At Ortiz Law Firm, we recently helped a client secure the reinstatement of her long-term disability (LTD) benefits after Unum wrongfully terminated her claim. Through a strategic and comprehensive appeal, we were able to achieve a full reversal in less than 45 days.
Background of the Claim
Our client was initially approved for long-term disability benefits after she became unable to work due to a complex combination of serious medical conditions, including:
- Chiari malformation
- Chronic migraines
- Foraminal stenosis
- Neuropathy
- Cognitive impairment
- Significant medication side effects
These conditions, taken together, made it impossible for her to reliably perform her job duties or sustain full-time work.
Unum’s Abrupt Termination
After paying benefits for approximately one year, Unum suddenly terminated the claim. The insurer asserted that our client could return to her regular occupation, despite no meaningful improvement in her condition.
In reaching this decision, Unum:
- Relied on paper reviews from non-examining physicians
- Selectively cited medical records while ignoring key imaging findings
- Offered opinions outside the reviewers’ areas of expertise
- Failed to consider the combined impact of all conditions and medication side effects
- Did not provide the review reports to the claimant before issuing the denial
This process fell short of the requirements for a full and fair review under ERISA.
Building a Strong Appeal
We immediately appealed the termination and developed a comprehensive appeal package designed to address every weakness in Unum’s decision.
Our submission included:
- Updated and detailed medical records
- Strong opinions from treating physicians
- Sworn statements from the claimant
- Third-party witness testimony
- A fully favorable Social Security Disability decision
We demonstrated that Unum’s denial was both legally and factually flawed, and that the evidence overwhelmingly supported our client’s continued disability.
Unum Acknowledges Its Errors
In a notable development, Unum’s appeals unit recognized the serious issues with the original denial. Before completing the formal appeal review, Unum requested permission to send the case back to the same disability benefits specialist who issued the termination for reconsideration.
This unusual step highlighted how indefensible the initial decision had been.
Benefits Reinstated in Less Than 45 Days
Within the initial 45-day appeal review period, Unum overturned its denial and reinstated our client’s long-term disability benefits. This swift resolution spared our client from a prolonged appeals process or litigation and restored her financial stability.
How Ortiz Law Firm Can Help
Insurance companies often terminate valid disability claims using flawed reviews and incomplete evaluations. A strong, well-supported appeal can make all the difference.
If your long-term disability benefits have been denied or terminated, Ortiz Law Firm can help you fight back and protect your rights.
Call (888) 321-8131 today for a free consultation. Let us help you get the benefits you deserve.
