Louisiana State College Director Wins Unum LTD Appeal But Then Denied Again
Client was Regional Director for the State of Louisiana. She was diagnosed with cervical radiculopathy, spondylosis, lumbar spondylosis and bilateral carpal tunnel syndrome. In 2020 she underwent an anterior cervical discectomy and fusion. Unfortunately the surgery did very little to resolve her neck pain, radiculopathy and discomfort.
She was a Regional Director for a community college in Louisiana. Prior to leaving work her EMG/NCV confirmed radiculopathy and nerve involvement cause by bilateral carpal tunnel. She was approved by Unum initially and they paid through her post operative recovery period. However, soon after her recovery period, Unum contacted her orthopedic surgeon who stated to Unum that our client could return to work in a sedentary occupation. After receiving this statement from her doctor Unum terminated the claim.
We appealed the decision arguing that the medical records and the client’s limitations show that she is not able to return to work performing the substantial and material duties of her occupation as a regional director. It was important to address the purported statement by her orthopedic surgeon since it was the primary reason Unum had denied her. She returned to her orthopedic surgeon with a questionnaire that we prepared which addressed her ongoing limitation and seeking the doctors opinion, based on the records and the examination of the patient, on whether she could return to work in her occupation. Her surgeon confirmed that she was not able to return to work and that she was not currently at maximum medical improvement.
Our appeal was successful, but only in part, because within the same letter that they were overturning their decision, Unum stated it was only through a particular date and it was denying benefits thereafter. They state that the limited medical records support disability beyond that date. What Unum is not considering is that its failure to pay benefits as it should have caused the client to lose their health insurance and created a gap in her treatment. She is a veteran so she switched her care to the VA, which unfortunately is backlogged and is only now getting in to see doctors. We will appeal again and submit new records and likely pursue an FCE that would show objectively the extent of her functionality and limitations.
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