We don’t believe your doctors; we don’t believe our doctor; and we don’t believe you do what you do.
Eric T. (Unum)
Prior to the onset of his disability, Eric was employed by a large insurance company as the Director of the company’s Special Investigations Unit (SIU). His duties required that he spend in excess of 80% of his time in a sitting position, taking and making phone calls, participating in teleconferences and in-person conferences, all of which required detailed note taking. In addition, he did computer research, investigative tasks, report writing, development and writing of policies & procedures, and a variety of other written and electronic communications, as well as meetings with staff, corporate legal counsel, law enforcement agencies at the employer’s campus and at various locations throughout California and the United States. His position also required an approximate 45 minute commute, each way, from his home. His occupation required that he sit most of the time, with only brief periods of walking or standing.
All of Eric’s treating physicians, and even one of Unum’s own examining physicians agreed that as a result of severe back pain he was restricted from prolonged sitting. He was forced by disability to leave work and submit a claim for Long Term Disability benefits. His claim was very well supported by the reports of his treating physicians. Unum paid his claim for more than two years under what it called a “reservation of rights”, which is not cognizable under either the LTD plan or the law. Unum did this while it persisted in gathering more and more evidence to try to defeat his claim. As a result of this 2-plus year “investigation”, Eric’s claim file exceeded 3,000 pages, but contained little of any substance.
Although Unum’s own “independent medical examining” physician agreed that Eric suffered a significant sitting restriction, (which would in and of itself support a finding that he was disabled from his occupation, if that occupation were properly defined), Unum nevertheless terminated his benefits, concluding that that he could perform the duties of his occupation with what it called a “reasonable accommodation” of an adjustable work station and walking for 15 minutes every hour, which was impractical as the duties of his occupation required his presence at numerous locations outside his office.
Unum first tried to rely upon an inapplicable job profile for a “Sr. Consultant” to establish that Eric’s job duties were less than what they were. When confronted with clear evidence that his job title was Director of SIU, not Sr. Consultant, Unum persisted and tried to morph his position into that of a “Senior Consultant / SIU Director”, so that it could continue to make use of the inapplicable “Sr. Consultant” Job Profile and the “accommodation” excuse.
Eric submitted his own administrative appeal, which Unum denied following an outside paper review by its own reviewing physician. Unum’s new non-examining, reviewing doctor conveniently found no restrictions at all. So a different physician, in a different specialty field, stated an entirely new basis for upholding the LTD claim denial, and found no restriction of any kind. And surprisingly Unum elected to rely upon the “denial friendly” findings of its paper reviewer to the exclusion of all other medical evidence presented. The denial letter simply parroted the observations and conclusion of the reviewing physician that “no specific restrictions for standing, walking or sitting would be indicated except allowing change from sit to stand as needed.” This contradicted the findings of two of Eric’s treating doctors, who had examined him on multiple occasions, as well as the findings of Unum’s own examining physician. The reviewing doctor, whose opinion Unum chose to rely upon had never laid eyes on him and absolutely nothing corroborated his opinion. Unum upheld the claim denial, based upon an alleged absence of any “specific restrictions”.
At that point in the process I was retained. I immediately obtained a copy of the claim file and all plan documents and notified Unum that after I had a chance to review those documents, I was confident that I would want to supplement the administrative record with additional medical evidence, vocational evidence, and my own comments, which I did.
Result: Unum reconsidered its position, reversed its denial and paid Eric all LTD benefits due and continued paying for the maximum duration of his policy.