UNUM is a large insurance company that provides insurance for workers through their employers. However, when it comes to paying disability claims for long-term diseases such as fibromyalgia, the insurance giant consistently denies claims, especially for those who go on short-term disability and start working again. Two issues lead to disability insurance claim denial. If UNUM denied a claim you filed for long-term disability, contact a disability insurance attorney as soon as possible.
Denied Disability Claim
In the present case, a 59-year-old woman worked at an Air Force base for 33 years. Her job required her to lift, climb and carry. During the last 15-plus years of her tenure, she suffered from fibromyalgia. The woman went on short-term disability for fibromyalgia several years ago. Her doctors recommended that she go on long-term disability, but instead, she went back to work and worked through the pain of the disease because she loved her job. The woman had to force herself to get up every day to do a job she loved. She wasn’t ready to give up a job that she enjoyed.
However, the woman decided she could not work through the pain after she turned 59 – close to retirement age. Not only did her condition worsen, but her doctors recommended that she stop working. After quitting her job, the woman filed a claim with UNUM. The insurance company did pay the claim for the short-term, but denied her for the long-term disability benefits.
Issues Causing Disability Insurance Denials
The two major issues with the disability insurance denials are that the insurance company cherry-picks records and does not do a full patient work-up including, sending her for an independent medical exam (IME). Once the woman submitted a claim, UNUM reviewed the woman’s medical records, but never did more than a cursory physical examination. Instead, the disability insurance company relied on the portions of the woman’s medical records that would benefit the insurance company’s bottom line. Furthermore, UNUM never sent the woman for an IME. Upon the casual review of the woman’s medical records, UNUM denied her claim without sending her for the independent medical exam, which would have told UNUM that her condition did, in fact, worsen.
According to Attorney Rachel Alters, this course of action is common with UNUM. While most of the problems with denials fall on UNUM’s hands, some problems also lie with the doctors. With the advent of computerized records, doctors just check off boxes in a patient’s record, and often that box states that the patient “has the same complaints.” The doctors are not specifying that the pain and/or condition is worsening over time, so insurance companies misinterpret that by not fully checking a patient and use it to deny claims.
In the interview, Alters stated that the judge who heard the case was “a little bit upset” that the insurance company did not send the woman to an independent medical examination and that the woman was in severe chronic pain.
An IME would have determined whether the woman’s pain was restricting, whereas her medical records may or may not have shown that, depending on whether the doctor amended the simple checkboxes in the woman’s computerized medical records. In a nutshell, UNUM is paying a doctor to review records instead of actually doing a hands-on physical examination that is complete. It is this reason that UNUM is able to deny claims. If the company doesn’t see a disability, they won’t pay, and they can’t see a disability when they rely on incomplete medical records.
Tennessee’s 6th Circuit of Appeals
If the woman decides to appeal her case, it would be in the 6th Circuit Court of Appeals in Tennessee. The district courts believe that if the patient has extensive documentation of a condition and the insurance company does not send the patient for an IME, the court is most likely going to find that the insurance company acted unreasonably in denying a long-term disability claim.
In the instant case, the insurance company never examined the patient, and its doctors came to a different opinion than the woman’s doctors, especially since the woman has extensive medical documentation, including documentation advising her to stop working.
When You Try to Work Through a Disability
The way the insurance company looks at claims, if you try to work, it looks at that as, “You are working despite your diagnosis – you must not be disabled.” That discourages those who do have a disability and who do try to work from working. If people think that the insurance company is going to deny a claim, they will stop working earlier instead of trying to work with a disability. This would be harder on the family and would cause the insurance companies to pay out more money over a longer period of time.
Those who do try to work eventually have to stop working as their disease progresses and becomes worse. They should not be penalized for trying to make an honest living. The court looks at going back to work after a short-term disability differently: It prefers that people try to work, even with a disability, if they want to, and does not believe that you should be penalized for trying.
Contact Attorneys Dell & Schaefer
If your disability insurance denied your disability claim, especially if it did not require you to have an independent medical examination, contact Attorneys Dell & Schaefer for a consultation today. Disability insurance companies are ignoring pertinent information about your health in making their decisions, which means that you are going to be forced to work against doctor’s orders and possibly suffer additional injuries. If you need to apply for disability insurance coverage, contact our long-term disability insurance attorneys today, as we are here to help you anywhere in the country. Our initial phone consultations are always free.