Our client, let’s call him Mr. P, was an electrical engineer. His job required not only that he sit at a desk most of the day, but also that he spend a substantial amount of his time examining circuits through a microscope. As a result of a serious car accident Mr. P suffered a debilitating back injury which was never fully resolved even after spinal surgery. Moreover, Mr. P had a serious case of diabetes which was causing or exacerbating glaucoma and vitreous hemorrhaging. Chronic back pain and impaired vision rendered Mr. P unable to function at his job. UNUM paid Mr. P long term disability benefits for a short while but then, after having him examined by an eye doctor, decided he was capable of performing the duties of his occupation. UNUM then cut off his LTD benefits.
We decided to have an”Independent Medical Exam (IME) conducted by an ophthalmologist for his diabetic retinopathy. The ophthalmologist conducted a thorough examination and analyzed the nature of Mr. P’s daily work activities, and ultimately agreed that there was no way Mr. P could perform the duties of his occupation. Moreover, she even questioned his ability to perform any reasonably similar occupation on a full time, consistent basis given his training, education and experience. We sent the IME Report to UNUM with a comprehensive summary of all of the medical evidence and argument about why UNUM had made an improper decision in denying benefits. Approximately 60 days later, UNUM reversed its denial and agreed to commence paying benefits to Mr. P.
We see cases like this every day. Sometimes insurance companies will reverse themselves and start to pay benefits once they are challenged. More often, however, they don’t change their decisions, and we have to file a lawsuit. The point is, we will do whatever we have to to fight for the rights of our clients to try and force their insurance companies to do the right thing, or to have a court of law force them to do the right thing.
Whether you do it yourself or hire a lawyer, the important message here is to not let your insurance company take advantage of you. They frequently deny claims which are absolutely legitimate and justified, and they do so because too many people fail to push back. Challenge them any reasonable way you are able.