posted November 12, 2002
What options are left to me when I am told by my employer that I need a release from my doctor to return to work but my doctors who treat me cannot provide a release because my disabling condition prevents me from returning to work, BUT my disability company says they are not going to pay disability benefits because their doctor (who has never seen me) has determined that I am not disabled from performing my occupation and I should return to work?
I have provided some quotes from my UNUM disability claim file (which is now about 12 inches high). I would be happy to provide any further information or assistance you may need. I am not looking for my "fifteen minutes of fame," but only wish to have every opportunity to have my disability benefits reinstated! I also hope that no one else has to go through the stress that UNUM has caused in my life! I know this is a lot of information, but that in itself is evidence that UNUM has continued to ignore a lot of evidence! If you have any interest, I have also prepared a chronology of my entire claim and all of the significant documents included in my file, but I have not included that in this information.
I have three physicians that have each written letters to UNUM on my behalf. Dr. Ignacio Salzman is my primary care physician in Orlando, Dr. Roland Filart is my cardiologist/electrophysiologist in Orlando, and Dr. Blair Grubb is my cardiologist/electrophysiologist at the Medical College of Ohio in Toledo. Dr. Grubb is a world renowned specialist in syncope (sudden loss of consciousness) and my condition, and I was referred to him by my local physicians in April, 2001, because of the severity of my condition. My HMO considers my referral to Dr. Grubb as medically necessary and pays the medical expenses of my visits to Dr. Grubb, although I have to pay the travel costs. My HMO has also provided, at their expense, a permanent pacemaker, a $6,000 electric wheelchair, a manual wheelchair, a bedside commode, a walker, at home physical therapy when needed, at home nursing care when needed and, most recently, has approved and provided a new medication recommended by Dr. Grubb which would cost me $10,000 per year if it had not been approved by my HMO.
I quote from these physicians as follows:
Dr. Salzman:
9/4/01 (also signed and approved by Dr. Grubb)- "…I have monitored her care closely since (2/99)) since she frequently experiences syncope, as well as other debilitating symptoms including frequent heart arrhythmias (both bradycardia and tachycardia), nausea, dizziness, diarrhea, migraine headaches, mental confusion, difficulty concentrating, blurred vision, sleep difficulties, extreme fluctuations in blood pressure, exercise intolerance, extreme fatigue, thermoregulatory problems such as heat intolerance, venous pooling, shortness of breath, tremulousness and frequent pain, especially in the shoulders and neck. I have attended Ms. Joseph (now Hausmann) in the emergency room, as an inpatient in the hospital and in my office many times during the last 2 ½ years and have seen physical evidence of many of these symptoms first hand…My overall observations of this patient…her condition has continued to deteriorate and greatly impairs the overall quality of her life…there is no known cure for Ms. Joseph’s condition…This is a chronic condition, therefore, her actual restrictions and limitations as to times may vary slightly on any particular day…is unable to maintain proper heart rate and blood pressure for many hours at a time and is restricted to her home at those times…No driving…No working at heights…No operating heavy equipment…Avoid heat and other temperature changes as her condition prevents her ability to properly regulate body temperature…Avoid prolonged standing - this may vary from a few moments to several minutes, but standing for longer periods of time leads to syncope due to venous pooling…No sitting for more than one - two hours, since this may also cause venous pooling and lead to syncope…Avoid stressful situations, as stress is proven to provoke symptoms and syncope in patients with this condition…Limited to modest physical activity during periods between symptoms…Limited to short periods of mental concentration - no longer than one hour…Avoid walking alone - restricted to short, slow walks…Avoid situations which prohibit patient from lying down quickly when necessary to prevent injury from fall due to syncope…is not able to maintain an upright position for 8 hours…She is, and will continue to be, totally and permanently disabled within a reasonable degree of medical probability and should not return to work in any capacity…"
7/25/02 - …"suffering from Neurocardiogenic Syndrome with severe symptoms…had an unfortunate outcome because her disability status, she is unable to do ADL, drive…she is bed confine(d) most of the day…ambulating with an electric chair was a need…developed post viral autonomic neuropathy characterized by both postural orthostatic tachycardia and recurrent syncope, several organs were involved including but not limited to Urological, cardiovascular, neurologic, digestive…HHC (home health care) was set for helping with bathing and taking meds…she is disabled from any point of view…"
Dr. Filart:
9/21/01 - "…suffers from severe form of neurocardiogenic syncope associated both with sudden drops in blood pressure as well as heart rate…Her workup has be extensive and I would like to refer you to Dr. Ignacio Salzman’s extensive and very complete account of her workup and his letter dated 9/4/01...suffers from exacerbation of her symptoms they often occur quickly with little or no warning and present suddenly with syncope…tilt table test demonstrating the presence of neurocardiogenic syncope which mimicked her clinical symptoms…permanent pacemaker implanted…again experienced a resurgence of her symptoms that are just as severe as before, despite permanent pacemaker. Therefore, she was sent to an expert in the area of neurocardiogenic syncope and is currently under his care (Dr. Grubb)…(listed similar restrictions and limitations as Dr. Salzman)…do not currently have a cure… is likely to continue and become progressive…It is my opinion that Ms. Joseph is totally and permanently disabled to any reasonable degree of medical probability and cannot return to work in any capacity…"
Dr. Blair Grubb:
9/20/01 - signed Dr. Salzman’s letter dated 9/4/01
7/31/02 - "…severe recurrent neurocardiogenic syncope that has thus far proven refractory to all treatment modalities…sudden and unpredictable loss of consciousness due to a fall in blood pressure and heart rate. These episodes occur because of a disturbance in the regulatory functions of the autonomic nervous system of the brain…may be rendered completely incapacitated by the condition…has a severe form of this disorder and thus I believe to the best of my medical knowledge is completely unable to work in any meaningful occupation. She therefore should be considered completely disabled from any gainful employment…"
I now quote from a letter from HomeBanc Mortgage Corporation who was my employer at the time of the onset of my disability. HomeBanc insisted in November, 1998, that I discontinue working and go on disability until such time as I was able to get my symptoms under control and get a release from my doctor allowing me to safely return to work. The letter was written to UNUM on 9/17/01 by Colleen Haddow, AVP Human Resources, HomeBanc Mortgage Corporation:
"…Her doctors never released her to return to work…was a Loan Officer in our Orlando Office…driving was an essential part of her job…her condition was not good, she passed out several times and the paramedics had to be called…she would lose consciousness, sometimes had vomiting, dizziness, nausea, arrhythmias and other symptoms, which were visually evident to coworkers and clients. Her condition caused stress to her coworkers and to Karen…condition never stabilized it continued to get worse…never while in our employment received a release from her doctors to return to work..."
