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Unum did approve their long-term disability for just under a year, then later denied the claim. This video discusses why migraine disability claims are tough to prove, why Unum employs their own internal doctors to review claims, and how Unum saves money.

The case involves a client who worked as a customer service representative from home for a financial investment firm. She suffered from severe migraines, which led to her filing for short-term and long-term disability benefits with Unum. Initially, Unum approved her long-term disability benefits for approximately eight to nine months. However, Unum later denied her claim based on a review by an in-house doctor, who concluded there was insufficient objective evidence of impairment, citing the subjective nature of migraines.

Attorney Stephen Jessup and his team challenged Unum’s denial by building a robust appeal. Key steps included:

• Collaborating with the client’s doctor, who provided supportive attending physician statements.
• Having the client maintain a detailed headache log to document the frequency and severity of her migraines.
• Making legal arguments that subjective complaints, when verified by a doctor, should be considered objective clinical evidence, supported by relevant case law.
• Requesting an Independent Medical Examination (IME) by a neurologist, as opposed to Unum’s initial suggestion of a physiatrist. This was a strategic move, as Jessup believed Unum was likely to deny the claim regardless, and an IME by a practicing neurologist offered a chance for a fair assessment.

The IME was conducted by a practicing neurologist, who found the client’s complaints credible and determined that her migraines significantly impaired her ability to work. Within a week of the IME, Unum reversed its decision and approved the client’s benefits. Additionally, the IME doctor recommended further treatment options, potentially opening avenues for the client to seek specialized care for her migraines and related sleep issues.

The attorneys criticized Unum’s reliance on in-house doctors for claim reviews, highlighting the inherent bias in such processes, as these doctors are salaried employees incentivized to deny claims. They noted that Unum’s “roundtable” discussions during appeals often lead to groupthink, further skewing decisions against claimants. The success of this case hinged on the strategic decision to push for an IME by an independent, practicing doctor, which provided the objective assessment Unum claimed was lacking. The attorneys emphasized that requesting an IME is a case-by-case decision, as an unfavorable IME report could strengthen an insurance company’s position in court. In this instance, the approach was a “Hail Mary” that paid off, securing a significant victory for the client.