Reinstating Long-Term Disability Benefits After Unum Terminated a Claim That Had Been Approved for 16 Years

At the Law Office of Justin C. Frankel, P.C., we recently secured the reinstatement of a client’s long-term disability benefits after Unum wrongfully terminated a claim that had been continuously approved and paid for approximately sixteen years.

The termination was particularly troubling because the claimant’s disabling medical conditions had not improved. Despite years of medical documentation supporting disability, ongoing treatment, and a lengthy history of benefit payments, Unum abruptly determined that the claimant was allegedly capable of returning to work and terminated benefits. Like many insurers, Unum relied heavily on file reviews, selective interpretation of the medical evidence, and an analysis that minimized the real-world impact of the claimant’s limitations.

Our firm immediately undertook a comprehensive review of the entire claim file. Rather than simply responding to the insurer’s conclusions, we built a detailed administrative appeal that addressed every aspect of the termination decision. We carefully analyzed the medical records, treating physician opinions, diagnostic testing, functional limitations, occupational requirements, vocational evidence, and the insurer’s consultant reports. We identified multiple flaws in the insurer’s analysis and demonstrated how critical evidence had been ignored, mischaracterized, or taken out of context.

One of the central themes of our appeal was that disability claims cannot be evaluated by focusing on isolated records while ignoring the totality of the evidence. The medical record as a whole demonstrated continuing impairments that prevented the claimant from performing the material and substantial duties of work on a full-time, reliable basis. We highlighted objective findings, treatment history, chronic symptoms, pain-related limitations, functional restrictions, and the longitudinal opinions of treating providers who had followed the claimant for years.

Our appeal also exposed significant deficiencies in the insurer’s vocational and medical reviews. We demonstrated that the consultants failed to adequately consider the claimant’s actual functional capacity and instead relied upon theoretical work abilities that were inconsistent with the documented medical evidence. We further showed that the insurer’s analysis ignored the practical realities of sustained employment, including the need to perform work activities consistently, predictably, and eight hours per day, five days per week.

In addition, we emphasized an important issue that frequently arises in long-term disability claims: the failure to properly evaluate chronic pain and its vocational consequences. Even when diagnostic studies may not fully capture the severity of symptoms, insurers are still obligated to evaluate the functional effects of pain, fatigue, medication side effects, and other disabling symptoms. Our appeal demonstrated that these factors had not been given meaningful consideration.

After reviewing our submission, Unum reversed its decision and reinstated the claimant’s long-term disability benefits.

This result is a powerful reminder that insurance companies do not always get it right. Even claimants who have received benefits for many years can unexpectedly face termination when an insurer decides to reevaluate a claim. Unfortunately, many individuals assume that a long payment history guarantees future benefits. Our experience shows that insurers continue to scrutinize claims regardless of how long benefits have been paid.

The appeal process is often the most important stage of a disability claim. In many cases, it represents the claimant’s last opportunity to fully develop the evidentiary record before litigation. A well-prepared appeal can mean the difference between a terminated claim and restored benefits.

At the Law Office of Justin C. Frankel, P.C., we focus extensively on disability insurance appeals and understand the strategies insurers use to deny or terminate claims. We routinely challenge improper medical reviews, flawed vocational assessments, surveillance-based determinations, paper-only physician reviews, and selective interpretations of medical evidence. Most importantly, we know how to build a persuasive administrative record designed to withstand scrutiny and maximize a claimant’s chances of success.

If your long-term disability benefits have been denied or terminated do not assume the insurer’s decision is final. The right appeal can make all the difference. Our firm has successfully helped claimants overturn disability determinations and restore critical benefits.

When your financial security is at stake, experience matters. Contact the Law Office of Justin C. Frankel, P.C. to discuss your disability appeal and learn how we may be able to help protect the benefits you have earned.