Bartolic Law has helped many clients, across all lines of work, get their long-term disability claims and denials paid by Unum. In one case, a client with arthritic knees was denied long term disability because Unum asserted the client’s occupation could be done sitting down. We persuaded Unum the occupation could not be performed sitting. In another case, our client could no longer perform the client’s occupation due to loss of a license, triggered by the medical condition. Unum denied the claim based on policy language that loss of a license does not entitle the insured to benefits. We persuaded Unum the license loss was due to the medical impairments, and not independent of it. we were able to persuade Unum that our client’s spinal degeneration rendered the client unable to sit in sufficiently long intervals or enough total in a day to work at a sedentary occupation, even if it allows alternating from sitting to standing. We have also helped a disabled anesthesiologist with lasting impairment from a cardiac event claim Unum disability insurance and maintain the claim in pay status.
Unum refers to its hired medical reviewers as independent medical reviewers, but it contracts the same vendors over and over, who in turn hire the same doctors to review the files. These medical reviewers often appear in many Unum court cases and get criticized by courts over and over again, yet Unum still relies upon them.
When medical reviewers criticize your doctors’ advice, and disagree regarding your abilities, they often rely upon evidence that is immaterial, ignore the pertinent evidence, and sometimes even just misstate the contents. When you are disabled, and a medical reviewer disagrees, finding the flaws in the process, rather than just asserting your doctors know better, is the best way to fight it.
Ferrin v. Aetna Life Ins. Co., 336 F. Supp. 3d 910 (N.D. Ill. Sept. 28, 2018) (holding insurance policy’s grant of discretionary authority is void under Texas law due to certificate being issued after effective date of regulation, and policy renewing after effective date, and holding Plaintiff was disabled from Any Reasonable Occupation where treating doctors certify she can sit at the occasional level, and insurer’s consultants opine Plaintiff can sit frequently, as weighing all evidence together would make capacity likely at low end of frequent range at best).
Sadowski v. Tuckpointers Local 52 Health & Welfare Trust, 281 F. Supp. 3d 710 (N.D. Ill. Dec. 20, 2017) (holding plan was arbitrary and capricious in denying medical benefits for removal of spinal cord stimulator following a fall down the stairs and infection where plan argued the expenses were caused by the same injury as the car accident necessitating implantation of the stimulator years earlier)
Tassone v. United of Omaha Life Ins. Co., 264 F. Supp. 3d 867 (N.D. Ill. Aug. 30, 2017) (awarding client long term disability benefits denied by United of Omaha despite insurer’s doctor opining there was no objective evidence of functional impairment)
Suson v. PNC Fin. Servs. Grp., Inc., No. 15-CV-10817, 2017 WL 3234809 (N.D. Ill. July 31, 2017) (holding Liberty Mutual’s denial of client’s long term disability benefits was arbitrary and capricious where Liberty Mutual disregarded client’s carpal tunnel syndrome and relied on a vocational opinion to which client never had an opportunity to address before litigation)