Mr. “F” called our office, through co-counsel, when Unum terminated his long-term disability (LTD) insurance benefits. Although he had been receiving monthly disability benefits for years, Unum claimed he was no longer disabled under the group insurance policy provided by his employer. Because the insurance was provided through work, his claim was governed by the Employee Retirement Income Security Act of 1974 (“ERISA”).
Mr. F suffers from spinal hemangiomas, chronic pain syndrome, cluster migraines, arachnoid cysts and cognitive impairment; all conditions which were diagnosed and properly treated by his health care providers. Unum claimed Mr. F’s conditions were no longer supported by the medical evidence. Indeed, the insurance carrier actually tried to assert that our client’s condition had changed after he had been receiving LTD benefits for over seven years.
Pursuing an ERISA Appeal: How We Helped Mr. F
Our office worked with Mr. F’s treatment providers to obtain detailed opinions about his conditions and their patient’s disabling health problems. Our law office ultimately submitted an internal appeal of the long-term disability claim denial to Unum, as required by the policy of insurance and ERISA statutory and regulatory procedures. The appeal addressed the report written by a physician paid by Unum to review claims.
It is not surprising (at least to us) that these hired gun physicians conclude that a claimant is not disabled even though the physician has never examined the claimant or even knows what he looks like. We addressed the errors in the reviewing physician’s report and provided substantial new evidence to support our client’s inability to work.
Because of the efforts undertaken by our office, along with our extensive experience in handling these types of claims, Unum agreed with our position and reinstated Mr. F’s LTD benefits. Our ERISA appeal succeeded in convincing Unum to overturn its prior denial of the claim. Our client is now being paid the benefits that should never have been terminated.
This particular client’s situation was somewhat unique but not overly so. We have seen many, many legitimate claims terminated by disability insurance companies even though that same insurer agreed the person has been disabled for years. Insurers such as Unum, who are protected by the ERISA laws meant to have just the opposite effect, suffer no real consequence for denying claims, no matter how legitimate.
If you have experienced a denial or termination of a legitimate claim for long-term disability benefits, you MUST consider hiring an experienced attorney to assist you. There are numerous hurdles and considerations that the denied individual is not aware of. Only experience counsel can best protect your rights.