What to Do When Your Doctor Agrees with the Long-Term Disability Insurer’s Opinion You Can Work

Employees in Chicago and the rest of Illinois with claims for long-term disability insurance benefits often encounter medical consultants on behalf of the long-term disability insurer contacting their treating physicians asking if the treating physician agrees with the insurer that you can go back to work. The insurers often use sneaky tactics to try to secure this agreement from your doctors, such as selectively representing medical records from other treating physicians, or misrepresenting the content of surveillance. Usually treating doctors do not respond to these sorts of requests, especially if they already rendered an opinion to the insurer regarding your work capacity. But sometimes they respond agreeing with the insurer. The following recent case demonstrates how devastating it can be to your claim when your doctor agrees with an insurance company’s doctor about your work capacity.

In Black v. Unum Life Insurance Co. of America, No. 3:22-cv-2116, 2024 WL 4960010 (N.D. Tex. Dec. 2, 2024), Black went on disability leave in 2014 following complications from a gallbladder removal surgery. Unum insured the employer-sponsored long-term disability plan covering Black, and Unum approved the claim. After some years, Black developed thoracic outlet syndrome and symptoms remained disabling. In 2021, Black’s health began to improve and her doctors responded to requests from Unum agreeing Black could perform sedentary work. Unum then terminated the long-term disability benefits. After Rieger unsuccessfully appealed, she sued Unum under ERISA § 502(a). The United States District Court for the Northern District of Texas granted Unum summary judgment and ruled in its favor, deciding Black was no longer entitled to long-term disability benefits. The Court found it persuasive that Black’s doctors agreed with Unum’s doctors that Black could perform sedentary work, notwithstanding Black’s contention she could not.

So what do you do when your doctors agree with the insurer that you have capacity to work? In our experience, the most effective thing to do is obtain objective and valid testing of capacities, such as a functional capacity evaluation, and present the results to the treating physician. Often the treating physician will retract the agreement with the insurer if the functional capacity evaluation shows you lack work capacity. Occasionally treating physicians can get defensive about their opinions, but this appears to be the exception, rather than the rule. Ultimately, you must equip the doctor with something concrete that can justify the doctor changing his or her mind.

If your claim for long-term disability insurance benefits has been denied or terminated, don’t waste any time. Call a knowledgeable ERISA long-term disability attorney today.