Request Legal Help Now - Free

First Unum: Primary care physician advised Patient to get a lawyer

. By
Rogersville, TNFirst Unum denied Angie long-term disability benefits (LTD) because her original claim stated the primary symptom as nausea, which subsided after she changed medications. Her diagnosis turned out to be a lot more serious. She was also denied LTD because it took the doctors so long to determine her illness. Is that Angie's fault?

"I'd had a heart attack two years ago and thought it was happening again. To make a long story short, I wound up in ER. I ached and hurt all over, like a really bad case of the flu," says Angie.

Doctor AdviceAngie wasn't having another heart attack, but nobody could figure out what was wrong. A battery of tests ruled out suspected illnesses, from diabetes to lupus. In the meantime she wasn't getting any better and could barely work. "Then I realized that I had insurance through work--a policy with First Unum," says Angie.

"I applied for short term disability (STD) about six weeks after the hospital incident. On August 21, 2007 my doctor sent Unum a medical report. She said I have gastric pain and I am under restrictions and limitations. She also said I have multiple joint pain and recommended that I not work until this is sorted out. I received one check for about $500 and the other for about $400 and that was it. My LTD was supposed to kick in after that last check."

But Angie never received another check.

'We paid you STD because you were having projectile vomiting and chest pressure but we gave you benefits because of the vomiting—the primary reason," said Nancy Thomas, my rep at First Unum. I explained to her that I changed meds and then my nausea subsided but I still had bouts with it. However, my main symptoms now were chest pressure and pain in my joints. And my primary care doctor told her the same."

Did Unum figure out that Angie's nausea would subside, this was their "out"?

"This pain feels like I have been lifting weights all afternoon," says Angie. "If I walk to the store it is so painful; the base of my heels are so sore I can barely get up in the morning. I can't even make my bed.

"Unum kept telling me it would take 30 days to reach a decision. Every 30 days they said they needed more information and this went on for several months. As for me, I had good days and bad days but wasn't well enough to go back to work.

My doctor sent me to a neurologist and he said that I likely have fibro-myalgia. Unum kept sending him forms asking the same questions over and over again, every month. My doctor thinks it is because they don't want to pay me. My neurologist told Unum that he did not tell me to stay off work, nor did he tell me to go back to work. "We will not release her to go back or stay off work" he said in a letter to Unum. He isn't taking a stand one way or the other, he is neutral.

Unum finally sent a denial letter last month. And it is trying to make me pay for requests they made to my neurologist -- $15 each time. I don't even have an income, how can I pay? They just kept requesting my complete medical records, the same information, over and over again. The doctor's office confirmed that it sent my records to Unum some time ago. I have the records.

Unum has totally ignored my primary care physician. Why bother paying into insurance when you are denied? I paid into my policy and my company also paid. I talked to my company about getting denied but they haven't even paid my two weeks vacation pay so they won't help me.

I have applied for social security benefits but haven't heard from them yet—it takes 90 days to reach a decision. For now I have to rely totally on my husband for support and that makes me feel terrible; he can barely support himself.

And I have 90 days to appeal Unum's decision. Unum has so many lawsuits against them because they have refused LTD for so many people. I am now working with a law firm that has requested all my papers and denial letters from Unum. This will determine if I have a case against Unum. Meanwhile, my financial situation is grim.

Unum said that the nausea I have is a pre-existing condition. If I had applied to Unum with the symptoms I have now, I would have qualified for LTD. And it took several months to get a diagnosis because nobody knew what was going on. That wasn't my problem—it took until October to finally get diagnosed with fibromyalgia. My physical therapist never told Unum that I was free of pain yet Unum says they called her and she confirmed that I was pain-free. Unum only hears what they want to hear."



Fields marked * are mandatory. Please read our comment guidelines before posting.


Note: Your name will be published with your comment.

*Email Address:

Your email will only be used if a response is needed.
*Your Comment:

Are you the defendant or a subject matter expert on this topic with an opposing viewpoint? We'd love to hear your comments here as well, or if you'd like to contact us for an interview please submit your details here.

Click to learn more about
Request Legal Help Now! - Free