In 2013, a medical doctor notified Provident Life and Accident Insurance Company (“Unum”) of his claim for disability insurance benefits based on medical conditions of PTSD, grief, panic attacks, anxiety, cognitive impairment, insomnia, fatigue, and major depressive disorder. Unum approved his claim and paid the doctor his benefits from under the 24-month Mental Disorder Limitation of the policy.
At the end of the Mental Disorder Limitation period, the MD requested an additional six months of disability benefits in order to improve his physical disabilities. Unum agreed to pay the MD benefits for an additional six months, based upon his expected return to work. Unfortunately, and with great frustration, the MD’s physical conditions did not improve as expected during that six-month time-period. As he remained severely disabled due to his physical conditions, the MD requested Unum continue his disability benefits. Unum improperly claimed that he remained disabled due to mental conditions and not physical conditions, so he was no longer entitled to benefits. The disability attorneys at McDermott Law, LLC filed an appeal on behalf of the MD, arguing that the MD suffered from physical restrictions and limitations arising from his physiological conditions as illustrated by the medical evidence. Unum failed to render an appeal decision within the 90-day time period provided by the policy, so the MD filed a lawsuit to obtain his benefits and to pursue bad faith damages against Unum. The claim was eventually resolved prior to trial.
The disability attorneys at McDermott Law, LLC have assisted many claimants whose disability benefits have been limited by the insurance company based on a mental health limitation. Insurance companies often assert a mental health limitation in situations similar to this and ignore physically disabling conditions in order to limit their financial exposure. Please contact us for a consultation if your claim has been denied or your benefits have been terminated under similar circumstances.