Unum Approves Fibromyalgia Claim

Thursday, October 28th, 2010

Several years ago I was able to get Unum to approve long term disability (“LTD”) benefits for a woman who worked for Keyspan when her claim was reviewed under the Reassessment Settlement Agreement. Towards the end of last year, Unum started to re-evaluate her claim, which included a field visit interview, even though the identical questions had already been answered in response to questionnaires Unum sent, and new medical records, even though her treating doctor said that the claimant’s condition had not improved.

The claimant was disabled by fibromyalgia, which was being treated by a rheumatologist. Courts recognize that a rheumatologist is the appropriate specialist to treat fibromyalgia. I provided reports from the rheumatologist that showed the claimant’s condition had not changed since Unum had approved LTD benefits. Nonetheless, Unum insisted on receiving reports from the claimant’s internist and chiropractor, who were not treating fibromyalgia.

I sent Unum letters stating that records from doctors other than the rheumatologist showed that Unum was either failing to understand the nature of the claimant’s disability or that it was not proceeding in good faith. However, because Unum stopped paying LTD benefits during its re-evaluation, to expedite a decision, I allowed Unum to receive reports from the claimant’s other doctors, but not before ensuring that they understood the type of responses that Unum would seize upon to terminate benefits. Although records from her other doctors were irrelevant because they were not treating fibromyalgia, Unum restored the LTD benefits only after receiving their reports.

Fortunately, because the claimant had discussed the situation with her other doctors, even though their reports were not actually relevant, they did not contradict the information provided by the rheumatologist. I have no doubt that if a report from one of the other doctors was inconsistent with the rheumatologist’s report, then Unum would have terminated the claimant’s LTD benefits. Unfortunately, when dealing with disability insurance companies, you have to be very careful, even with evidence that is not actually relevant.

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