Our Client v. Unum Life Insurance Company of America
Our Client v. Unum Life Insurance Company of America
United States District Court for the Eastern District of Tennessee (2023)
After developing occipital neuralgia, a neurological condition that causes severe pain in the back of the head and upper neck, and suffering from severe left shoulder pain, our client was no longer able to work at a medical society. He claimed long term disability benefits from Unum Life Insurance Company of America. Unum found that our client was disabled due to a mental illness and provided benefits for 24 months. Unum then denied our client’s claim for continuing benefits as its policy limits benefits payable on account of mental illness to only 24 months. Throughout this time, our client continued to suffer from severe headaches, limited neck mobility, and worsening mental health issues.
The client retained our services and we sued for a judicial review of Unum’s decision. Unum denied his claim, but used only reports from its in-house medical professionals, who never physically examined our client. These reports discounted the severity of his self-reported pain and cognitive issues. Rather than consider our client’s cognitive abilities when evaluating his claim, Unum failed to recognize that our client’s headaches were considered a severe impairment and denied him further benefits.
We helped our client to gather evidence, including treating physicians’ exams, sworn statements, and benefits from the Social Security Administration, to prove his disability status. Physicians agreed that our client could not “function in a full time work setting,” rendering our client disabled under Unum’s policy.
A judge concluded that general visitation notes from Unum’s physicians were not considered “tantamount to a medical evaluation of [our client’s] cognitive functioning.” Unum’s hired physicians could not assess our client’s credibility and demeanor because they never saw him. Unum did not cite any medical notes suggesting that treating physicians who examined our client suspected any malingering or exaggeration. The court determined that refusing to consider subjective complaints, like our client’s, is inappropriate per the Sixth Circuit’s previous rulings.
The court found that Unum erroneously denied benefits to our client given the conflicting evidence at hand. Furthermore, Unum failed to conduct a physical exam or obtain an independent medical exam, and its physicians did not review the SSA’s previous conclusions regarding our client’s benefits. The case was remanded to Unum, requiring a relevant independent medical exam be obtained before making a decision regarding our client’s benefits.
