Tiffany has carpal tunnel syndrome and cervical facet damage, which means the nerves traveling between the discs in her spine are damaged. Both injuries are work-related so she collected Workers' Compensation after she was deemed disabled by her doctor. She didn't know that additional funds were available through her Unum policy—Tiffany says that the City of Oakland, her employer, "started the deception" by keeping this information from her. She was injured in 2005 and fired a year later "because they couldn't accommodate my work restriction any longer," says Tiffany.
But it wasn't until 2009 when Tiffany discovered that she was entitled to Unum benefits. "I phoned Unum, told them where I had been employed and filled out their application form," says Tiffany. "I also sent copies of e-mails to Unum from my union rep, proving that I had inquired about disability benefits…without those e-mails I wouldn't have received back pay."
Unum tried to deny Tiffany back pay, saying she had just contacted them and they would start payments from the date of her application. Because of her perseverance, Tiffany received about $48,000 from Unum. "I had borrowed money from just about everyone I knew—Workers' Compensation had stopped paying after two years—so when I paid everyone back, I was left with $8,500," she says.
"I started getting monthly checks from Unum. In June 2010, my doctor filled out a Maximum Medical Improvement form, meaning that my condition cannot be improved any further—I had the surgeries and injections and there was nothing else to be done. My rating was 88 percent, which meant that I could never return to my field."
Like many disability policies, Tiffany's Unum policy has parameters regarding what kind of work she could do. Because her experience and training involved sedentary work and computers, Unum would have to find a similar job, but at the same time, she was not physically able to perform that work.
"Around this time, Unum changed my claims rep and she scheduled an independent medical evaluation," explains Tiffany. "Their doctor said he had nothing to do with examining my neck, just my upper extremities for the carpal tunnel. But he didn't do any medically recognized tests for carpal tunnel. He reported that I 'appear normal, grip normal, I am not disabled and none of my symptoms were consistent with carpal tunnel,' and he could not recommend any course of action because it is 'all in my head' and I am 'simply angry because the City of Oakland terminated me.'
"He also confirmed that I had carpal tunnel syndrome but it had been corrected by surgery. Of course, Unum cut me off—this was the report they wanted.
"But 18 months after surgery, I still tested positive for carpal tunnel. Then they misquoted my doctors' reports when he rated me with my neck restrictions. In other words, they translated the reports into their own terminology so they could support their findings and no longer pay me disability.
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"I used to be very active and physically fit with only 12 percent body fat. When my Workers' Comp payments were cut off, I couldn't afford physical therapy and just had the meds to rely on, so I gained 60 pounds. Unum's back pay helped but it doesn't go far with kids to feed—I can't even afford to buy new clothes.
"I sent an appeal within three hours of receiving their denial letter and I won't know until the end of this month whether I need an attorney, but I have a dismal outlook. From what I understand, anyone dealing with Unum needs an experienced insurance attorney."