The federal court ruled that UNUM Life Insurance Company of America (“UNUM”) wrongly denied long-term disability (“LTD”) benefits to a CEO suffering from back and hip issues, including osteopenia, spondylosis, moderate to severe bilateral foraminal stenosis, disc extrusion, and entrapment and swelling of a nerve root.
Mr. Jerry Barnes’ Disability Claim
Before becoming disabled, Mr. Barnes was employed by The Woman’s Clinic as Chief Executive Officer. He stopped working in January 2017 due to inoperable back conditions, including herniated disc, osteopenia, and disc disease, as well as other complications from cancer treatment and labile blood pressure. No longer able to perform his job duties, Mr. Barnes filed a claim for LTD benefits with Unum.
Initially, Unum approved Mr. Barnes’ claim but expected him to obtain an MRI to track the progress of his osteopenia. His doctor, however, recommended not getting an MRI to avoid additional radiation exposure. After reviewing Mr. Barnes’ file without the new MRI, Unum ultimately decided to deny the claim.
Mr. Barnes then submitted an appeal with additional evidence of disability, including:
- a functional capacity evaluation (“FCE”),
- documents showing approval for benefits from Social Security and another disability plan,
- a support letter from one treating physician, and
- a form listing his restrictions and limitations completed by a second provider.
Unum denied Mr. Barnes’ appeal relying heavily on medical records reviews completed by its consulting physicians. It did not do any in-person testing even though it had the right to have him examined by its own doctors. Following the denial of his appeal, Mr. Barnes filed a lawsuit against Unum.
The Court’s Decision
The court ruled for Mr. Barnes finding that:
“when a plan administrator’s file-reviewing doctor questions the creditability of an opinion without examining the claimant, then the plan administrator’s opinion does not receive as much weight, especially when the plan administrator has the right to examine the claimant.”
In ordering Unum to pay LTD benefits to Mr. Barnes, the court specifically found that:
- Mr. Barnes provided objective evidence that he suffers from numerous health conditions;
- There was also objective evidence of Mr. Barnes’ work restrictions and limitations;
- Unum should have asked Mr. Barnes to take another FCE or undergo an examination by one of their physicians if they questioned the credibility of his evidence or doctors’ opinions; and
- There was no need to grant Unum’s request to allow it to conduct another review of Mr. Barnes’ LTD claim.
The court’s decision is significant because it emphasizes that insurance companies “should not be given two bites at the proverbial apple where the claimant is clearly entitled to disability benefits.”
Lawyers with Expertise in Disability Insurance Claims
This law firm has always focused on disability insurance law.
Because we specialize in long term disability, our clients get the benefit of:
- Having an attorney who is an expert in long term disability claims;
- Having an attorney who has experience with every major disability insurance company;
- Being backed by a law firm that has a proven track record of winning tough disability lawsuits.
Call Dabdoub Law Firm to get experienced disability lawyers on your side.
We can help with:
- Submitting a disability insurance claim;
- Appealing a long-term disability denial;
- Negotiating a lump-sum settlement; and/or
- Filing a lawsuit against your disability insurance company.
The firm represents clients nationwide with disability claims governed by federal law, even if we are not located in your state.
Call (800) 969-0488 or contact us online to speak with an experienced disability attorney. Consultations are free.
