When receiving a Unum disability claim denial on a policy you’ve potentially paid into for years, it can be disheartening, to say the least. It can also cause devastation to lose your source of income and live with a long-term disability (LTD), making the Unum denied disability even more significant to your ongoing quality of life. But the situation is not entirely without hope, as you have the legal right to file an appeal of the Unum denied claim.
Disability insurance attorneys Greg Dell and Stephen Jessup discuss Unum disability appeal strategies to help those with LTDs know what to expect and how to proceed. Unum is the world’s largest disability insurer for long-term disabilities, and the attorneys at Dell & Schaefer have collectively handled thousands of appeals against Unum of behalf of their clients.
The Most Important Concern When Filing a Unum Appeal
According to attorney Stephen Jessup, the first and foremost important concern when dealing with a disability insurance claim denial is the medical information. What’s in your records? A recurring theme in almost any denied disability claim is that a diagnosis alone isn’t going to establish a disability. He stresses that just because you have a medical condition, it doesn’t mean the insurance company is going to find that you’re disabled. And just because your doctor writes a note that says you need to be out of work, that doesn’t necessarily lead to a conclusion that you have a long-term disability.
“It’s really about what’s the meat and potatoes of the medical records,” explains Stephen Jessup, “the information that’s in their exams, findings, clinical findings, objective medical evidence, MRIs, X-rays … whatever the case may be, based upon the medical condition.”
Attorney Greg Dell agrees, noting that the insurance company can lead a long term disability insurance policyholder to believe the appeal process is simple and that it’s easy to just send a basic letter from a doctor or to provide another attending physician statement. “Well, they already had it,” he points out, “and they denied your claim. So obviously, that’s not enough.”
Getting Appropriate Medical Support and Attending Physician Statements
It’s important to realize, according to Stephen Jessup, that when doctors are writing their records, they aren’t doing them with the knowledge that an insurance company will be evaluating them to establish a disability. They’re keeping their own records and history, so there may be an absence of information specifically documenting the patient’s long-term condition and his inability to work.
The insurance company will then assume there is no problem, especially if the physician makes notes indicating that the policyholder had a good day or looked well-nourished or had any kind of improvement. But those types of notes are really only referring to the activities of daily living, rather than to work restrictions.
The essential question when it comes to a denied disability claim is: What would prevent you from working? The biggest thing about a “definition of disability” is whether your medical condition prevents you from performing the duties of your occupation or another occupation.
When a disability insurance attorney such as Greg Dell or Stephen Jessup is handling your appeal, he eschews the one – or two-page standard form that Unum uses. Instead, the law firm tailors the attending physician statement to target the disability and establish connections to occupational duties and restrictions. It’s crucial to draw the nexus to be able to prove to an insurance company that you’re entitled to the benefit.
For example, if the claimant is establishing the inability to perform his or her “own occupation,” and that occupation is a sedentary desk job, the lawyer will question the doctor about things such as the ability to use the keyboard for more than four hours a day. Can the person sit in front of the computer in a fixed position for more than four or five hours a day; can she rotate her neck 5,000 times a day; will she have difficulty focusing; or will it be necessary to take more than two breaks a day for more than 15 minutes?
A disability insurance attorney working on behalf of a disabled client has an advantage due to having done so many claims and depositions as well as reading detailed Unum training manuals, hiring experts and writing countless attending physician statements. Even so, Greg Dell notes that Unum will still send everything out to their hired-gun doctor or their internal physician to find a point of contention or disagreement.
Attorney Stephen Jessup agrees. “I think the cards are stacked against someone, especially if the information isn’t presented in a very informative way and as complete as possible.” It often comes down to vital pieces of missing information in the medical records, especially if the case goes to a lawsuit later and the policy becomes subject to an “arbitrary and capricious review” down the road.
“That’s a real important art and skill that I think has been one of the big keys to our success,” states Greg Dell, “that we’re able to present the information in such a way as to bootstrap the outside doctor, because we know it’s going there.” Even if they don’t get past that doctor, he says, it presents very strong evidence for a lawsuit, which would be the next stage if the appeal is denied.
How Important is a Vocational Assessment?
Finally, the importance of a vocational assessment cannot be underestimated when filing an Unum disability appeal. That assessment is what establishes what your “own occupation” actually entails as well as your capacity to perform “any occupation.” It’s crucial to define how the job is performed not only for your particular employer but in the national economy overall. Stephen Jessup points out that it’s a matter of presenting that occupational information either through your own experts or even from the plethora of information available from the Department of Labor and other standardized occupational products.
Another advantage of working with a disability insurance lawyer is that they hire a vocational expert, whose reports can cost several thousands of dollars to generate. Many claimants are not able to risk that kind of money during an appeal, but the law firm handles all appeals on a contingency fee basis. This means that the claimants don’t have to come up with any out-of-pocket money to pay for these reports. If the appeal is successful and the case is won, the cost comes out of the claimant’s settlement.
A disability insurance attorney at Dell & Schaefer can help anyone in the country who has received a disability insurance claim denial from Unum. The initial consultation is always free, and they’ll let you know right away if they can help.