I now quote from UNUM’s doctor, Dr. Thomas Hashway, Jr.:
10/12/01 - "…I agreed with R&L’s of no working at heights or operating heavy machinery, which would include an automobile, because of the possible risks. The issue about driving as an integral part of her job, as described above, is a contractual issue…Is her risk higher at her job than not at her job? There is no proof of that either, except for the element of driving. However, there is no other element of her job that appears to imply higher risk. The employer may not be willing to accept the risk of litigation but this is not the same issue. Yes, the claimant may faint, whether at the job or not. But does that preclude her from performing her occupation, especially if she and her employer recognize that risk, and common sense is used to adapt to that risk? Not if she is motivated to work…the additional material does not alter my previously expressed opinions…"
Since that time, I experienced serious injuries in July, 2002, from a fall due to syncope while in Dr. Filart’s office, and spent 10 days in the hospital in July, as well as spending that last several months in bed recuperating from these injuries which included damage to my spleen, injuries to nerves in my back. UNUM refuses to consider the medical data for these injuries stating "…You draw specific attention to medical information, some which is beyond the date of file being considered. We regret those situations have accrued, they are not within the time frame of the claim under appeal…" This is a quote from a letter from UNUM to my attorney dated 10/29/02. This was my final denial letter and I refer to it again below.
Portions of my final denial letter from UNUM to my attorney are quoted as follows:
10/29/02 - "…You noted that Mrs. Hausmann’s policy states we have the right to have the insured examined by a physician or other health care professional. That is an option we could have taken but did not. We have had the medical information submitted to us reviewed by a physician Board Certified Internal Medicine & Cardiovascular Diseases…R&L’s of no driving, working at heights or operating heavy machinery. However, otherwise, she is capable of any exertional level activity…In response to your questions, the new material suggests a persistent pattern of syncope. In this setting, she should avoid working at heights, avoid driving, and avoid operating heavy machinery. Otherwise, in my opinion, she has no other occupational R&L’s. This is consistent with my previously expressed opinions…do not support R&L’s which preclude Mrs. Hausmann from returning to her occupation…Therefore the prior decisions (denial of benefits) have been upheld as correct and appropriate…administrative records are closed…Mrs. Hausmann has exhausted the administrative remedy provided by her policy…"
In addition to medial evidence in my file, there is also occupational evidence and information. UNUM did an Occupational Analysis on my occupation as a mortgage loan originator which contains the following:
"…Driving is a requirement in the performance of the duties of a loan originator. Modifications do not appear to be viable to the current occupation…"
Other occupational information in UNUM’s file includes Addendum Transferable Skills Analysis (TSA) which includes a Summary Conclusion containing the following information:
"…A TSA was attempted with the restrictions of no driving, working at heights, or operating heavy machinery along with the wage requirement. Due to the restrictions of the wage requirement and identifying occupations not requiring management skills, no comparable occupations were identified at this time…"
Pursuant to the above information, the file contains a Memo To The File which states:
"Please note the overturn decision in the claim file…"
I was not sent a copy of this overturn decision, even though I was informed by Randi Smith at UNUM in December, 2001, that she was recommending that the decision to deny my benefits be overturned and that I should receive a check for all back benefits, as well as begin receiving future benefits in January, 2002. In January, I received a check for back benefits and a letter stating that UNUM needed more time to investigate my claim, even though they had been investigating it for almost one year at that time, and that I would not be receiving any further benefits until a final decision had been made. When I asked for a copy of my file, that overturn decision was conveniently left out, even though copies of the materials mentioned above were included. My final denial came in the above mentioned letter dated October 29, 2002. During the year 2002, there was at least one period of time of more than 100 days when UNUM did absolutely nothing on my file!
I received disability benefits from UNUM from 6/1/99 through 3/31/02, including the aforementioned back benefits. According to my policy, I should receive 60% of my pre-disability benefits until age 65 if I am unable to work due to a disability. I am 46 years old and my pre-disability income was significant enough that UNUM apparently does not want to willingly pay me for the next 19 years, however, if UNUM has the right to decide not to pay based on their need to increase their bottom line profits, what is the purpose of having disability insurance?
Do you know of any company that would hire me based upon the above medical information, symptoms and the fact that I totally lose consciousness several times per week with no warning and do not know which of the above listed symptoms may prevent me from performing normal activities at any given moment?!?!?!?!?!
Because of the limitations of my condition, this has taken me a long time to prepare. I prepared it on my computer and am now going to copy it onto your website as an email. I appreciate your taking the time to read it and consider the information contained in it.
Karen Hausmann
234 N. Lakeview Avenue
Winter Garden, FL 34787
(407) 877-8173
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