Rare and complicated illnesses pose especially difficult challenges to obtaining long term disability insurance benefits. We have represented many individuals facing life-changing disabilities that took months or even years to be properly diagnosed, while the long term insurance companies batted back their claims. One such case against Unum was recently resolved and we are proud of the success in representing a woman whose illness and inability to work was evident but Unum needed to be educated on the extent of her impairments and how they impacted her.
Making the claim even more challenging was the physical nature of her work, which isn’t readily apparent. She was a highly compensated freelance product designer and development specialist in the apparel industry. Her tasks included market research, creative design, sales, production management, contract negotiators, showroom design and financial analyst, among other responsibilities.
Our client, 55 years old and a resident of Connecticut, was an extremely high functioning person, commuting to New York City, travelling to China to visit factories often, shopping markets in fashion centers around the world, conducting high level negotiations while developing and building relationships with buyers responsible for millions of dollars of merchandise. She was also responsible for the entire financial side of the transactions, including ordering, inventory, chargebacks, invoicing, credit terms and factory compliancy.
Her disability began with an ankle wound that became a deep scab with severe inflammation that would not heal, despite extensive medical treatment. The extremely painful wound did not heal, and she began experiencing excruciating leg pain, to the extent that she could not walk. She went to many specialists, underwent biopsies, diagnostic tests and had a number of visits to the Emergency Department. Infectious disease specialists suggested Leishmaniasis and a retinal specialist thought it might be Behcet’s Disease. She underwent 75 blood tests, 2 biopsies, 2 CT scans, and one MRI, X-Ray, and ultrasound. The wound expands with new nodules starting and becoming infected. Any physical contact with the skin sets off another round of nodules and new wounds.
Traveling to her NYC office became impossible, as her leg had to be covered in heavy padding and wound dressing. The showroom where she worked is a high traffic area, with rolling racks of garments, mannequins, and boxes, and everything and everyone moves at a fast pace. She tried to keep working, despite the threat to her condition in every possible situation: commuting, walking from the train station to her office, and being in the showroom.
We filed her claim retroactively to Unum for a period of partial disability insurance benefits as she attempted to keep working, despite a significant drop in income resulting directly from her disability. Newfield Law Group was engaged at this time, and we set to work developing and building her claim for benefits against an insurance company known for denying claims.
Part of our approach included demonstrating the impact of a chronic wound and the risks inherent in living with an open, unhealed wound. The risk of system-wide infection resulting in fatal damage to the heart, kidneys and brain is real. Prolonged inflammation presents a risk to the entire body, even if it is occurring only in one location. Overall immunity is impaired by chronic wounds and can lead to many other complicating conditions.
We gathered a significant amount of published medical journals from well established sources to educate the claims reviewers on the impact of chronic wounds on a person’s well being to prove this point. We interfaced with all of her treating doctors and reviewed her entire, lengthy, medical history. We knew we had to go in with every piece of evidence possible.
Another challenge: anyone who works in a freelance capacity knows well the need to document and prove income. LTD claims adjusters target these claims to attempt to disprove the income levels, seeking all manner of financial information. Our client enjoyed a high income as the result of her fast-paced, high intensity career, and her income stream was highly documented, so we were able to present her pre- and post-disability income with great detail.
After lengthy discussions with Unum, we were successful in getting our clients’ benefits paid, as well as the benefits she was due during the time her claim available but prior to her filing for benefits. She is now able to keep her legs elevated, protect her wound, and is focusing on learning to live with a disability that has completely changed her life as well as her livelihood.