Monday, November 22, 2010

Unum Reverses Termination

I represent a former advertising executive whose long term disability ("LTD") benefits were terminated by Unum after its in house psychiatrist rejected the opinion of the claimant's treating psychologist. Unum had repeatedly approved LTD benefits based upon the treating psychologoist's summary narrative reports and responses to Unum's form questionnaires. Unum terminated benefits after its psychiatrist issued a medical report that concluded the claimant was no longer disabled.

The report from Unum's psychiatrist set forth eight reasons why the claimant was not disabled. Fortunately, the treating psychologist continued to support the claimant's inability to work, and provided a detailed report that rebutted each of the eight reasons espoused by Unum's psychiatrist. Without being able to rely on the report of its psychiatrist any longer, Unum reinstated the claimant's LTD benefits.

LTD insurance companies always defer to their doctors' opinions. Therefore, in order to succeed in reversing an adverse determination, you need to ensure that the treating doctors specifically address and rebut each of the contentions that the insurer relied on to rationalize its denial or termination.

2 comments:

Big Bill said...

What do you do when it's the government's doctor that pulls the same stunt to deny that you're ill? Here in the UK the government is being/has been advised by consultants from Unum about testing the disabled to see if they should be receiving benfits. Many, many people are claiming the testing doctors are simply ignoring all and any well-established health issues and finding them fit to work. This sounds like textbook Unum behaviour. We can't complain to the authorities though, it's the authorities doing it.

BB

The Law Offices of Jeffrey Delott said...

Unum claims in the U.S. are governed by a law called ERISA, which unfortunately is inapplicable where you live. I can only suggest that you contact a local barrister regarding your situation.