Sometimes a Unum disability denial is correct, even after 5 years of payments

It is vital for claimants to remember that just because disability benefits have been approved and are being paid, this does not mean the insurance company has closed its file and is no longer investigating your claim for disability. You must continue to treat for you illness or injury and your physicians must continue to support your being disabled and not able to work due to your illness or injury. Additionally, medical evidence of the disability must be routinely provided to the insurance company or they will find grounds to deny your claim for continued benefits.

It is not uncommon for disability insurance companies to conduct video surveillance, especially when they have been paying benefits for 5 or 10 years, as a means to “check up” on your functional status and to try to catch you “in the act” of performing activities you claim unable to do as a result of your illness and disability.

In this article let’s take a look at a recent case in which Unum denied benefits to a former medical device sales rep after paying her for 5 years. Our law firm did not represent this claimant, and based upon the reported facts it appears obvious that Unum and the Court made the right decision by denying long term disability benefits. It is rare for us to say we agree with a Unum decision, but this claimant did not have proper medical support for disability and her lack of honesty resulted in a clear disability. Any experienced disability insurance lawyer would have known immediately that this case had no chance of being won in court. It is always important to hire an experienced disability attorney that will give you an honest opinion about your chances of obtaining disability insurance benefits.

Heger v. Unum Insurance Company

The plaintiff in this matter, Ms. Hegger, was previously employed by Medela Inc. as a medical device sales representative. She stopped working in December 2004 due to back and neck pain. In April 2005, Unum approved Ms. Hegger’s claim for disability benefits. From 2005 through 2010, Unum conducted periodic reviews of Ms. Hegger’s claim and determined that she remained disabled and continued to pay her disability benefits. However, in November 2010, after five years of payments, Unum determined she was no longer disabled and terminated her long term disability benefits. Ms. Hegger appealed in 2011 and her appeal was denied. Thereafter, she filed a disability insurance lawsuit against UNUM in california under ERISA.

The Medical Records Were Inconsistent and Lacked Support

At the time she stopped working, Ms. Hegger was diagnosed with lumbar degenerative joint disease and lumbar myofascial pain and an MRI revealed a L5-S1 disc bulge.

During the time period from 2004 until 2010, Ms. Hegger treated with numerous physicians. The records indicated that she had significant pain complaints, with intensities reaching 8-9 out of 10. However, the records also indicated that once one of her treating physicians determined that she was capable of returning to work, even with some restrictions. Ms. Hegger sought out treatment from another doctor who would then determine her disabled from work. Ms. Hegger underwent 3 independent medical examinations, relating to her workers’ compensation and social security proceedings, which all determined that Ms. Hegger was able to work, but with certain restrictions. The records also reflected that Ms. Hegger reported that she did go to the gym for stretching and strengthening and a comparison MRI performed in 2008 showed that her disk bulge had diminished.

Unum had 2 of its own physicians perform file reviews. The first determined that Ms. Hegger’s condition had improved and received confirmation from one of her treating physicians that she was able to return to full time work. The second Unum physician found discrepancies in Ms. Hegger’s reported complaints and no medical basis for her physician’s conclusions that she was not able to work. The second reviewing physician also determined that Ms. Hegger was capable of full time work.

In 2007, Ms. Hegger filed a claim for Social Security Disability benefits and was subsequently denied. A year later she filed an application for Social Security benefits, and her application was denied at hearing by an administrative law judge. A medical expert and vocational expert testified at the hearing. The ALJ concluded that Ms. Hegger’s medical conditions could be reasonably expected to produce her reported symptoms, but that her own statements regarding the “intensity, persistence and limiting effects of these symptoms are not entirely credible to the extent they would preclude the residual functional capacity for”¦light work.” This evidence is not good at all for supporting a long term disability claim.

Claimant’s Activities and Actions Give Cause To Question Her Credibility

In addition to the medical evidence, other evidence was considered which gave cause to question Ms. Hegger’s credibility when reporting her symptoms. It was discovered that Ms. Hegger took first place in a Tae Kwon Do martial arts tournament in early 2007. She admitted to earning her black belt rank prior to 2005 and that she “occasionally” practiced Tae Kwon Do since allegedly becoming disabled. She also admitted to participating in a martial arts tournament in 2008. However, Ms. Hegger never reported participating in Tae Kwon Do to her doctors or to Unum, and even falsely reported that she did not engage in any sports activities. During the times she was engaging in martial arts tournaments in 2007 and 2008, she was reporting to her doctors that she was regularly suffering from extreme, debilitating pain.

