefits were denied based on a paper review, you are not alone — and the denial may be weaker than it appears. A paper review — sometimes called a file review — is a process in which a physician retained by the insurance company reviews medical records without ever examining the claimant. Unum relied on a clinical consultant who never examined our client, never spoke with his treating physicians, and reached conclusions about his functional capacity that were contradicted by every doctor who had actually evaluated him. When functional capacity is the central issue in a disability claim, a paper review that discounts treating physician opinions without objective testing is inherently unreliable.

An independent vocational evaluation can expose a flawed transferable skills analysis. Unum’s vocational department identified “Customer Service Supervisor” as a sedentary occupation our client could perform. An independent vocational expert we retained analyzed the actual demands of that occupation against our client’s documented limitations and concluded no such occupation existed at the required wage level. If Unum has identified alternative occupations it claims you can perform, an independent vocational assessment may be the most powerful tool in your appeal.

Progressive, compounding conditions undermine the insurer’s “improvement” narrative. Unum characterized our client’s condition as improved and stabilized. The medical record told a different story — new diagnoses, escalating interventions, and worsening symptoms across multiple body systems. When an insurer terminates benefits it previously approved, the courts have held that it must demonstrate a meaningful change in medical evidence. Here, no such change existed.

A Social Security Disability award is evidence the insurer must confront. Our client had been found disabled by the Social Security Administration, yet Unum’s denial failed to meaningfully reconcile its contrary conclusion with that federal determination. Ignoring an SSA disability finding does not make it go away — it makes the denial vulnerable.

Unum’s Denial: A Paper Review, a Flawed Vocational Analysis, and a Foregone Conclusion

Our client’s long-term disability claim was originally approved because his medical records supported his inability to perform the duties of his own occupation as a service supervisor for Cummins. He had stopped working after suffering a myocardial infarction — a heart attack — and undergoing triple coronary artery bypass graft (CABG) surgery, a major open-heart procedure in which surgeons use blood vessels from elsewhere in the body to bypass blocked coronary arteries and restore blood flow to the heart. For nearly three years, Unum agreed he was disabled.

Then the policy’s definition of disability changed. Under the any-occupation standard, Unum was required to determine whether our client could perform the duties of any gainful occupation — defined in his policy as any occupation that could provide an income exceeding 60 percent of his indexed monthly earnings within 12 months of returning to work. Unum concluded he could and terminated his benefits.

How Unum Built Its Case for Termination

Unum’s denial letter revealed the architecture of its decision. The termination rested on three pillars:

• Selectively cited medical records suggesting stabilization — including notes from our client’s cardiologist and primary care physician indicating that certain cardiac symptoms had improved following an atrial fibrillation ablation procedure
• Statements from our client’s primary care physician indicating our client had the functional capacity to perform sedentary occupational requirements on a full-time basis
• A clinical consultant — a physician who reviewed the file but never examined our client — who determined that the available information did not support inability to perform sedentary physical occupational demands on a sustained full-time basis

There were critical problems with each of these pillars.

The Denial Ignored Restrictions from Multiple Treating Providers

Unum acknowledged in its own denial letter that our client’s orthopedic surgeon had previously opined he was limited from climbing and lifting up to 50 pounds, and that a subsequent evaluation limited him to exerting no more than 10 pounds for lifting and carrying — with an inability to walk for more than 10 minutes without resting. Unum’s letter stated that “none of these prior opinions would limit sedentary work capacity.” That assertion ignored the practical reality: a person who cannot walk for more than 10 minutes or lift more than 10 pounds faces restrictions that directly affect sustained full-time employment — even in a sedentary role.

Unum also noted that our client’s orthopedic surgeon “did not respond to our more recent request for work restrictions.” Rather than following up or conducting its own examination, Unum simply moved forward with termination — treating the absence of a response as evidence supporting its conclusion rather than as a gap in its own investigation. Unum’s own policy reserved the right to require a medical examination by a physician of its choice — a right it chose not to exercise, opting instead for a paper review that cost less and revealed less.

The Vocational Analysis Was Built on a Flawed Foundation

With the assistance of its vocational department, Unum identified a single alternative occupation: Customer Service Supervisor, classified as sedentary under the Department of Labor’s Dictionary of Occupational Titles, at a wage of $30.38 per hour. Sedentary work is defined as work that involves sitting most of the time, with occasional walking or standing, and lifting no more than 10 pounds. Unum concluded this occupation was within our client’s capacity and that benefits were no longer payable.

