Insurance Company Tactics:
Ignoring Cognitive Deficits

It is not uncommon for those experiencing debilitating physical conditions, such as musculoskeletal issues, to experience cognitive impairments as well, resulting from both pain levels and side effects of medications.  In fact, these cognitive impairments may even be the basis for continuing disability benefits—but will your insurance company recognize this?

One such example is the case of Sisung v. Unum[1].  Dr. Sisung, a pharmacist, became unable to practice when she was injured at work in 2006.  Her injury resulted in lower back and neck pain.  She treated with physical therapy, radiofrequency ablation, and medications.  While the medications helped, they caused her problems with cognitive functioning, as her physician reported to Unum.

While Unum paid benefits to Dr. Sisung for the own-occupation period of her policy, they denied her claim when she reached the “any-occupation” period of her policy, when she would only be considered disabled if she was unable to perform the duties of “any gainful occupation” for which she was “reasonably fitted by education, training or experience.”  Unum argued that Dr. Sisung’s physical condition had improved to the point that she was able to return to work in another occupation, and suggested that other professions she may be able to work in a sedentary-level occupation, such as a pharmacy area supervisor, a pharmacy manager or a pharmacy supervisor.  Unum argued that Dr. Sisung did not have any cognitive impairment that would prevent her from performing these jobs.

The Court found otherwise—concluding that Unum’s determination was not supported.  In part, they said that there were no conflicting statements in Dr. Sisung’s medical records regarding her cognitive impairment, Unum didn’t pursue their option of obtaining a second opinion through an Independent Medical Examination (IME), and Dr. Sisung had presented a neuropsychological examination which supported her claims of impairment.

This case demonstrates the uphill battle that claimants can face when a claim is based on cognitive impairments. If you have filed a claim and feel like your insurance is ignoring your diagnosis, please feel free to contact our attorneys directly to set up a consult.

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 not evaluating your claim under the proper standard, an experienced disability insurance attorney can help you assess the situation and determine what options, if any, are available.

[1] Sisung v. Unum Life Ins. Co., No. 1:20-cv-00497-WMR, 2022 WL 1772273 (11th Cir. June 1, 2022).


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