A 51-year-old manager and supervisor of an industrial plant enjoyed a successful career working for a major international technology and business consulting firm. He suffered from numerous orthopedic issues due to degenerative disc disease, cervical (C6-C7) and lumbar disc herniation, spinal stenosis, cervical and lumbar radiculopathy, lumbar spondylolisthesis, bilateral hip/pelvis osteoarthritis, arthritis of the spine, sciatica, a labral tear of right hip joint and peripheral neuropathy.
He lived with a great deal of pain for many years and like many claimants of his generation with a strong work ethic, continued to work despite the pain, but at a certain point, his multiple co-morbid conditions made it impossible to perform the duties of his position. It became too physically demanding and he could no longer handle the intense and constant pain. He was also taking a number of medications, and the side effects took a significant toll on his cognitive abilities. Thus, he could not find a happy medium to allow him to work; either medications hurt his functionality, or pain impaired him.
When his physicians advised him to stop working and to apply for short-term disability, Unum approved his short-term claim and agreed that he was disabled from performing his own occupation on a full-time, sustained basis. It seemed as if they appreciated the significance of his impairment. However, after his short-term disability claim was exhausted, and because his condition remained poor, his physicians told him not to return to work and advised him to apply for long-term disability. Despite no change in his medical condition, Unum denied his long-term disability claim. The same evidence which supported short-term disability was no longer effective support for the long-term claim.
We attacked Unum’s purported “independent” peer-reviewing consultants and the well-known pro-insurance company vendors Unum typically retains to bolster its claim denials. Many of these doctors are weathered from years of blanketly denying claims and being chastised by judges. Additionally, to further influence the issues, and develop a strong case for litigation if necessary, we developed powerful arguments revealing Unum’s bias and egregious conduct. These arguments included Unum’s failure to consider our client’s chronic pain, overall co-morbid conditions, side effects of his medication, and the nature of his work situated in a manufacturing plant. This is placed in the context of Unum’s vast history of biased claim administration and adversarial conduct toward claimants.
With this appeal, Unum based its determination on a faulty vocational analysis which miscategorized our client’s occupation as a manager and supervisor of an industrial plant and failed to appreciate his functional deficits. He had been reassigned to lighter duty but was not able to perform the necessary tasks. That did not seem to matter to Unum. Unum erroneously misconstrued his duties by only acknowledging the sedentary duties of the occupation.
On appeal, we worked closely with our client in establishing evidence with his employer delineating his day-to-day occupational duties, reinforcing the fact that his own occupation by no means could possibly be considered “sedentary.” Even with the reassignment of his occupation, Unum refused to acknowledge his restrictions and limitations. We were able to demonstrate, through functional testing, that his condition removed him from the competitive work landscape and that he was entitled to benefits.
We were excited to reverse Unum’s decision through aggressive, meticulous, and unwavering representation, the use of supporting materials documenting the material and substantial duties of our client’s job and highlighting the biased nature of the medical reviews created by Unum’s doctors. By working harmoniously with our client for this collaborative effort, success was achieved.