The Medical Evidence Unum Chose to Ignore

The appeal assembled by attorney Cesar Gavidia presented a comprehensive accounting of our client’s medical record — evidence that Unum had either overlooked or deliberately minimized. The picture it painted was not one of improvement. It was one of progressive, compounding deterioration across multiple body systems.

Cardiac Disease: From Bypass Surgery to Persistent Atrial Fibrillation

Our client’s cardiac history began with a heart attack and triple bypass surgery that forced him out of work. In the years that followed, his cardiac disease required repeated interventions:

• Persistent atrial fibrillation — an irregular heart rhythm that causes the heart’s upper chambers to beat chaotically — requiring multiple cardioversions (electrical procedures to reset the heart’s rhythm)
• A catheter ablation with pulsed field pulmonary vein isolation — a procedure to destroy the heart tissue causing the arrhythmia — complicated by post-procedural pericarditis (inflammation of the sac surrounding the heart)
• Ongoing dyspnea on exertion — shortness of breath with physical activity — and intermittent palpitations
• Significantly limited functional reserve, requiring lifelong anticoagulation therapy, beta-blockers, statins, and additional cardiac medications

Our client’s cardiologist noted that while the ablation reduced his atrial fibrillation burden, he continued to experience fatigue and shortness of breath with exertion. Research on long-term quality of life after coronary artery bypass surgery confirms that patients with recurrent symptoms and comorbidities experience significantly worse functional outcomes than the general population — precisely the clinical profile Unum chose to ignore.

Musculoskeletal Disease: Progressive and Profoundly Disabling

Beyond his cardiac conditions, our client suffered from severe musculoskeletal disorders that independently limited his ability to work:

• Chronic bilateral hip osteoarthritis — degenerative joint disease affecting both hips
• Lumbar degenerative disc disease and lumbar spinal stenosis — breakdown of the spinal discs and narrowing of the spinal canal in the lower back
• Neurogenic claudication — pain, weakness, and cramping in the legs caused by compressed nerves in the lumbar spine — confirmed by orthopedic evaluation
• Persistent low back and radicular pain resistant to conservative management including physical therapy

The appeal letter emphasized the clinical significance of these findings: “Orthopedically, his condition is profoundly disabling. He has chronic bilateral hip osteoarthritis, lumbar degenerative disc disease, and lumbar spinal stenosis that has progressed to neurogenic claudication.” This diagnosis explained our client’s persistent difficulty standing, walking, and tolerating sedentary postures for more than brief periods — limitations that directly affected his ability to sustain any full-time occupation, including a sedentary one.

Beyond the Heart and Spine: A Cascade of Compounding Conditions

Our client’s impairments extended well beyond his cardiac and spinal conditions. He was also managing:

• Chronic obstructive pulmonary disease (COPD) — a progressive lung condition limiting respiratory function
• Stage 3 chronic kidney disease — indicating moderate loss of kidney function, with a GFR of 30–59
• Type 2 diabetes mellitus with hyperglycemia — only moderately controlled despite dual oral therapy
• Hyperlipidemia, obesity, and fatty liver disease
• Depression and anxiety — conditions that worsened in the aftermath of his cardiac decline and loss of the ability to work

As the appeal stated: “The record demonstrates not improvement, but deterioration. His conditions are chronic, progressive, and mutually compounding.” Each condition complicated the others. His cardiac medications interacted with his diabetes management. His spinal stenosis limited the physical activity that might have helped manage his cardiovascular health. His depression and anxiety were driven by the very disabilities Unum was trying to deny. The notion that this individual had improved to the point of being able to sustain full-time competitive employment was, as attorney Gavidia argued, medically indefensible.

The Independent Vocational Evaluation That Dismantled Unum’s Alternative Occupation

A Transferable Skills Analysis (TSA) is a vocational assessment used by disability insurance companies to identify alternative occupations a claimant might theoretically perform based on their education, training, work experience, and physical capabilities. Unum’s vocational department performed a TSA and identified “Customer Service Supervisor” as a viable sedentary alternative for our client. On paper, the analysis looked straightforward. In practice, it was deeply flawed.

