Insurance Company Manipulation of Herniated and Degenerative Disc Claims

Many people have some form of degenerative back condition, ranging in severity.  Certain activities and professions can aggravate these symptoms into a condition that makes working almost impossible.  Several types of doctors, such as interventional cardiologists and radiologists, are susceptible to back injuries and herniated discs from wearing heavy lead aprons.  While there are several types of surgeries that may help relieve symptoms, including discectomies, insertion of rods and pins, and spinal fusions, these surgeries do not always work.  Before and even after such surgeries, patients can suffer from numbness, weakness, and loss of sensation in their extremities.  When the conditions become unbearable, many people decide to stop working and file for their disability insurance benefits.  However, getting your disability claim paid is not as simple and easy as it was promised.  Here are a few ways insurance companies defend against these claims to delay or not pay benefits. Continue reading

UNUM Success Story!

A 56 year-old surgeon, suffering from arthritis and lumbar disk problems, had become uncertain whether he could remain in a surgical suite for sufficient periods to complete all of his surgeries. To compensate for his chronic pain, he reorganized his responsibilities to assisting on some surgeries and doing more clinical work, including pre- and post-op patient visits. He was in a multi-physician practice that was able to accommodate his changes by rearranging duties and work schedules.

The surgeon bought a UNUM disability insurance policy in the early 1990’s that provided for $12,000 of monthly benefits and had faithfully paid his premiums. Since he was no longer performing most of his surgical procedures due to his pain and weakness, he realized the only way he could maintain his income would be to file a disability claim with UNUM. The office manager of the practice contacted their insurance agent, who referred her to the claims department. Claim forms were obtained, completed, and submitted.

After almost 75 days of repeated telephone calls and letters back and forth, UNUM denied his disability benefits due to ambiguity in the symptoms, unclear medical proof of the claimed conditions, and an unduly broad inclusion of occupational duties.

A mutual friend mentioned our firm to the very upset and frustrated doctor. After calling and meeting, he decided to engage our firm to go through the documents that were already submitted to UNUM. We worked with the doctor to prepare a much stronger, more detailed, and clearer disability claim. After working with the insured, his practice manager, and his attending physicians, we were ready:

  • Complete and detailed descriptions of his occupational duties were prepared.
  • Additional tests were performed to document the claimed conditions.
  • A clear and fully documented history of his disabling conditions was written.
  • Letters were written explaining the errors that were made in evaluating the originally submitted claim.
  • Claim forms were completed again with the additional, more complete, information.

Finally, all of this information was compiled and presented in a manner that was easy for the claims examiner to review and accept…which is exactly what happened!

Our client started receiving his monthly disability benefits within 2 weeks, plus 9 months of retroactive benefits. His only regret is that he didn’t use our firm from the beginning! His benefits are still continuing today, more than 7 years after starting his claim. Of course, we’ll check in or he’ll have questions from time to time – as the claims process never stops. But, he’s been able to collect on the promises made when he made the wise decision to protect his income in case of disability.

This case is just one of the many examples why you should never give up when an insurance company denies your disability claim. With the standard operating procedure of “question then deny,” many companies exhaust their insureds into giving up when they get the dreaded denial letter. With our help, clients can easily handle the mass of paperwork and communication the insurance companies use as weapons to deny claims.

We welcome and encourage your comments on this blog. If you would like to add your own experiences, please share them!