Long-Term Disability Insurance Won for Control Panel Operator

Long-Term Disability Denial by UNUM Reversed on Appeal for Control Panel Operator with Seizure Disorder

Denial of Long-Term Disability Claims for Seizure Victims – Unfortunate, Yet Common

Our client, James (not his real name), suffered from an extreme case of seizures. His claim story and his symptoms are scary, as you’ll read below, for a number of reasons. 

James’s treating physicians told him that he was absolutely unable to work as a Control Panel Operator for Valero, as the job required him to work from heights and with hazardous equipment, and he would be putting himself and others at risk. Yet UNUM Insurance Company ignored their opinions and denied his claim. UNUM further claimed that the evidence he presented was insufficient to prove his case, despite his treating physicians’ unwavering opinions that he was disabled from working at heights or with dangerous machinery. 

Being accustomed to a steady (and high) wage of $114,000 annually, James was scared to death about losing everything. He never imagined having to fight UNUM for the benefits he purchased to protect himself, all while coping with a difficult medical condition.

Learning James’s Whole Story to Help Appeal the Bogus Claim Denial

We worked closely with James to help him build his claim carefully and systematically with new, undeniable evidence far beyond what he had presented to UNUM before they denied his claim. 

In helping James gather evidence to build his case, we needed to learn all the details of his story. We learned that his seizures could occur at any time without warning, and that his job was inappropriate given the obvious dangers of an unexpected seizure. James simply needed to tell his story more vividly and effectively to the insurance company in his appeal.

How James Won His Case: Obtaining Medical Support and Presenting His Story Effectively to Appeal the Claim Denial

With James’s help, we were able to speak with some of his treating physicians and create detailed physician notes. These physician notes were made into formal signed statements. 

We were also able to create a much more vivid, detailed sworn statement for James’s own signature, describing his symptoms, the details of his job description, some close calls, and how he would have no warning at all that he was about to have a seizure. 

James’s wife, his father, and his mother also completed affidavits of their observations of James’s episodic seizures as well.

We presented this and other new overwhelming evidence that was not part of James’s initial denied application to UNUM.

James’s description of how many ways the seizures affected his life was compelling. He described how some of the medications he had to take caused him to experience dizziness and nausea leading to errors and inability to keep pace as required to accomplish any work timely. He described how whether or not taking the medications, he experienced increased anxiety over the pressure to complete his work, and how the stress that comes with all jobs seems triggered seizure-like episodes, often while he was engaging in hazardous job duties.  

He described experiencing dizziness accompanied by excessive sweating requiring that he lie down and immediately get in front of a fan to relax and cool down, and having to pause to regain balance when standing from a sitting, stooped or bent position.

Every time a significant seizure event occurred, he would require a driver for 90 days. His wife had to often take days off work to take him to the doctor because he was unable to drive.

James described the added financial strain to his family, resulting in additional medical expenses and added stress from loss of medical insurance.

A Just Outcome 

Thankfully, presented with undeniable new evidence in James’s appeal, UNUM finally did the right thing. They paid him for all past due benefits as well as a lump-sum settlement amount based on what would have been owed to him under the policy going forward.

Victims Of Disability Should Always Appeal Unfair Claim Denials

In the end, because he continued to fight, appealing the insurance company’s denial of his disability claim rather than just accepting it as the final word, James was able to maintain his financial security while he took some much-needed time to pursue further treatment and focus on healing and alternative vocational pursuits. 

Unfortunately, disability insurance companies unfairly deny legitimate claims every day, but anyone faced with an unfair claim denial should continue to fight and properly present stronger evidence on appeal.

James deserved the benefits he had paid premium for over the years, and it was an honor to help such a wonderful physician and person overturn such an unfair claim denial.

Results may vary. Every case is different, and no outcome can be guaranteed.