“Unum’s reasoning for denial was that my doctor was not supporting my claim, but there was some confusion about which doctor filed medical reports,” Yolanda says. “When my doctor and I finally realized the mix-up, we explained it to Unum and they still denied me.”Last June Yolanda was working on her home computer when she slipped on a mat - Unum didn’t see it as a work-related injury - and injured her back. Unum did pay short-term disability benefits but the last STD payment was sent in October. Yolanda sent more medical reports from her doctor to Unum.
“During the time I was out for a back injury, I was also being treated for bilateral carpal tunnel, which I developed from typing on the computer so much,” Yolanda says. And here is how the confusion happened.
“Michelle, my regular PCP (primary care physician) kept me out of work for my carpal tunnel and put me on restrictions - verbally. I had seen Dr. Ingram, another PCP, about my back injury and Michelle thought Dr. Ingram had sent my carpal tunnel report to Unum as well as my back report. Meanwhile, I saw Dr. Jameson, a hand specialist, in December and had surgery in January of this year. Michelle had me out of work with restrictions but she didn’t relay this information to the caseworker, thinking that Dr. Ingram had sent the paperwork about my hand to Unum. Anyway, when we realized that Dr. Ingram just had me out of work for my back, Michelle wrote a letter to Unum.”
Unum obviously thought this explanation was too confusing.
Michelle told Unum’s Appeals Department that Yolanda had been out of work for six consecutive months, which is the elimination period for long-term disability (and of course Yolanda knows this). Unum replied, they still believed that Yolanda wasn’t supported by her doctor. Even though Michelle explained the mix-up, that she supported Yolanda and listed her restrictions, Unum refused to recognize that she was indeed medically supported. The hand doctor also kept Yolanda out of work. She couldn’t do anything after surgery and had to keep her arm elevated.
Still, Unum wouldn’t accept Michelle’s or Dr. Jameson’s statements. And Unum never called the doctors. “Unum didn’t believe that I was disabled, even with my doctor’s letters,” says Yolanda. “They never sent me to their own Independent Medical Examiner. They denied workers comp, even though I was working when I hurt my back; they denied everything.”
Once long-term disability is approved, Unum pays benefits for two years if it is a mental condition and covers five years for a physical condition. After two years, Unum evaluates physical conditions and gets you on Social Security benefits. And the law has changed regarding carpal tunnel syndrome.
“I accepted claims for carpal tunnel as an illness rather than work-related, that is how Unum instructed us,” says Yolanda. “Dr Jameson, my hand doctor, knew the law had changed and reported that my condition was an illness. Still, Unum denied me.
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“I resigned from Unum because I placed a complaint through HR about conditions in the workplace and it never got any better,” notes Yolanda. “Management kept changing the way things were being done - what applied to one claim didn’t apply to another. There were no standard rules in place. I specifically complained about a manager who set people up and terminated them for no reason. Nothing was ever done about my complaint. Everyone was stressed out and our workload increased. We were on salary and had to work mandatory overtime that we weren’t compensated for. But that’s another claim...”