Unum Overturns Original Decision to Deny Benefits to Disabled Account Manager Following Appeal Submitted by Dell & Schaefer Appeals Team
Author: Attorney Cesar Gavidia
In 2016, Sarah, an Account Manager, began suffering severe abdominal pain accompanied by bloody diarrhea. The frequency and condition was so severe that she was diagnosed with anemia from the blood loss and profound fatigue from the nutrient loss. By the end of 2016 Sarah was no longer capable of effectively performing the material and substantial duties of her own occupation as an account manager and was forced to stop working. In early 2017, Sarah attempted to return to work but failed, and was forced to file a long-term disability claim with her employer’s long-term disability insurer, Unum Life Insurance Company (“UNUM”).
Soon after she submitted her disability claim, Unum began its investigation, which included a doctor to doctor – or peer to peer as it’s often referred to by disability insurers – teleconference. Sarah’s primary care physician confirmed that her chronic conditions prevented her from returning to work, and were uncontrolled. Sarah’s primary physician also confirmed to Unum’s physician that she had referred her to a gastroenterologist specializing in digestive disorders to treat her.
Despite Unum’s peer to peer consultation with Sarah’s treating physician and the medical evidence strongly evidencing her clear and unquestionable claim, Unum denied her claim and informed her that if she wanted to challenge their adverse decision she could submit an administrative appeal within 180 days, as provided by ERISA.
Sarah retained Attorney Cesar Gavidia and his appeal team at Attorneys Dell & Schaefer to challenge Unum’s decision and prepare her ERISA appeal.
The Appeal submitted by Attorney Gavidia and his appeal team addressed several flaws in Unum’s decision to deny benefits, including Unum’s failure to adequately consider Sarah’s occupational requirement for travel and Unum’s lack of consideration to the psychosocial impact of Sarah’s condition on her functionality. A detailed and exhaustive historical chronology of Sarah’s medical condition and her symptoms was also included.
Approximately three weeks after the submission of the Appeal Unum overturned its decision and approved Sarah’s claim for benefits. Attorney Gavidia and his team continue to represent Sarah and actively monitor Unum’s handling of her long-term disability claim.
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