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Data Specialist With Chronic Fatigue Wins UNUM Disability Appeal

The case involves a data specialist whose occupation required her to spend most of the workday sitting at a desk and using a computer. She had a complicated medical history that included chronic fatigue syndrome, chronic pain syndrome, degenerative disc disease affecting her back and cervical spine, dizziness, headaches, and widespread pain. She was receiving treatment from her primary care physician and multiple specialists, including a rheumatologist, who supported her decision to stop working because of her symptoms and limitations. She applied for long-term disability benefits through Unum, but the insurer denied her claim from the outset.

Unum concluded that she remained capable of performing her sedentary occupation for 40 hours per week. The insurer reached that decision through a paper review of her medical records rather than having her personally examined. Much of the client’s existing medical evidence documented subjective complaints such as pain, fatigue, headaches, and dizziness, leaving an opportunity to develop additional objective evidence demonstrating why those symptoms prevented her from working.

Attorney Rachel Alters began by examining whether additional testing could provide objective support for the client’s complaints. Although the client reported that she could not sit or stand for extended periods because of pain, she had not yet undergone an MRI of her back and neck. An MRI was obtained and revealed bulging discs and degenerative disc disease, providing objective findings that helped explain her pain and physical limitations.

The appeal was developed using multiple forms of evidence to document both the client’s medical conditions and their functional impact. Key components included:

• Obtaining MRI imaging of the cervical and lumbar spine that documented bulging discs and degenerative disc disease.
• Working with the client’s treating physicians to ensure that her physical examination findings, pain, restrictions, and limitations were thoroughly documented.
• Submitting a pain log and daily headache log showing the frequency and severity of her ongoing symptoms.
• Encouraging the client to bring written lists of her symptoms and limitations to medical appointments so important problems were consistently documented in her records.
• Documenting additional symptoms, including pain in her hands that interfered with typing and pain in her feet.
• Arranging a Functional Capacity Evaluation (FCE) to objectively assess her ability to sit, stand, push, pull, bend, and perform other physical activities required for work.

The FCE became particularly important because the client’s occupation was sedentary. To establish disability, the appeal needed to demonstrate that she could not reliably perform the physical and cognitive demands of desk work, including prolonged sitting. The evaluation concluded that she could not sustain sedentary employment because of limitations involving sitting, standing, pain tolerance, focus, and concentration. Alters then provided the FCE results to the client’s treating physicians, who agreed with its findings and confirmed that she was unable to perform sedentary work.

This combination of independent functional testing and support from the client’s treating physicians strengthened the appeal considerably. Rather than relying solely on the client’s reports of pain and fatigue, the evidence connected objective imaging, functional testing, physical examinations, symptom logs, and physician opinions to her inability to perform her occupation. Unum ultimately reversed its denial and approved her long-term disability benefits without the client having to proceed to litigation.

Winning the appeal does not end the client’s claim. Unum will continue evaluating whether she remains eligible for benefits, making consistent medical treatment and documentation important. Her policy also contains a change in the definition of disability after 24 months, when the standard shifts from whether she can perform her current occupation to whether she can perform any gainful occupation. That transition may result in another detailed review of her medical evidence and functional capacity.

The case demonstrates the importance of documenting not only a diagnosis but also how symptoms translate into specific functional restrictions. Conditions involving chronic pain and fatigue can be difficult to establish through medical records alone when many of the symptoms are subjective. Objective imaging, functional testing, detailed symptom documentation, and clear support from treating physicians can help establish why those conditions prevent a claimant from reliably performing even a sedentary occupation.