M&T Bank Product Manager With Adenocarcinoma Wins New York Unum Long-Term Disability Insurance Appeal After Benefits Terminated During Treatment
Unum approved our client’s long-term disability claim, paid it for months, and then terminated his benefits — while he was still receiving chemotherapy for terminal cancer. He was a senior Product Manager at M&T Bank Corporation in New York, and he had stopped working because of metastatic gastroesophageal cancer and the relentless side effects of the treatment keeping him alive.
We have watched Unum run this play over and over: pay a claim just long enough to look reasonable, then engineer a way out. It is exactly the kind of termination our long-term disability insurance lawyers have challenged and reversed many times. We filed an administrative appeal, and Unum backed down — reopening the claim, reinstating benefits, and paying what it owed.
How Unum built its denial — and how we took it apart — is worth understanding for anyone whose disability insurance company is using performance scores, everyday activities, and a single phone call with a doctor to argue that a seriously ill person can work. If Unum or any other disability insurance company has denied or terminated your benefits, we invite you to speak with one of our lawyers. Our representation is nationwide, and there is no fee unless we recover benefits for you.
Table Of Contents
- 1. Why this case matters for every Unum claimant
- 2. A senior bank Product Manager sidelined by metastatic cancer
- 3. How Unum built its denial: a phone call, an ECOG score, and berry picking
- 4. Why an ECOG score and a walk around the block do not prove you can work
- 5. The cognitive demands Unum refused to measure
- 6. Unum reverses course — and the life insurance premium waiver comes back too
- 7. Talk to a disability insurance lawyer before you take on Unum alone
Why this case matters for every Unum claimant
Before the case-specific detail, here is what this reversal teaches anyone fighting a Unum termination — and why it reaches far beyond a single diagnosis.
- Approval is not permanence. Unum paid these benefits for months and then terminated them — proof that a paid claim is never a settled claim, and that a carrier can build a termination file while the checks are still going out.
- A performance score is not a measure of whether you can work. Unum leaned on an ECOG score of 0-1, an oncology shorthand for how physically active a patient is, as if it answered whether our client could run a demanding banking job forty hours a week. It does not.
- What you do on your own schedule is not what an employer requires. Walking the neighborhood, preparing meals, and picking berries happen at your own pace, on your own time. None of it proves you can sustain full-time, high-pressure work — a point that matters for every list of “activities of daily living” a carrier throws back at a claimant.
- If your occupation is cognitively demanding, the real fight is over your mind. Unum reduced a senior product-management role to a “sedentary” physical classification and ignored the concentration, memory, and judgment the job actually required. Objective testing forced the true demands of the occupation back into the record.
- One disability insurance denial can put other benefits at risk. The same decision had frozen our client’s life insurance premium waiver. When the disability finding came back, so did that coverage — protection worth a great deal to his family.
We have handled a great many long-term disability claims brought by cancer patients, and the through-line is almost always the same: the diagnosis is not disputed, but the insurer insists the treatment and its aftermath still leave the claimant able to work.
A senior bank Product Manager sidelined by metastatic cancer
Our client spent his career as a senior Product Manager at M&T Bank Corporation, a role that carried real institutional weight. His work set strategic direction for entire product lines and shaped the bank’s revenue and risk.
His diagnosis was metastatic gastroesophageal junction adenocarcinoma (ICD-10 C16.0) — a cancer that forms where the esophagus meets the stomach and, in his case, had already spread to other parts of the body. Treatment was aggressive and continuous: an initial multi-drug chemotherapy regimen, followed by ongoing maintenance immunotherapy delivered every three weeks. This is the kind of treatment that does not end so much as become a permanent condition of daily life. It left him with the fatigue, diarrhea, and other side effects that commonly accompany this class of cancer immunotherapy: unrelenting exhaustion that forced daily naps, four to five episodes of diarrhea a day, and a persistent mental fog.
The duties of his own occupation were not physical — they were cognitive and high-stakes:
- Setting strategic direction for multiple product lines and presenting business plans to senior management;
- Owning product pricing, cost structure, revenue planning, and profitability;
- Managing sales-channel strategy and evaluating new products, markets, and competitors;
- Ensuring products complied with legal and regulatory requirements while minimizing risk to the bank;
- Exercising full managerial authority over staffing, performance reviews, and terminations.
