Paper Shuffle Causes Denial of Benefits?

July 22, 2010

Paper Shuffle Causes Denial of Benefits?

Unum Life Insurance Company has come under scrutiny due to a lawsuit filed July 6th concerning the plaintiff Robert Scheuermann. Mr. Scheuermann is seeking long term disability from Unum under a group policy held by his then employer, claiming that Unum has abused its discretion in the matter.

Mr. Scheuermann worked for a company that builds log home as a carpenter from 1992 until September 3, 2003. After a work related back injury during the summer of 2003 orthopedic surgeon Dr. Tipton made a diagnosis of sciatica and the necessity to operate. Mr. Scheuermann continued to work until the day before his first back surgery on September 4th.  Over the next 6 months Dr. Tipton performed 3 back surgeries on Mr. Scheuermann. In November of 2004 a rehabilitation specialist, Dr. Foreman performed a fourth surgery. The fifth surgery took place in June of 2005 by Dr. Malone. In November of 2006 Dr. Malone implanted a neurostimulator in the plaintiffs back for pain management.  Despite the years of surgeries and treatments Mr. Scheuermann claims to suffer from severe back pain.

Before the 4th surgery occurred in September of 2004 Dr. Tipton as an attending physician, informed that Scheuermann was under medical orders not to work, not to lift any object weighing more than 30 pounds, often could not lift or carry items weighing more than 15 pounds and was unable to sit or stand for longer than one hour continuously, and could not bend repeatedly.  In a subsequent report Dr/ Tipton noted that Mr. Scheuermann was completely disabled.

When reviewing Mr. Scheuermann’s claim for long term disability which is defined under the policy as a “sickness or injury” that renders the claimant   “unable to perform the duties of any gainful occupation for which reasonably fitted by education, training or experience.” Unum physician Dr. Sentef reviewed Mr. Scheuermann’s file in April of 2006 and claimed that he believed the restrictions and limitations were overly restrictive. In July of 2006 Unum physician Dr. Tsourmas performed what is known as an IME or independent medical evaluation and declared that  Mr.Scheuermann should be able to work after rehabilitation in a light duty capacity.  Dr. Tsourmas did choose to gather more information before issuing this as a final decision. He asked to review the MRI that Dr. Malone had performed several months previously and requested extension x-rays to judge the instability in Mr. Scheuermann’s back after being operated on multiple times.

On the basis of the IME Unum vocational consultant Waymire decided that Mr. Scheuermann was capable of performing some sedentary job that existed at the time in the Austin economy.

Publisher: Salient News