Transportation Manager with Brain Injury Wins Unum Disability Benefit Appeal
Unum unjustly terminated our client’s disability insurance claim after it had approved and accepted liability for six months. Unum unreasonably concluded, without any evidence of improvement, that the claimant had resumed the sustained work capacity to perform the material and substantial duties of her high level occupation as a Transportation Division Manager. The claimant was forced to cease working in her occupation due to persistent symptoms of headaches along with memory loss and cognitive dysfunction deemed related to a head injury/concussion that occurred approximately two weeks prior. Given the demonstrated severity of her condition, Unum found the claimant to be totally disabled. After paying benefits for six months, Unum terminated her benefits effective June 14, 2022, wrongly asserting that she was no longer disabled and “now” capable of performing the material and substantial duties of her occupation as a Transportation Division Manager.
Unum’s decision to terminate the claim was not only wrong but an abuse of discretion. There was no proper ground or defensible basis upon which to terminate LTD benefits as the medical evidence – including the diagnoses, assessments, and opinions of attending physicians – substantiated an ongoing severity of impairments that would not allow for any reasonable or reliable return to sustain work activity in her high level cognitive demanding occupation. The claimant remained under consistent treatment and underwent extensive evaluations with multiple different physicians, all of whom affirmed her ongoing and severe disability as well as endorsed medically necessary restrictions and limitations that would preclude her ability to work. They have consistently maintained the opinion that the claimant is unable to perform her occupational duties due to her residual cognitive, behavioral, and physical symptomatology related to her medical condition. In an office note dated January 31, 2022, Dr. Keith Anderson documented her persistent memory issues requiring her to “take notes on everything”. He further noted that she still gets overwhelmed and is maintained on amantadine. While he noted some prior improvement, he confirmed regression and worsening of condition due to the claimant contracting the COVID-19 virus on January 10, 2022.
Unum Provides No Evidence of Improvement of Claimant’s Condition
Unum has provided no evidence to substantiate improvement that would demonstrate the claimant could reasonably or reliably resume the demands of her occupation. Despite the extensive evidence of cognitive dysfunction, Unum failed to perform a neuropsychological evaluation to assess for neurocognitive impairments although such examinations are provisioned for in the policy. Basing their misguided judgement on inconsequential activities (i.e. moving to Florida, flying back and forth between Florida and North Carolina for medical care, being able to use a checkbook and debit card) purportedly performed by the claimant, Unum and its ill-advised medical consultants injudiciously concluded she would be able to resume working in her occupation as a Transportation Division Manager; thereby, illogically presuming that these activities equate to an ability to reasonably perform sustained work activities in a high level cognitive demanding occupation.
Neuropsychological Evaluation Supports Inability to Work in Any Capacity
The ongoing and significant impairments related to the claimant’s traumatic brain injury has been further substantiated through neuropsychological testing completed on December 28, 2022. The results of the evaluation supports that the claimant is unable to work in any capacity.
SUMMARY: Results of this neuropsychological evaluation do indicate that the patient has a major neurocognitive disorder from her head injury. Relative to estimates of premorbid functioning, significant declines were found in her verbal memory, sustained attention and measures of frontal lobe functioning. She reports significantly increased apathy and overall executive functioning impairment relative to her abilities prior injury. Additionally, the patient is exhibiting severe despression at this time due to neurocognitive losses. Overall adaptive functioning is low, and she clearly is unable to work.
It could not be clearer that, the claimant remains disabled pursuant to the terms of the LTD Policy. Unum ignored the relevant medical evidence and relied solely on the biased opinions of its own contracted medical consultants. Their opinions, however, lacked any factual basis and was clearly unfounded considering the claimant’s medical history and examination findings and therefore should be disregarded. The totality of the medical evidence, including that already in Unum’s possession and the updated evidence provided with this appeal to include multiple letters from friends and family attesting to the observed decline in her functioning, substantiates that the claimant was and continues to be totally disabled due to her severe residual symptomatology to include impaired cognitive function related to diagnosis of post concussive syndrome status post head injury. As such she is eligible for and entitled to continued long term disability benefits under the policy.
After submitting an appeal along with substantial medical support Unum determined that its decision to terminate benefits was incorrect and the claimant’s benefits were reinstated including all back pay owed and are currently being managed by Attorney Rachel Alters.
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