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Unum Denial? Insist on a Functional Capacity Evaluation

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Chicago, ILBeth was denied Unum LTD benefits because she didn't have sufficient proof of her disability. But she recently had a Functional Capacity Evaluation and her attorney says this is proof enough. "I asked my Unum rep about this test for pain months ago and he didn't know anything about it," says Beth. "I am sure that reps in the appeals department know about this test—it is just another denial tactic. My attorney says if they told me about it, Unum would be forced to pay my benefits sooner."

At the time Beth applied for disability benefits, she didn't have significant proof of her pain, even though she had undergone an MRI and her doctor reported that she had degenerative discs and debilitating arthritis. "Quite honestly I don't blame them at that point for denying me; anyone can say their pain is so bad they cannot work," says Beth, a former dental hygienist.

"I always thought I would get my benefits because I am an honest person... Paying my attorney's fees is money well spent."
"Sitting and twisting in my chair all day made my pain worse and my doctor knew that," says Beth. "My doctor said I had limited range of motion and my disease is degenerative, so it will get worse over time. I had to stop working last August and filed a claim with Unum right away. My policy is occupation-specific and I have the right to collect long term disability benefits if I cannot perform my work as a dental hygienist. I assumed there would be no problem and it didn't even cross my mind that Unum would deny me. I have learned a lot about this process since.

"Unum didn't seem to care what my doctor said and basically ignored the MRI results. They needed more proof. I finally discovered that there is a functional capacity evaluation, and I want your readers to be aware of this test. Anyone can take this four-hour test at a physical therapy clinic. It simulates your job, whether you are a dental hygienist or a UPS driver, and will tell if you are able to do your job or not." (Functional capacity evaluation is defined as a systematic method of measuring an individual's ability to perform meaningful tasks on a safe and dependable basis.)

"When my appeal was denied, I found an experienced insurance lawyer and asked if he recommended that I take this test. 'Yes, it will prove to Unum whether or not you can do your job,' he said. I took the test three days ago.

"Thank god it only cost me $20 co-pay with my health insurance; otherwise I would have to pay $600. I got the results back and it proves that I am definitely disabled. Now my lawyer is going to submit the results to Unum and if they don't believe me or deny me, that's when I will sue them; that is when they will be in bad faith.

"I can understand that they will deny just on my word but this test changes everything. If they deny me, they'd better watch out. If they deny my appeal after this test, I will ask my lawyer if I can sue them, not only for denying LTD benefits, but for unnecessary stress and financial burden they have caused all these months. It can take up to a year to settle, either in court of out of court, according to my lawyer. That's crazy.

"My lawyer also said that if we end up having to sue Unum, they will most likely settle out of court; they don't like to have a jury because they could probably get sued for a lot more. He also said that Unum will probably send the evaluation results to their independent medical examiner. That's a joke.

"When I first appealed my case, my Unum appeal rep said they will have this third party doctor look at my case. I asked if there was any way I could see or talk to this physician because I believe, as any good physician knows, that they should examine or interview the patient. But Unum said, 'No way'. How can a doctor evaluate a patient based solely on reading Unum's report? Baloney.

"Thank god I am married to a great guy who supports me. What if I was single and had a mortgage to pay? I would likely be forced to work at something that would make my condition worse. Or I would have to dip into my 401K to pay my bills. What if I didn't have a 401K? I could lose my house or live with relatives…

"Having an experienced private insurance attorney shows Unum I mean business. My lawyer said that when Unum gets this evaluation—even if they know I can't do my job—it depends on their financial statement! If their financials for this quarter are down, they will just drag this out. If their financials are looking good and they've made a profit, they will probably accept my claim and pay my monthly benefits.

"I always thought I would get my benefits because I am an honest person, especially after this evaluation. Paying my attorney's fees is money well spent."

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READER COMMENTS

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Unum closed my case for what they call failure to submit doc letter. I asked for extension bc my doc had paperwork and it takes 4 to 6 weeks. never missed submitting before. unique situation at doc, on their part. my doc declares me disabled permanently with test. had a equivalent of functional capacity test by Unum ordered review and they left me alone for about two, two and half years then they send these threatening letters about closing my claim. switched my handler and refuse to writeto me insist on having phone conversations. denied my request to settle outright. don't communicate about it in writing as requested. doc they sent me to told me he works on their behalf and not mines. had to go on vacation and was putting pressureon me to finish a test. I don't understand everything but I know I am not being treated with respect financial burden and hardship

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