Ignoring Treating Providers: A Case Study
We’ve regularly seen insurance companies, in particular Unum, go to great lengths to deny a claim. Tactics can include overemphasizing daily activities, ignoring treating providers, and relying on the opinions of doctors who have not examined the insured.
One example is the case of Chicco v. Unum[1]. Ms. Michelle Chicco worked as a tax accountant until debilitating back pain, as well as fatigue and weakness in her limbs, caused her to be unable to continue at her job. She filed a claim with Unum for long-term disability benefits, which was initially approved. Chicco received benefits for several months and then tried to return to work part-time; however, her symptoms began to worsen as she ramped up to full-time work. Unum reviewed her claim and determined that she was no longer considered disabled and could return to work full time. Chicco appealed this decision and, when Unum upheld the denial, she filed a lawsuit.
As part of their review, Unum obtained the opinion of several doctors who reviewed Chicco’s medical records but did not examine her directly. Despite her own treating provider’s diagnosis of radiculopathy and fibromyalgia, one of Unum’s experts surmised that her minimal improvement after spinal injections was not consistent with radiculopathy and suggested that the pain was myofascial (and that this myofascial pain should not have prevented Chicco from working).
In response to this report, Chicco submitted an updated letter from her treating provider and an examination performed by a neurologist—who confirmed that her physical examinations were consistent with her reports of pain and fatigue, as well as diagnoses of fibromyalgia and radiculopathy. Despite this, Unum’s reviewing doctor upheld his original conclusion.
Here, Unum’s disregard for the medical records and opinions for physicians who had actually examined Chicco did not go unnoticed. The Court found for Chicco, indicating that she has submitted both subjective and objective medical evidence of her condition, and inability to work. The Court also found it “significant” that none of Unum’s physicians personally examined Chicco, whereas every physician who had examined her had found her unable to perform her job duties.
In addition to these paper only reviews, Unum also argued that if Chicco’s pain was as severe as she claimed it was, she would have received more serious treatment and would not have been as active at home. The Court dismissed this argument, explaining that Chicco, before she stopped working, was on an “escalating treatment regimen” including medication, physical therapy, and multiple spinal injections (and was later referred to a spine surgeon for a surgery consultation). The Court also noted that Chicco reported that she was only able to engage briefly in light housekeeping and self-care tasks—which the Court found were consistent with the severity of her condition.
Too often we’ve seen Unum, and other disability insurance companies, ignore meaningful evidence submitted by claimants (including supporting evidence by treating physicians). If you feel that your insurer may be engaging in these types of tactics, please feel free to reach out to one of our attorneys directly.
Every claim is unique and the discussion above is only a limited summary of the court’s ruling in this case. If you are concerned that your insurer is using any of the tactics above to evaluate your claim, an experienced disability insurance attorney can help you assess the situation and determine what options, if any, are available.
[1] Chicco v. First Unum Life Ins. Co., 20cv10593 (DLC), 2022 WL 621985 (S.D. N.Y. March 3, 2022)
