UNUM’s Claim that Policy Holder’s Back Pain was Out of Proportion to the Evidence of Radiculopathy on Exam Reversed by Federal Judge
One of the common reasons disability carriers like UNUM deny or terminate benefits is the argument that the policy holder’s pain is out of proportion to examination findings and, therefore, the policy holder isn’t disabled by the terms of the disability plan or policy.
Many times, disability carriers can get away with this argument because the disability plan or policy has “get out jail free” language that grants the plan or policy the discretion to determine whether the policy holder is disabled. It can be extremely hard to legally prove that a disability carrier has abused its discretion in denying a claim. As a result, many denials are upheld under the arbitrary and capricious standard of review.
That’s not necessarily the case if the applicable standard of review is “de novo” which means that the federal judge can substitute their judgment for that of the disability carrier.
For example, in the case of Chicco v. First UNUM Life Ins. Co., 2022 WL 621985 (S.D.N.Y. Mar. 3, 2022), Ms. Chicco was a tax accountant for D.E.Shaw & Co., L.P.. In 2013 she started to have fatigue, weakness, and body pains. Her doctors diagnosed her with fibromyalgia and radiculopathy. She tried different types of treatment and attempted a return to work. Unfortunately, by 2019 she was unable to work and applied for long term disability benefits.
UNUM, of course, denied the claim on the basis that her reported pain was “out of proportion” to the evidence of radiculopathy on examination and she was able to work. They suggested that if she was in as much pain as she claimed her treatment would be more extensive and her abilities at home would be more limited.
Fortunately, the judge used the “de novo” standard of review and concluded that there was both subjective and objective medical evidence” to support her claim. All of her treating physicians determined she was disabled, while UNUM’s reviewing doctors did not examine her and discounted the relevant medical records.
What a great win for Ms. Chicco.
However, when UNUM decides to terminate her benefits again, they will have her undergo a liar for hire insurance medical examination. Guaranteed!
Don’t let a disability carrier, like UNUM, rob you of your financial peace of mind by denying or terminating your ERISA disability insurance claim for fibromyalgia and radicular pain.
ERISA Disability Insurance Claims is a Niche Practice
- has practiced ERISA law nationwide for over 20 years,
- has written many consumer books for ERISA policy holders, including Robbed of Your Peace of Mind and finish adding,
- had written over x number of blogs and articles about ERISA and disability claims,
- has x number of videos on You-Tube,
- has a weekly podcast about disability insurance claims called “Winning Isn’t Easy,”
- has lectured to other lawyers, including ERISA lawyers, about ERISA disability claims,
- has given presentations to medical professionals about ERISA MS disability claims,
- handles all litigated cases personally, regularly appearing in federal courts across the country, and,
- has taken on disability insurance carriers like UNUM across the country.
Why Cavey Law is Different Than National ERISA Law Firms
Cavey Law is a personalized law firm that helps ERISA clients with MS make the difficult decision to stop work and apply for benefits, submits winning disability applications, writes 25 to 65 pages appeals (which are the trial of your case), files ERISA lawsuits across the United States, actively litigates ERISA cases, settles cases as appropriate and actively manages ERISA claims to keep her clients getting the disability benefits they deserve.
On the other hand, many national law firms take a cookie cutter on size fits all approach to every aspect of an ERISA case. National law firms are settlement mills going through the motions. In fact, one such firm has an unwritten agreement not to do any discovery in an ERISA claim and settles cases for pennies on the dollar churning and burning through cases.
Is that the kind of law firm you want to represent you in your ERISA disability claim?
No! There is one more thing that makes Cavey Law unique. Ms. Cavey’s father, a World War II veteran who fought in the Pacific War, became disabled when Ms. Cavey was growing up. She watched him make the difficult decision to stop work and apply for his disability insurance benefits and Social Security disability.
Nancy has been in the family of a disabled breadwinner and experienced the personal and financial consequences of disability. How many ERISA lawyers have this background, this motivation, or this drive to see that her clients get their benefits?
Need Help With Your UNUM ERISA Disability Claim?
At The Law Office of Nancy L. Cavey we represent clients Nationwide regardless of where you live in the United States. Give us a call at 727-894-3188 or use the contact form on the website.