An Unum disability denial lawsuit has been filed by a pediatrician who accuses the insurance company of unfairly terminating her long term disability payments.

Dr. Natalya P. had disability insurance coverage through Unum Life Insurance Company of America while she was employed by Caring Health Center of Springfield, Massachusetts.

In January 2007, Dr. Natalya “was injured and sustained a disc herniation in her thoracic spine, causing a thoracic radiculopathy,” pain from the nerves that control the chest and abdominal muscles. The discomfort starts in the middle of the back and reaches around to the front of the trunk.

Unum accepted and approved her disability claim. But after two years of benefits payments, Unum revised the definition of disability in the long term disability policy.

In November 2008, Dr. James S. Greenspan, M.D., a neurologist, examined Dr. Natalya and determined there was “no productive work she could do on a routine basis” and deemed the prognosis “guarded.”

According to the Unum disability denial lawsuit, “In December 2013, Unum began to examine the claim for possible settlement and performed a present value calculation of future benefits.”

At that time, Unum decided a review of Dr. Natalya’s functioning capacity was necessary. In addition to conducting video surveillance of her, Unum had their own orthopedic surgeon conduct a medical exam. Dr. Brian Gordon determined in June 2014 “that it was ‘not likely that she could function as a pediatrician’” but also suggested Dr. Natalya undergo a psychiatric evaluation. Dr. Gordon suggested a psychological aspect to the pediatrician’s disability.

Unum Disability Denial Lawsuit Alleges Inferior MRI Scan Hid Injuries

Dr. Gordon examined the surveillance video and said that new MRI results would be needed before he could determine Dr. Natalya’s true physical limits. Dr. Kantrowitz, who was Dr. Natalya’s treating neurosurgeon, ordered and read new MRI scans, but Unum did not share the films with Dr. Gordon.

According to the Unum disability denial lawsuit, “Dr. Gordon ordered films to be taken on an inferior MRI machine, owned by his medical practice.” Dr. Gordon only read the reports from Dr. Kantrowitz’s advanced MRI scans and never saw the films “showing multiple abnormalities that did correlate with the patient’s symptoms.”

Because Dr. Gordon’s final opinion was based on his own machine’s inferior MRI films, he determined from the lesser quality images that he could not see any physical issues that would cause Dr. Natalya’s symptoms.

In March 2015, Unum notified Dr. Natalya that she needed to have a psychiatric examination per Dr. Gordon’s recommendation. The Unum disability denial lawsuit states, “In the letter, Unum made clear that if she was found to have a mental impairment, the two years mental limitation in the policy could be invoked and that if the psychiatric exam supported the limitation, it would be applied retroactively.”

On April 4, 2015, Dr. Natalya underwent a psychiatric evaluation that supported her claim of continued physical disability, but on April 30, 2015, Unum stopped her disability payments.

In her Unum disability denial claim, Dr. Natalya alleges the insurance company “sought out and relied on a flawed and dishonest expert medical opinion” and “made deceptive omissions in supplying records to its medical expert.”

Among other accusations, Unum allegedly “chose to rely on a physician’s dishonest opinions where every other physician who examined Plaintiff, including two hired by Unum, supported the treating physician’s opinions that Plaintiff remained disabled.”

The Unum Disability Denial Lawsuit is Case No. 3:17-cv-30064-MGM in the U.S. District Court for the District of Massachusetts, Western Division.