Dentist Claims Injury, Unum Claims Sickness to Deny

San Diego, CAA dental surgeon has filed a bad faith lawsuit against Unum, or First Unum after the giant insurer denied his long term disability benefits claiming his injury is a sickness. The Unum lawsuit claims that Unum denied the dentist his rightful benefits to protect their own interests.

In September 2014 Dr. Frank L. Pavel sustained severe injuries in a diving accident, which he says has left him now totally disabled. Pavel injured his neck after diving from a boat into a lake. The accident resulted in paresthesia – a burning or prickling sensation that is usually felt in the hands, arms, legs, or feet, but can also occur in other parts of the body, according to the National Institute of Neurological Disorders and Stroke (NIH). Most everyone has experienced paresthesia: that feeling of pins and needles when your arms or legs “fall asleep.” This sensation usually happens when you’ve inadvertently put pressure on a nerve. But chronic paresthesia can cause a stabbing pain and may lead to clumsiness of the affected limb, states healthline.com.

Chronic Paresthesia Disability

NIH says that chronic paresthesia is often a symptom of an underlying neurological disease or traumatic nerve damage, and prognosis depends on the severity of the sensations and the associated disorders. Pavel specialized in oral and maxillofacial (face and jaw) surgery; paresthesia has prevented him from performing his occupation, which involves precise and careful movement. In his lawsuit, Pavel claims his symptoms became worse and weeks after the accident he began to experience atrophy in his right hand and forearm. He sought medical treatment but doctors determined that the injury is permanent; in October 2014 he submitted an Unum disability claim.

Unum’s Disability Denial

At first the insurer granted Pavel long-term disability benefits, but noted that benefits would end on March 29, 2019—Pavel’s sixty-fifth birthday. But Pavel was unable to work and in August of 2015, he asked Unum to reevaluate his claim. Three months later, Unum issued a bad faith insurance denial.
Next up, Pavel requested an appeal. This time, Unum requested that Pavel provide additional information—and prolonged the process for the next two years. Unum sent an official denial in January 2018.

Pavel bought his Unum policy back in 1988, and paid his premiums for the next 30 years. As any policyholder would expect from their insurer, Pavel expected to receive benefits if ever he became disabled and unable to work.

Dr. Pavel sought legal help and filed an Unum bad faith insurance denial lawsuit in August in the U.S. District Court for the Southern District of California. The lawsuit argues that Unum considers Pavel’s injuries to be a sickness and will not pay lifetime disability benefits. Pavel filed the lawsuit on counts of breach of contract, bad faith, and declaratory relief. Case number 3:18-cv-01778-LAB-KSC

Social Security and Paresthesia Disability

On the basis of neuropathy, there are a few ways that Social Security can approve disability benefits. Its criteria states that:

You must have peripheral neuropathy that is characterized by either:

• The inability to control the movement of at least two extremities (either an arm and a leg or two arms or two legs). This must result in extreme difficulty in the ability to balance while standing or walking, to stand up from a seated position, or to use the arms.
or
• “Marked” physical problems along with a "marked" limitation in any one of the following:
• thinking (understanding, remembering, or applying information)
• interacting with others (social problems), or
• finishing tasks (problems with concentration, persistence, or speed).
Second, if you don't meet the criteria of the disability listing, you may still be approved for Social Security disability if your peripheral neuropathies severely limit you in other ways.