Unum Motion to Deny Total Disability Benefits to OB/GYN Denied by Tennessee Judge
In Barbara J. Nylander, M.D. v. Unum Life Insurance Company and Paul Revere Life Insurance Company, Dr. Nylander, a board-certified physician whose practice included gynecological surgery, was injured on April 21, 2015, when another doctor with whom she was performing an operation accidentally cut her index finger, severing a tendon. The injury was so serious, surgery was required to try and repair the damage.
Nylander was insured under three disability policies, all administered by Unum. Initially, Unum paid short term disability benefits to Nylander with a report from her treating orthopedic surgeon that she should be able to return to work by October 15, 2015.
As October 15 neared, Nylander informed Unum that she was unable to suture and therefore, could not return to the surgical part of her practice. She informed them that surgery amounted to about 25 percent of her time, but generated nearly 50 percent of her revenue.
After several reports to Unum that she should be able to return to work without limitation, her surgeon ordered a Functional Capacity Evaluation (FCE) test. Relying on the results of that test, her surgeon informed Unum that Nylander could no longer perform surgery since she could not grip certain instruments and could not suture. Nylander submitted a claim for total disability under the definition of the policies.
Unum ordered an independent medical exam (IME) and review of her medical records. Then, it denied her claim for any further disability benefits.
Definition of Total Disability Under the Policies
All three policies defined total disability as an injury that “restricts the Insured’s ability to perform the material and substantial duties of [her] regular occupation…” Nylander claimed that doing surgery was a material and substantial duty of her regular occupation. Since she was unable to perform that duty, she claimed she was entitled to total disability benefits.
Unum argued there was no objective evidence that Nylander could not perform her job duties. The Court disagreed and found the FCE to clearly be objective evidence of her limitations. The FCE was performed over a four-hour period of time by a board-certified hand therapist. The therapist reported that Nylander had difficulty handling surgical tools and performing “various suture techniques.”
The Court cited a number of Sixth Circuit cases and other District Court cases that held “An FCE is generally a ‘reliable and objective method of gauging the extent one can complete work-related tasks.” The Court also pointed out to Unum that it had used FCE results to deny benefits to past claimants.
The Unum doctor who performed the IME spent only 30 minutes with Nylander. He suggested she could make accommodations in surgery, such as “wear oversized gloves” or “use different digits.” Nylander laughed at these suggestions and it seemed as though the Court may also have found them amusing. Ultimately, the Court found that whether the IME report contradicted the FCE was “irrelevant to the question of whether Dr. Nylander has adduced objective evidence of ‘proof of loss.’”
Since there were disputes of material fact, the Court denied Unum’s Motion for Summary Judgment on the issue that Nylander had not presented objective evidence of total disability according to the definitions of the three policies.
This case was not handled by our office, but we thought it could be helpful to those who may have a similar issue and are struggling to obtain benefits, but the insurer is denying the claim even when there is an FCE in support of eligibility for disability benefits. For more information about this issue, or any issue relating to your Unum disability claim, contact us at Dell & Schaefer for a free consultation.
Resources to Help You Win Disability Benefits
Get Your Unum Disability Application Approved
Prevent a Unum Disability Benefit Denial
Negotiate a Unum Lump-Sum Settlement
Our goal is to negotiate the highest possible buyout of your long-term disability policy.
Policy Holder Rating
Q: Does UNUM periodically review Group Long Term Disability Insurance claims/payments? For example, do they verify medical eligibility every five or ten years?
Q: My group long term disability insurance allows me to work part time up to 20% of my pre-disability earnings without affecting my benefit. If I take advantage of this, will Unum use this to deny my benefit?
After appeal filed by Attorney Jay Symonds, UNUM overturned previous denial of long term disability benefits for South Carolina Nurse
Unum Overturns Original Decision to Deny Benefits to Disabled Account Manager Following Appeal Submitted by Dell Disability Lawyers Appeals Team
After appeal filed by Attorney Jay Symonds, UNUM overturned its previous denial of long term disability benefits for Colorado Plumber
Court Rules Plaintiff's Medical Records Was Replete With Evidence Supporting Claim of MS & Was Not A Pre-Existing Condition
After paying for 13 years Unum Denies Disability Benefits to Woman with Lyme Disease and Endometriosis
Inexperienced Lawyer Handles Unum Disability Lawsuit and Fails to Provide Evidence to Support Occupational Argument
Massachusetts court overturns Unum's decision to terminate disability benefits after paying for nearly ten years
Reviews from Our Clients
Very satisfied with the work of this team. Took well care of my case and took all the necessary time to be responsive and attentive when I had questions. Guided me through recovery and returning to normalcy. All thanks to Jason & Tabitha, thank you!
I’m extremely satisfied with the experience I have had with this firm from day one. The lawyer who has handled my case, Alex, is very efficient and attentive to all my questions and concerns. They are always aware of how my case has gone and they care about my health. I feel optimistic with them because they are very attentive during the process of my claim. I would not hesitate to recommend families and friends if in any situation they need their services. Kathleen as well has been very well and assisted me with this case. I highly appreciate everything they have done for me.
It’s unfortunate when disability insurance companies come after older disabled policyholders just to help their bottom line. It can be a living nightmare the damage they can do to a family. Dell Disability Lawyers are polite, understanding and knowledgeable. They call you back and answer any question you have no matter how unimportant it can be. The amount of stress they took off of myself and family was incalculable. I recommend them highly to take care of any disability case whether it be filing for benefits or reversing a claim decision. They are outstanding.
I could not have been happier or more appreciative of the hard work they performed on my behalf. I was well briefed on my case and it was closed in a timely manner with a financially successful resolution.
Mr. Symonds and Sonia as well as everyone else we have worked with throughout this process have been very helpful, professional and caring to our situation. We are very thankful to have this great team on our side.
Without them my LTD company was dropping my plan with me still suffering from my accident, even with doctor’s statements I’m still disabled. The LTD company didn’t want to advance my policy to the next stage of years of pay. Dell Disability Lawyers saved my policy, and helped to enforce the LTD company’s own policy (for its policy holder, me) that I would be covered still under the LTD policy I had paid for at my previous job, when my accident occurred. These lawyers know what they are doing and can help you too. LTD companies will try to drop you when you still need coverage just because they don’t want to pay on your policy anymore. Don’t let them break contract with ya because they are trying to get out of it. Hit em with legal action to ensure the continuation of your policy you paid for. Dell Disability worked very well for me and continue to do so.
I was denied long term disability benefits from The Hartford after being on it for years. I found Dell Disability Lawyers after doing research online. In a matter of days they responded and explained to me everything that would be done. Dell Disability Lawyers were able to settle my suit against The Hartford very quickly and responded to me quickly. I would definitely recommend this team of lawyers for anyone that is fighting for their disability insurance.
I have had nothing but a great experience with Dell Disability Law Firm. Mr. Alex Palamara and his team went above and beyond my expectations. They will respond to emails and phone calls in a timely manner. Thank you once again for taking my case.
This law firm is the best so far. MetLife denied me two times, they appealed two times for me and they won of course. So if you are on disability and want a chance at winning your case use this firm Dell disability lawyers, kind courteous understanding and they get the job done. You won’t be disappointed.