Tennessee Court Reverses UNUM Denial for a 59 year old Woman with Fibromyalgia


GREGORY DELL: Hi, I am here
with attorney Rachel Alters. And Rachel, it seems like
Unum’s been on a streak right now of trying to deny
people with fibromyalgia. Earlier today, we filmed a
video on another claimant that had fibromyalgia for nine
years, and was getting paid. And they denied that claimant. And obviously we’re
getting tons of phone calls around the country
from other claimants that have been denied recently
that had fibromyalgia. So obviously, you
came across a case of a claimant that
had fibromyalgia that Unum had denied. And we’re going to
talk about that case. But that case is already a
year and a half, two years old. So it’s not really a new trend. It’s an ongoing
trend because Unum and most disability
insurance carriers tend to challenge the
diagnosis of fibromyalgia. So let’s talk a little
bit about your case. And what was significant here. And what our viewers can learn
from this particular case. RACHEL ALTERS:
This is a case that involved a 59-year-old woman
who had worked at an air force base for about 33 years. She had a physical job that
involved a lot of lifting, and carrying, and climbing. And she had been suffering from
fibromyalgia for over 15 years. She did go out on
disability a long time ago. She had short term,
but then her doctors had suggested that
she go out of work. But she didn’t want to. She wanted to push through it. She really loved her job. So she really pushed herself
to wake up every day. Work through the pain. And at some point,
when she turned 59, she just couldn’t do it anymore. Her condition had progressed. Her doctors really said
this is the time to stop. So she went out of work,
and filed a claim with Unum. They paid the short term, and
then when it came to long term, they denied it based
on the fact that they didn’t think that her
condition had progressed. And she’d been working
this whole time already with the diagnosis. So how is it that she
couldn’t work anymore? GREGORY DELL: All right. So you have a
59-year-old woman who’s got a documented
history of at least 10 or 15 years of medical records. And they basically say
no, you’re not worse. You’re better. And what did Unum
rely upon to say that? RACHEL ALTERS: Well Unum– this is typical. But Unum basically cherry
picked the records. And just looked at
the records they wanted to look at to determine
whether her condition had progressed or not. And they hired their
own peer review doctors that worked for
Unum to review the records. Who of course typically state
that you’re not disabled, you have no restrictions
and limitations, your condition hasn’t
progressed over the years. And they didn’t send her to
an IME, which the judge was a little bit upset
about stating that she was in severe chronic pain. Unum should have
sent her for an IME to determine whether this
pain was restricting. And they didn’t do
any of those things. They just do their
typical peer review. Pay a doctor to review records. Say that you’re not disabled. And deny you. GREGORY DELL: One thing
significant we didn’t mention. This was out of the Middle
District of Tennessee where we have numerous clients
in the state of Tennessee. But the Tennessee falls
under the 6th circuit Court of Appeals, which is where
this case would get appealed to if Unum chooses to do that. The 6th Circuit Court of
Appeals is one of the few– I shouldn’t say one of the few. But they have a
very strong position that if a claimant has extensive
documentation of a condition and the insurance company
doesn’t choose to do an IME, that they are going to frown
upon that significantly and find that the insurance
company acted unreasonably by not doing an IME. And so that’s probably
why the judge in this case was very offended
to say, look, you have two doctors conflicting. Your doctor never
looked at the claimant. And there’s really a lot of
medical documentation here. You should have done an IME. And because of that I’m
finding that you acted– RACHEL ALTERS: Arbitrary. GREGORY DELL: Arbitrary
and capricious. So not uncommon in Tennessee. Really not uncommon in other
parts of the country as well. But especially with a
condition like fibromyalgia where you have these
conditions where there’s no objective evidence
to document the condition. Was there anything
else significant in this particular case
other than talking about them not doing an IME? RACHEL ALTERS: Yes. The court actually
made a point that they didn’t want to
punish the claimant for trying so hard to work
while having a disability. And the court stated
that, yes, she may have worked for
a long period of time with a disability and
pushed through it. But at some point,
something’s got to give. And as your condition
progresses, a lot of people can no longer do that. And they shouldn’t be
punished for trying. The court wanted to state
that, yes, maybe she should have stopped
working earlier on because her condition was bad. But gave credit to the
claimant for trying, and doing her best to keep
her job, and earn her salary. GREGORY DELL: So the
reality of why we see this, and you talked about
cherry picking the record, is that this woman continues
to go to a doctor for years. And really every time
she goes to the doctor, the doctor has
computerized records. She kind of says the
same thing over and over. And the doctor just says,
saw the patient here. Still has same complaints. And all this boxed they checked. And doctors aren’t
really documenting for insurance companies. And so the insurance
companies get the records, and they manipulate
them, and say, yeah, we see all
your complaints. But they’ve been the same. Nothing changed. So that’s the big problem. That’s where when we represent
clients who are applying or we do their appeals,
we know how the insurance company is looking at it. And try to get the records
to accurately reflect what’s really going on with the
claimant instead of the doctor just doing the routine
review that they usually do. RACHEL ALTERS: Right. And in this case
actually, she had gone to see a couple new doctors. She’d started
taking pain medicine that she wasn’t taking before. And Unum completely ignored it. They just overlooked it. And didn’t even mention
it in their denial letter. And the judge was
upset saying, you can’t ignore
pertinent information. It’s arbitrary and capricious
to completely ignore these records, and just
look at the records you think benefit you. GREGORY DELL: Right. Well, this is a typical
technique of Unum. Let’s try to deny the claimant. Push them to go back to work
or do something to make money so they can’t be eligible. Or just go away
because it’s going to be hard for them to fight. Luckily, there’s
lawyers like us that are out there that will
help the claimant not have to go through any big expense or
anything to bring the lawsuit. It’s something that
we do every day. So if you’ve been denied by
Unum, you need to appeal, you need to apply,
you need to file a lawsuit or any other
disability insurance company, feel free to call Rachel or
any of our long term disability insurance attorneys. We’re available to help you
anywhere in the country. And we’ll always offer
you a free initial phone consultation. We look forward to the
opportunity to speak with you.

1 thought on “Tennessee Court Reverses UNUM Denial for a 59 year old Woman with Fibromyalgia

  1. I been denied with fibromyalgia ..i had since 2005 a no the last year they denied. They send me to a Dr. For evaluation a stop my benefits. Am living in PR

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