Disability Insurance Blog

UNUM Wants Stage IV A Cancer Patient To Wait For Disability Benefits — Frankel & Newfield Cuts Through The Delay To Get Benefits Paid


Wednesday, February 22nd, 2012

Our client is a vascular surgeon who is unable to perform the duties of his profession due to numerous co-morbid conditions, including Hepatitis C, fatigue, diabetes, hemochromatosis, chronic and recurrent alcoholism, hyperparathyroidism, lumbosacral disc herniations, degenerative disc disease, facet arthropathy, forominal stenosis, chronic pain, depression, and anxiety.

His residual disability benefits were terminated on September 6, 2011 by Unum. At the same time of Unum’s termination of his claim, he received worse news: he was diagnosed with Stage IV a oropharyngeal cancer.

Unum determined that our client was disabled due to oropharyngeal cancer and indicated that he would have to satisfy a new elimination period (because his prior claim had been terminated). We fought back, and we won.

Frankel & Newfield successfully argued that his oropharyngeal cancer was a complication of and co-morbidity to excessive alcohol usage. We provided medical research literature and statistics documenting that in 70% of all oropharyngeal cancer cases, excessive alcohol use is a common risk factor. We further supported our argument by providing medical research literature that oral cancers are twice as common in men as in women, and the likelihood of developing oral cancer increases with age, which supported our assertion that our client’s oropharyngeal cancer was a complication of and co-morbidity to excessive alcohol usage – a disability for which our client had been receiving benefits.

We also educated Unum with background information on our client’s particular type of cancer. The symptoms of throat cancer are not specific to cancer. The symptoms — cough, hoarseness, difficulty swallowing, ear pain, and/or sore throat — are common to many illnesses. Our client’s symptoms began in late July 2011. When the symptoms persisted, our client scheduled a consultation with an ENT (Ear, Nose and Throat) doctor.

Our client was diagnosed with Stage IV a tonsillar carcinoma (T2 N2b M0), a type of oropharyngeal cancer considered to be advanced cancer. It was unlikely that his cancer advanced from Stage 0 to Stage IV a within the short time from when he started to experience the symptoms and called for an appointment, to when he was diagnosed.

After considering the extensive medical records, the exhaustive medical research information, including the statistics, literature, and studies that we provided, combined with the duties and tasks required to perform his position as a vascular surgeon, and the side effects of the treatment, Unum had no choice but to reverse the termination of our client’s benefits, with no requirement to satisfy a new elimination period.