We recently overturned a termination of a long-term disability insurance claim, which UNUM had terminated, for an oncology surgeon suffering significant impacts from Complex Regional Pain Syndrome (CRPS), formerly known as Reflex Sympathetic Dystrophy (RSD) that caused her to not be able to work as an Oncology Surgeon.
Our appeal submissions contain a large array of materials consisting of medical support, medical literature, vocational support, collateral statements, and legal development of issues. This cohesive and comprehensive approach often overwhelms the insurer who is more often confronted with an emotional, less factual, and methodical rebuttal. We find our approach is often successful.
Our client, nationally renowned in her medical field, had saved scores of lives over her career, but her condition made it impossible for her to continue practicing as a surgeon. Her claim was initially accepted and later terminated by Unum, who declared that her prior impairments in functionality no longer existed.
We are confident the claim was terminated because of its size: $30,000.00 per month for a professional in her young 50s, with many years of potential benefits remaining as exposure.
Once we were retained, we worked closely with our client and her doctors to develop powerful support to rebut the Unum termination decision. We buttressed our appeal submission with an additional medical assessment review, conducted of all of the medical and vocational materials, and submitted this report on our client’s behalf. We provided medical literature that supported the medical impairment issues and crafting support that harmonized with her vocational requirements. Both her physical functional and cognitive ability were impaired due to chronic pain and associated limitations.
In our appeal, we attacked Unum’s reliance upon in-house medical providers, who have been repeatedly chastised by other courts, revealing a bias which undercuts the opinions. We addressed the specific flaws in the opinions, and the failure to consider the various supportive medical records from numerous providers.
We also attacked the flawed vocational assessment, which failed to properly consider the occupation, or the extensive physical requirements of the occupation. The lack of consideration of the extensive need for standing to perform her surgical procedures had been largely ignored. We submitted materials from her employer to further buttress our submission of materials for her vocational requirements.
Further, we attacked the myopic review conducted and where it focused its review on issues that were an isolated office note which was aberrational to the other records – choosing to seize upon this record as evidence of improvement to terminate the claim.
In a further effort to buttress its claim decision, UNUM had sought to rely upon limited surveillance of our client, and we attacked its efforts to rely upon such limited and isolated moments, as well as efforts to utilize one-off life event as evidence of full-time functionality. We addressed those issues and were able to provide rebuttal affidavits to provide context and to undercut the purported supportive information.
Lastly, we tied all of its claim handling conduct to its financial conflict of interest, which we had identified with specificity and utilized Unum’s own corporate earnings report where they tout their successful reduction of its claim ratio (terminating more claims) and admit tacitly how its financial conflict of interest and chase for shareholder returns serves to influence its claim handling. We also shared how its significant history of antagonistic behavior toward claimants, recognized by many courts throughout the country, would also impact upon the analysis of its conflict of interest.
This was not a claim without significant challenges by Unum, but we persisted.
When Unum came back with further medical reports to try to sustain their claim termination, we engaged in another round of arguments, reinforcing our medical and vocational support and gathering further medical support opinions, while preparing our file for the potential litigation that might ensue. Our client was prepared for that outcome, and we were prepared to initiate suit on their behalf, having created a powerful record.
Our efforts were successful, as our supplemental submission and arguments created a reversal of Unum’s claim determination.
Our client is now receiving ongoing benefits of $30,000 a month and able to focus on her health, recovery and well-being.