Our client worked as a pharmacist for almost 20 years before he ceased working due to chronic pain conditions such as disc herniations, severe osteoporosis, cervical radiculitis, and dextrocurvature of the thoracic spine. As a result of these conditions, his doctors concluded that he is totally disabled. Unfortunately, UNUM’s doctor did not agree and his claim for long-term disability benefits was denied.
UNUM had our client examined by an independent medical examiner (IME) who UNUM chose and paid. UNUM’s IME doctor concluded that he was able to sustain work activities, but he did not provide any explanation as to what that means. The IME doctor failed to provide any indication as to our client’s ability to walk or stand, which is the main physical requirement of his job. The IME’s report also did not include any indication as to how a pharmacist could work with all these medical conditions that cause a lot of pain. Even though the IME doctor gave an incomplete report, UNUM relied on this report and denied his long-term disability benefits.
Our law firm submitted his appeal to UNUM. We showed that, as part of the job, he is required to stand for long periods of time, but that his musculoskeletal, bone density and other medical issues prevent him from being able to carry out his job duties.
Included with our appeal to UNUM were progress notes and chart notes from his doctor appointments. We also had a comprehensive rehabilitation evaluation conducted by a board-certified physician. The comprehensive rehabilitation evaluation is the most appropriate medical test that can be conducted to determine the functional capacity of someone who suffers from chronic pain. The doctor who administered this test on our pharmacist-client concluded that our client does not have the functional capacity to work 4 hours per day on an uninterrupted basis. This was medical proof that he could not work as a pharmacist.
With all the medical evidence we had, our appeal letter showed how his disability has prevented him from working in his occupation as a pharmacist or in any other occupation. The appeal argued that UNUM inappropriately relied on an incomplete medical report from their chosen IME physician.
After receiving this letter and the medical proof in support of his disability from working as a pharmacist, UNUM reversed its denial decision and approved his long term disability benefits.
Because each client’s case is unique and has different facts, results similar to those in other clients’ cases are not guaranteed.