Unum conducted video surveillance of Ms. Hegger in 2008 and 2010. The most significant video, taken in 2010, demonstrated that on one day, Ms. Hegger spent over 6 hours outside of her house. She spent 90 minutes at the gym and then went to a physical therapy appointment. After her physical therapy, she went shopping. The video shows her removing groceries from her SUV by herself, including a flat of water bottles. She is shown reaching overhead to close the trunk of her SUV while holding a flat of canned goods under her arm and balanced on her hip.

The record also showed that Ms. Hegger traveled substantially after leaving work for her disability. She traveled to Phoenix, Orlando and a 5-day Las Vegas convention while working for Hygeia, a competitor of her former employer. She also went to Hawaii a couple of times per year.

There was also evidence in the record that Ms. Hegger made false representations to Unum and her doctors about her work. After telling Unum she was not employed, she reported to her physical therapist that she was “self-employed”. Unum later learned that she was 50% owner with her husband in a business and had reported self-employment income for the years 2004 – 2007, totaling over $50,000. In 2008, Unum asked Ms. Hegger whether she owned a business and was self-employed, and Ms. Hegger denied both. Thirteen days after making that denial, she amended her 2005 and 2006 tax returns and changed the classification of the income she received for those years as non-taxable stating that “she was not active in the Hegger Insurance Agency.”

Unum also questioned Ms. Hegger in 2008 about whether she returned to work for Hygeia. She reported that she was not working and did not disclose she attended the Las Vegas conference. When asked specifically whether she attended the Las Vegas conference, she said that she had but claimed she was not paid for her work. In 2009, Ms. Hegger’s submitted a form to Unum reporting that she returned to work but was not getting paid, and later reported that she was only working part-time and earning only $30-40 per month. However, the evidence showed that in 2009 she worked for Hygeia for 10 months on a flexible scheduled and earned over $36,000.

Additionally, the court found that the evidence of her work for Hygeia demonstrated that Ms. Hegger remained employable in her occupation after she left work, and that she would be able to find gainful employed as defined by the plan if she returned to work.

The Court Determines the Evidence Proves Claimant is Not Disabled

Ms. Hegger’s California disability insurance attorneys (not Dell & Schaefer!) tried to argue that Unum could not use the evidence it had while it was paying disability benefits as evidence supporting a subsequent denial of benefits. The court held that “an initial grant of payment of disability benefits may be evidence relevant to whether a claimant is disabled, but it is not necessarily dispositive.” Further, Unum is not precluded from changing its evaluation, taking a fresh look at the claim file, or re-interpreting evidence based on new developments in the claim over time.

Ms. Hegger requested for the court to remand her claim back to Unum in order to challenge the reasons they denied her disability benefits for the first time on appeal. However, the court, in this matter, applied a de novo standard of review and found that a remand was inappropriate.

After thoroughly reviewing the record evidence, the court determined that Ms. Hegger was not disabled under the plan when Unum denied her appeal, and Unum’s motion for judgment was granted.

Attorneys Dell & Schaefer did not represent Ms. Hegger in her disability claim, appeal or lawsuit. If you have questions regarding your claim for disability benefits, or if your disability claim has been denied, feel free to call Disability Attorneys Dell & Schaefer for a free consultation.

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Unum Reviews

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Showing 8 of 58 Reviews

I feel like Unum is giving me the runaround!

Reviewed by Rachelle H. on May 11th 2022   Verified Policyholder
I have contacted UNUM multiple times since I’ve needed them. I feel like they are giving me the runaround! Please help!
Sent on May 11th 2022 by Attorney Stephen Jessup

Rachelle, the law provides certain timelines and deadlines with which to provide information or decisions. Please feel free to contact our office to discuss your situat... read more >


Unum terminated my benefits with no warning

Reviewed by K. Potter on September 9th 2020   Verified Policyholder
I was told I was covered with Unum through my employer (continuum). I got an email today for my termination, no prior talks of infractions with attendance, no warnings, no... read more >
Sent on September 9th 2020 by Attorney Stephen Jessup

K. Potter, termination as in your employment was terminated or a disability claim was terminated? If your employment was terminated and you had not filed a claim for di... read more >


I've been trying to care care of my Unum benefits for over a year. They’ve been so rude

