Denied After 17 Years of LTD Benefits for Peripheral Neuropathy
Prior to becoming disabled, our client worked as a licensed professional engineer in the St. Louis, Missouri metro area. Our client oversaw project designs and engineering studies for public infrastructure projects. As a licensed professional engineer, he was required by his job to stamp and seal all designs and reports for which he was responsible.
Over time, our client began noticing pain in his feet and legs. This pain forced him to see a neurologist who diagnosed him with peripheral neuropathy. The pain continued to worsen and occurred all the time, whether he was sitting, standing, walking, or sleeping.
Our client was prescribed many different types of medications for his neuropathic pain, which impaired his ability to concentrate and focus on his work. He knew that pain medication was not the best solution and wanted to keep working so he tried injections, had a spine surgery, and even paid out-of-pocket to see a specialist at the Mayo Clinic. None of it worked. The pain persisted.
Eventually, due to the pain and medication, our client could not perform the technical and physical requirements of his own occupation. He applied for LTD with UNUM and was approved. He continued to treat his neuropathic pain with prescribed opioids, but worried about the side effects and potential for addiction.
When the State of Missouri legalized medicinal cannabis, our client was granted a license to grow and use this medication to treat his neuropathy. This new approach was helpful in addressing his pain without the dangers of opioids. Unfortunately, the insurance company used this change in medication to argue that our client was no longer disabled, and his LTD benefits were terminated.
Licensing Requirements for “Own Occupation”
When our client got the denial letter, he was shocked. He needed his LTD benefits and was not sure what to do. Fortunately, he found our long-term disability law firm. Our practice is focused on ERISA disability and our long-term disability attorney knows how to fight back.
The first action our long-term disability lawyer took was to request the claim file and review the LTD policy. After a close review of the policy, it was revealed that our client’s disability was still governed by an “own occupation” provision. This means that our client would be deemed disabled so long as he was unable to do his own occupation of being a professional licensed engineer. This was different than language in some LTD policies that requires claimants to be unable to work in “any occupation.”
Unfortunately, there was no way our client could do that work for many reasons. First, he still had severe neuropathic pain with physical restrictions. His neurologist ordered a new EMG that presented objective medical evidence of this condition. Second, his condition required him to take controlled substances, including medicinal marijuana daily, which impaired his cognition. We presented evidence of these side effects in the appeal as well. Third, our client was legally unable to work as a licensed engineer while taking these medications. State licensure laws prohibited him from it because the safety and welfare of the public would be at risk.
Filing a Long-Term Disability Appeal Against UNUM
We diligently prepared an extensive appeal with exhibits and supporting case law. The result was that UNUM reversed its denial. UNUM paid all back benefits and reinstated our client’s monthly long-term disability benefits. The lifetime value of this award will be in excess of $300,000.00.
While future benefits are never guaranteed, we continue to legally advise our client to ensure that he will receive every dollar he is entitled to under his LTD policy.
How Our Long-Term Disability Attorney Can Help
We understand the challenges you face in dealing with disability insurance companies. Let us help you with our proven experience in long-term disability denials or appeals. Call the Law Office of Kevin J. McManus at 816-203-0143 or through our website contact form. If you have been denied benefits, we will review your denial letter for free.
Our client was very pleased Kevin called him back, out of all the lawyers he called. He knew he didn't go wrong when he won his appeal!
You can also download our free long-term disability book right now, Danger: Proceed at Your Own Risk. This guide shares useful insights regarding long-term disability appeals and why you should hire our long-term disability lawyer to handle such an appeal.