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The default position for many Long Term Disability (“LTD”) claims administrators, which are usually the insurance companies who issued the policy that has to pay the disability benefit under the LTD Plan, is to deny a claim. This is true even when it should be obvious that working will make the claimant’s symptoms worse. The insurer typically argues that the current medical evidence indicates the claimant’s condition has improved and is not severe enough to preclude work. However, the insurer usually overlooks the fact that the medical evidence reflects the claimant’s condition a substantial period after he or she stopped working.
I represent a 33 year old claimant with uveitis, and the medical evidence showed that the uveitis was exacerbated from work stress. The insurer denied the claim initially on the grounds that because the medical evidence revealed the uveitis had been treated and had currently abated the claimant should be able to resume working.
On appeal, I submitted additional evidence that essentially reiterated what the treating uveitis specialist had already submitted in connection with the application forms. The only real difference on appeal was that I had the opportunity to attack the insurer’s rationale denying the LTD benefits. Essentially, I emphasized that the claimant’s medical expert made clear that stress did not merely contribute to uveitis, but rather, triggers flare ups, just as stress can trigger a heart attack. Just as eliminating work stress helps prevent the risk of heart attacks, in the claimant’s case, eliminating work helps prevent uveitis exacerbations, which were causing permanent vision loss.
The Unum appeal reviewed called me to let me know that he had reversed Unum’s denial of benefits. He followed up with a letter confirming that he had reversed the denial of benefits. However, the person who issued the denial subsequently claimed that Unum did not reverse the denial of benefits.
There are many medical conditions that are exacerbated by work stress. It might be advisable to retain a vocational expert to render an opinion regarding the effect that work stress has on the claimant’s health condition. It certainly needs to be emphasized that the current functional limitations will get worse if the claimant were to resume working. In any case, make sure to record all telephone calls with Unum because they have proven that they cannot be relied upon to tell the truth.Previous Next
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