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Fibromyalgia Typical of Unum Claims Denials

October 3, 2011

Long-term disability insurance companies often attempt to avoid paying benefits for individuals whose conditions are hard to diagnose. Patients with conditions like depression, fibromyalgia and chronic pain receive extreme resistance from insurance companies.

The case of Kelly Ann Curtis demonstrates this problem well and is typical of Unum claims denials.  In Colorado United States District Court, Civil Action No. 11-cv-01471-CMA-KLM, Curtis was forced to file suit after Unum Life Insurance Company of America wrongly denied her benefits.

Kelly Curtis was working as a registered nurse when she was first diagnosed with fibromyalgia, a condition involving chronic muscle pain, fatigue, exhaustion, memory problems and mood swings. As an intensive care nurse, her job was demanding and stressful. She continued to work despite her painful symptoms. After three years, Curtis’ condition worsened. She was finally forced to leave her job because of the pain and stress of fibromyalgia.

When Curtis resigned at the hospital, she filed an application with Unum to receive short-term disability benefits. The insurance company found her eligible and began sending her payments for the maximum period allowed under that policy. After the policy expired, Curtis submitted an application to begin a long-term policy and sent medical records as evidence of her condition. She included notes from physicians who completed trigger point examinations, a process that determines if a patient has fibromyalgia.

Unum Treats Diagnosed Condition as Self-Reported

While Unum processed her application and agreed to provide her with long-term disability benefits, they claimed they could only extend her benefits for one year based on their “Self-Reported Symptoms Provision.” This clause states that the company will pay benefits up to 12 months when patients suffer from conditions with self-reported symptoms.

Curtis received benefits for the 12-month period. Unum then ended benefits. Ms. Curtis appealed and submitted all medical exams and documentation from the doctors who had treated her, including evidence of trigger point examinations that diagnose her condition. These tests are widely accepted in the medical world as a way to diagnose the disease. She also submitted paperwork showing that doctors had performed tests that ruled out any other conditions.

Even so, Unum denied her appeal. Curtis claimed that the insurance company contradicted both her doctor’s findings and the medical evidence that backed it up. The company wrongly used the Self-Reported Symptoms Provision to avoid paying benefits that she rightfully deserved. Curtis maintained that Unum knew that trigger point examinations were an accurate and accepted method for diagnosing fibromyalgia.

Unum Persists in Unfair Denial

Even as a layperson, Curtis knew that courts ruled in favor of patients in cases where trigger point examinations confirm the diagnosis and other medical conditions are ruled out. No doubt, Unum knew of such cases as well but denied benefits anyway. The case is currently in litigation as Unum continues to doggedly deny a claim that should obviously be paid.

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If you or a loved one has been denied long-term disability benefits, contact our office. Time to appeal your case is limited, so act quickly. Our experienced staff will offer a free consultation and work to win the benefits you rightly deserve.

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