Unum Denies Long-Term Disability Benefits Despite Ongoing Treatment
Long Term disability denials are often based on file reviews that do not fully account for the claimant’s condition over time.
In this case, Unum reversed its denial after the administrative record was developed to reflect the full extent of the claimant’s spinal and neurologic impairment.
Spinal Stenosis, Neuropathy, and Gait Disturbance in LTD Claims
The claimant, a Facilities Coordinator, was unable to continue working due to progressive spinal and neurologic conditions, including:
- Lumbar spinal stenosis
- Post laminectomy syndrome
- Neurogenic claudication
- Neuropathic pain
- Chronic gait disturbance
Although short-term disability benefits were approved, Unum denied Long Term disability benefits in May 2025.
The denial relied on non-examining reviewers who characterized the findings as mild and concluded the claimant could return to work.
How Record Development Changed the Outcome of the Claim
On appeal, the record was expanded to provide a more complete and accurate picture of the claimant’s condition.
This included:
- Updated diagnostic imaging confirming nerve root compression
- Longitudinal treatment records documenting persistent symptoms
- An independent consultative examination identifying limitations below light work
Functional Limitations That Prevented Return to Work
The evidence showed limitations incompatible with the demands of the claimant’s job and with sustained full-time employment more broadly:
- Markedly limited sitting tolerance
- Sharply restricted standing and walking endurance
- Minimal lifting capacity
- Gait disturbance
A Social Security disability determination independently reached the same conclusion, reinforcing the strength and consistency of the record.
Unum Reverses LTD Denial After Appeal
After reviewing the fully developed administrative record, Unum reversed its denial and approved Long Term disability benefits.
What This Case Shows About File Review Denials
When a denial is based primarily on a paper review, developing objective and functional evidence can significantly change the outcome.
Consistency across medical records, imaging, and independent evaluations often plays a decisive role in reversing a decision.
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