To expose those flaws, attorney Gavidia retained a board-certified rehabilitation counselor to conduct a comprehensive vocational evaluation. The vocational expert carefully reviewed the medical record, our client’s work history, and the transferable skills analysis on which Unum relied. His findings directly refuted Unum’s vocational conclusions.

The Customer Service Supervisor Role Was Not Viable

The vocational expert identified that the Customer Service Supervisor occupation, as described in the Dictionary of Occupational Titles, requires:

• Constant keyboarding
• Frequent lifting up to 10 pounds and occasional lifting up to 20 pounds
• Sustained concentration, verbal interaction, and tolerance for stress

These demands were inconsistent with our client’s documented limitations. His treating providers and Unum’s own internal review had acknowledged restrictions on lifting and carrying. The stress and exertional requirements of the identified occupation posed unacceptable risks of exacerbating both his cardiac and spinal conditions. We had seen Unum employ a nearly identical vocational strategy in a case involving a billing manager with a back disorder who was denied Unum LTD benefits — a denial we also reversed.

The vocational expert concluded that when our client’s actual restrictions and limitations were taken into account, “there are no occupations in the national economy that he could perform at the required wage level.” The independent vocational evaluation did not merely challenge Unum’s analysis — it dismantled it entirely.

Social Security Found Our Client Disabled — Unum Disagreed

Many claimants ask whether a Social Security Disability award helps their disability insurance appeal. The answer is yes — but only if the appeal forces the insurer to confront it.

Our client had been awarded Social Security Disability Insurance (SSDI) benefits — a determination that he had been disabled since the date he stopped working. The Social Security Administration applies a stringent definition of disability, requiring an inability to engage in any substantial gainful activity. Unum acknowledged the SSA award in its denial letter but attempted to distinguish its own conclusion by arguing that its policy’s definition of disability does not account for the claimant’s age, unlike the SSA’s framework.

The appeal confronted this argument directly. Under ERISA’s claims procedure requirements, an insurer that reaches a conclusion contrary to an SSA disability finding must meaningfully explain why its determination differs. Unum’s explanation — that its policy evaluates disability without regard to age — did not address the substance of the SSA’s medical findings. Nor did Unum produce evidence of medical improvement sufficient to justify terminating benefits it had previously approved. As the appeal argued, citing relevant case law, an insurer cannot terminate previously approved benefits without demonstrating a meaningful change in the claimant’s medical evidence.

This pattern — where Unum acknowledges an SSA award but fails to reconcile its own contradictory conclusion — is something we see repeatedly. We confronted a similar issue in a case involving a Unum claimant with heart conditions whose denial we reversed on appeal, and in a case involving a transportation manager with a brain injury who won his Unum disability appeal. The lesson is consistent: an SSA disability award does not guarantee your insurer will agree, but it is powerful evidence that a skilled long-term disability insurance attorney can leverage on appeal.

Unum Reverses Its Decision in Full

After reviewing the 632-page appeal submitted by attorney Cesar Gavidia — including updated medical records from our client’s cardiologist, orthopedic surgeon, endocrinologist, primary care physician, and family medicine provider, along with the independent vocational evaluation — Unum reversed its decision. In its approval letter, Unum stated that it had “completed a thorough and independent review of your client’s claim file and the information you provided on appeal” and determined that our client “continues to be eligible for benefits under the LTD policy.”

This was not a partial reversal or a conditional approval. Unum reinstated our client’s full long-term disability benefits, including all back benefits owed from the date of termination. The outcome confirmed what the medical and vocational evidence had demonstrated from the start: our client was totally disabled from any gainful occupation, and Unum’s termination was without foundation.

---

If Unum Has Denied Your Disability Benefits

If Unum has denied or terminated your long-term disability benefits — particularly at the 24-month definition change — you are facing a deadline that determines your legal rights. Under ERISA, you have 180 days from the date of denial to file an administrative appeal, and the evidence you submit in that appeal may be the only evidence a court can consider if the case proceeds to litigation. What you do now matters more than at any other point in the claims process.

Our firm has been representing disability insurance claimants nationwide since 1979. We have helped tens of thousands of claimants recover more than $2 billion in disability benefits from Unum and every other major carrier. We know how Unum builds its denials, and we know how to take them apart. Contact our office for a free consultation with one of our disability insurance attorneys — there is no fee unless your benefits are paid.