ClaimCave

Long-Term Disability

LTD claims and denials

Unum denied my long-term disability claim on a fibromyalgia and chronic fatigue syndrome diagnosis after 22 months on claim despite an own-occupation provision, treating physician support, and a Social Security Disability award by citing the policy mental and nervous limitation in a 24-month proof-of-loss letter that mischaracterized the ICD-10 diagnoses. Forced reinstatement and back-payment of $84,600 plus attorney fees using the ERISA 503-1 administrative appeal framework, the treating physician evidence rule, and the mental and nervous limitation challenge. The five-element approach to LTD denials on chronic pain and fatigue diagnoses

Posting this because long-term disability denials on fibromyalgia, chronic fatigue syndrome, post-Lyme disease syndrome, ME/CFS, and similar chronic pain and fatigue diagnoses are one of the most...

Posted by stressedClaimant865•
6 comments

Unum denied my ERISA long-term disability claim after dilated cardiomyopathy with ejection fraction of 28 percent forced me out of a software engineering role with a $174,000 base salary because the carrier asserted the cardiac limitation did not preclude sedentary work under the Any Occupation definition. Won the contested administrative appeal and a $612,000 lump-sum settlement using the vocational evidence framework, the treating physician deference analysis, and the ERISA administrative record strategy. The six-element ERISA LTD appeal playbook

Posting this because ERISA long-term disability (LTD) claim denials are among the most aggressively contested coverage decisions in the insurance industry, and the framework for prevailing on the...

Posted by stressedClaimant789•
7 comments

Unum terminated my long-term disability benefits at the 24-month 'own-occupation' to 'any-occupation' transition claiming I could perform sedentary work even though I have documented fibromyalgia, cervical radiculopathy from C5-C6 fusion, and Social Security Administration awarded SSDI benefits 8 months earlier. Won reinstatement plus 14 months of back benefits using the ERISA Section 502(a)(1)(B) framework, the Glenn conflict-of-interest analysis, and SSDI cross-reference. The four-pronged attack on any-occupation terminations

Sharing this because the 24-month own-occupation to any-occupation transition is the single most common point at which long-term disability carriers terminate benefits, and the legal framework for...

Posted by anxiousresident236•
6 comments

Unum denied my long-term disability claim for early-onset rheumatoid arthritis claiming I could perform 'sedentary work' even though my job as a dental hygienist requires fine motor control I no longer have. Won the ERISA appeal in 17 weeks by getting a functional capacity evaluation, attacking the file-review-only IME, and citing the vocational expert standard. The five documents that flipped the denial

Posting this because LTD claim denials under ERISA-governed group policies are systematically engineered to fail the policyholder on administrative appeal and the path to reversal is narrow but very...

Posted by anxiousresident589•
5 comments

Unum denied my long-term disability claim after 18 months on the policy citing 'self-reported symptoms' for fibromyalgia and CFS. Just won the ERISA appeal after submitting FCE results, three specialist reports, and a vocational expert opinion. Here is what worked

Posting this because the ERISA LTD appeal process is one of the most opaque and frustrating things I have ever dealt with and the published guides do not match the reality of what actually moves the...

Posted by stressedpolicyholder341•
7 comments

My LTD claim was denied 3 times before approval

After a back injury I couldnt work anymore. LTD claim was denied, appealed and denied again, appealed again and denied. Hired a disability attorney and finally got approved on the third appeal. If...

Posted by curiousSeller978•
7 comments