Under the own-occupation standard that governed his claim, our client was disabled if his illness left him unable to perform the material and substantial duties of his own occupation — the specific job he actually held, not some hypothetical lighter role. That distinction matters, and it is a common question claimants search for: what happens when a disability insurance policy shifts from own occupation to any occupation. His claim never reached that later, tougher standard. Unum terminated it while he was still measured against his own job.
After he satisfied the policy’s elimination period — the waiting period a claimant must remain disabled before benefits become payable — Unum approved the claim and began paying monthly benefits. It paid under the own-occupation standard for roughly seven months. Then it stopped. If you are wrestling with whether a cancer diagnosis even qualifies, our attorneys have written plainly about how cancer is treated under long-term disability policies.
How Unum built its denial: a phone call, an ECOG score, and berry picking
Unum did not deny this claim after examining our client. It never examined him at all. The termination rested entirely on paper reviews. A paper review, also called a file review, is an assessment in which a doctor the insurer pays reviews the medical records and renders an opinion without ever examining the patient. Being denied disability benefits based on a paper review, rather than an in-person exam, is one of the most common Unum tactics we see — and here, two of its in-house physicians drove the decision.
A phone call that was never put in writing
The termination began with Unum’s peer-review physician, Dr. Rajesh Ethiraj. In a peer-to-peer telephone call, Dr. Ethiraj reported, our client’s treating oncologist had supposedly agreed that our client could handle sedentary demands — mostly sitting, brief standing and walking, occasional lifting up to ten pounds. Unum closed the claim on the strength of that reported agreement, without ever obtaining written confirmation from the treating oncologist. When the treating oncologist did put his position in writing, it was the opposite: because of the persistent fatigue and diarrhea from ongoing immunotherapy for terminal disease, our client could not sustain full-time work. Unum had cut off benefits based on a characterization of a phone call that the physician himself contradicted.
A second reviewer, an ECOG score, and a contradiction Unum ignored
Rather than credit the treating oncologist, Unum routed the file to a second in-house physician, Dr. Kevin Konan, who reached the same conclusion. Dr. Konan rested heavily on the client’s ECOG performance-status scores of 0-1. His report also claimed the records showed “no adverse medication or treatment side effects” — in the very same review that conceded the nausea and diarrhea the treating oncologist had identified as the primary impairing symptoms. Unum’s own reviewer contradicted himself, and Unum adopted the contradiction anyway.
Mistaking a walk in the neighborhood for a workday
Finally, Unum pointed to our client’s activities of daily living — walking thirty to forty-five minutes when weather allowed, preparing meals, recreational berry picking, attending his son’s hockey activities, and driving — as evidence of preserved stamina, mobility, and cognition. On that record, Unum’s denial declared he was “not precluded from performing the duties of [his] regular occupation.” When we asked Unum to reconsider, it refused, stating that the additional information did not change its decision.
Why an ECOG score and a walk around the block do not prove you can work
This is where Unum’s file fell apart. Every pillar of the denial confused something small and measurable for the thing that actually matters — the ability to perform a specific, demanding job, all day, every workday, reliably.
An oncology score is not a vocational assessment
Start with the ECOG score. It is a single-dimension prognostic and treatment-planning tool used inside oncology, not a measure of whether someone can hold a job — and it is coarse enough that oncology researchers have pressed to move beyond performance-status scores like ECOG toward more precise measures of function. A 0-1 lumps together the genuinely robust and the seriously symptomatic-but-still-ambulatory. It was never designed to answer whether a person can concentrate through a full workday, meet deadlines, and exercise executive judgment. Treating a 0-1 as a green light to work is the difference between a screening shorthand and reality.
“Sedentary” describes lifting, not a banking job
Next, the “sedentary” label. Unum collapsed a senior banking role into the lowest common denominator of physical strength — the sedentary physical-demand classification that describes sitting and lifting up to ten pounds. But that classification says nothing about the sustained attention, rapid processing of complex information, and sound judgment the job demanded. A cancer patient can meet the physical description of sedentary work and still be nowhere near able to do the actual job.
Self-paced activities are not a forty-hour workweek
Then the daily activities. Walking the block, cooking, and berry picking are self-paced and self-scheduled — done when he felt able, stopped when he did not. That is an assumption of capacity, not a fact. None of it translates into producing consistent, high-level work on an employer’s timetable.
Unum’s fallback was that our client could simply take breaks as needed. Breaks are allowed in most workplaces, but that is not the same as an occupation tolerating four to five bathroom trips a day plus unpredictable fatigue naps that vary from one hour to the next. When symptoms disrupt work that unpredictably, they erode performance past any reasonable accommodation. Unum never analyzed how many breaks a real workplace would bear; it simply assumed the answer it needed.