Reviewed by Tracey W. on August 30th 2020   Verified Policyholder
I have been trying to take care of my Unum benefits for over a year. I’ve called and back in November I did appeal letter, they say they never received. I did everything... read more >
Sent on August 30th 2020 by Attorney Gregory Dell

Tracey, I am sorry to hear of your issues with Unum. We would love to learn more about your claim to see if we can get Unum to pay or if we can sue them with you. Pleas... read more >


I've paid for STD for 20+ years. Now, I'm actually sick and can't get paid

Reviewed by Natalie on June 29th 2020   Verified Policyholder
My employer uses unum for short-term disability. I was hospitalized back on june 13 and discharged on june 25. I was admitted for double pneumonia and hypoxia, which I end... read more >
Sent on June 29th 2020 by Attorney Rachel Alters

Natalie, hopefully your claim will be approved. If they deny the STD claim then you will need to appeal the determination.


Unum thought I was fine to work. I wasn't

Reviewed by Elizabeth L. on May 21st 2020   Verified Policyholder
48 yoa dentist POTs Dx aug 22. Attempted to return to work initially but got sick. Was going to go back 2 days/wk in September but could not. Then did go back part time as... read more >
Sent on May 21st 2020 by Attorney Stephen Jessup

Elizabeth, please contact our office to discuss the denial of your claim and your rights to pursue legal action against Unum.


Unum has made me feel like a criminal

Reviewed by Kevin on February 6th 2020   Verified Policyholder
Hi, I am currently receiving LTD from UNUM. I used to work as a Radiologist Tech at Vanderbilt Medical Center in Nashville, TN. for about 10 years. Than I started having g... read more >
Sent on February 6th 2020 by Attorney Gregory Dell

Kevin, I am sorry to hear all that you are going through and the stress this is causing you. The policy governing your claim likely does allow Unum to conduct an in-per... read more >


Unum keeps prolonging the process to approve my LTD benefits

Reviewed by Lamecia on May 28th 2019   Verified Policyholder
I have been waiting for UNUM to make a decision on my long term claim for almost two months. They constantly keep prolonging the process and approve my long term benefits.... read more >
Sent on May 28th 2019 by Attorney Rachel Alters

Lameica, you can email me at and we can set up a time to discuss your situation with Unum.


I only needed Unum once and to no aviail. I got denied

Reviewed by Monique G. on July 12th 2018   Verified Policyholder
I have had Unum for some years now. I only needed them once and to no avail. I was diagnosed with a goiter and on my second biopsy they found atypical cells so I scheduled... read more >
Sent on July 12th 2018 by Attorney Gregory Dell

Monique, I am sorry to hear that your claim was denied. Please contact us and speak with one of our attorneys. We will offer a free consultation and will gladly review ... read more >

Answered Questions by Our Lawyers
Showing 8 of 87 Answered Questions

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Answered on June 29th 2023 by Attorney Stephen Jessup
A: I am sorry to hear about the issues you and your partner have been going through. Unfortunately, if the policy... Read More >

Q: Am I required to file for Social Security family/dependent benefits if I don't want to?

Answered on June 21st 2023 by Attorney Jay Symonds
A: The carrier cannot make you file but they are entitled to estimate an offset if you don’t and reduce your mo... Read More >

Q: How can I avoid multiple offsets of my private DI policies by my SSDI amount?

Answered on June 6th 2023 by Attorney Gregory Dell
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Q: Unum discontinued the "long term Buy out option" in 2014. I was never aware of or informed of this action by Unum.

Answered on May 31st 2023 by Attorney Gregory Dell
A: Most Unum disability policies end at 65 or social security retirement age. I am not sure you have any options ... Read More >

Q: I was denied by Unum twice. What can I do?

Answered on May 2nd 2023 by Attorney Gregory Dell
A: I am sorry to hear about your Unum disability denial. Your remedy at this point is to file a federal lawsuit a... Read More >

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Answered on July 20th 2022 by Attorney Rachel Alters
A: Erma, you can file an appeal with the carrier if you believe you have coverage. Ask for a copy of the policy. Read More >

Q: Can Unum threaten for fire me at the end of FMLA's 12 week time period? Can Unum deny my benefits if my company does not offer the work Unum think sI'm eligible to do?

Answered on October 28th 2020 by Attorney Stephen Jessup
A: Kurt, I would recommend you contact your Union representative to see if you have additional protection outside... Read More >
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The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

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