One appeal to put the real evidence on the record
Because our client’s coverage came through his employer’s group plan, the claim was governed by ERISA, the federal law that regulates most employee benefit plans and requires a full and fair review of any denial before a claimant may go to court. ERISA’s claims-procedure provision gave our client one administrative appeal — a single opportunity to build the record — and we used it to put in front of Unum the evidence it had refused to gather.
The cognitive demands Unum refused to measure
Here is what Unum never addressed: our client’s job lived in his head. His role was built on memory, focus, speed, and judgment — and cancer treatment had quietly taken those apart. To prove what Unum would not measure, we arranged a comprehensive neuropsychological evaluation — a battery of standardized instruments, including the Neuropsychological Assessment Battery (NAB) and CNS Vital Signs, that objectively measures memory, attention, processing speed, and executive function — performed by a licensed clinical psychologist.
The testing documented objective, clinically significant impairment across the exact abilities his job required. In plain terms, the results described a mind that could no longer hold on to information reliably, think quickly, or juggle complex tasks the way a senior manager must:
- Severe verbal memory impairment — extremely low scores on immediate and delayed recall, meaning he could not reliably retain or retrieve information he had just taken in;
- Deficits in attention, processing speed, and reaction time — he needed far longer to work through information most people process automatically;
- Impaired executive function and cognitive flexibility — difficulty planning, shifting between tasks, and exercising the constant judgment his role demanded.
The evaluator characterized this as “global cognitive inefficiency and slowed mental processing” rather than an isolated weakness — a whole-brain slowdown, not one bad test. Just as important, embedded performance-validity testing — including the Test of Memory and Malingering (TOMM) — confirmed he was not exaggerating or feigning his difficulties: the results were a reliable picture of how his brain was actually working. His oncology records corroborated the same story, documenting the worsening treatment-related cognitive impairment that clinicians call “chemo brain” and concluding he could work no more than roughly four hours a day.
This is not the first time we have watched Unum wave away a cognitive disability because a claimant “looked fine” on a physical exam. We dismantled an almost identical denial for a Senior Project Manager whose cognitive limitations Unum ignored — a termination we also got reversed on appeal. These disability insurance claims built on cognitive limitations are ones we handle constantly, and the lesson repeats: when the job is mental, the case has to prove the mind, and a physical exam that finds “normal strength” answers a question no one asked.
Unum reverses course — and the life insurance premium waiver comes back too
Attorney Stephen Jessup assembled the appeal — the updated oncology records, the neuropsychological evaluation, and a point-by-point dismantling of Unum’s paper reviews — and submitted it as our client’s ERISA appeal.
Unum reversed. In writing, it acknowledged that its earlier decision was “no longer supported,” reopened the long-term disability claim, resumed monthly payments, and paid the benefits it had wrongly withheld, retroactive to the day after it had cut him off.
The victory did not stop at the disability claim. The same termination had suspended our client’s life insurance premium waiver. A life insurance premium waiver is a policy provision that keeps life insurance coverage in force, with no premiums owed, for as long as the insured remains disabled. With the disability finding restored, Unum reopened and approved that benefit as well: more than $620,000 in life insurance coverage that will continue, premium-free, while he remains disabled. That is protection for his family a wrongful disability insurance denial had quietly put in jeopardy — and a reminder that a long-term disability decision can reach benefits a claimant may not even realize are on the line.
None of this is unique to one claim. We have recovered benefits for a dentist with cancer who could no longer practice — another Unum cancer denial we defeated — and the playbook Unum ran here is one we see against claimant after claimant.
Talk to a disability insurance lawyer before you take on Unum alone
If Unum has terminated your long-term disability benefits, understand what happened to our client: the denial was not the last word — it was the opening move.
The most dangerous mistake is waiting. Under ERISA, you generally have 180 days from a denial to file your administrative appeal, and that appeal is very likely the only chance to get new evidence — updated records, objective testing, vocational proof — into your file before a federal judge ever reviews it. Miss the deadline, and the record closes for good.
Since 1979, our long-term disability insurance lawyers have helped tens of thousands of claimants across the country recover more than $2 billion in benefits. We represent clients in every state, against Unum and every other major disability insurer, and we charge no fee unless we recover benefits for you. Contact our office for a free consultation, and let us review your denial before you respond to it.
