Samuel Boykin was a former maintenance specialist for Valero Services, Inc. After a car accident in February 2014, Mr. Boykin tried to return to work but became disabled due to debilitating chronic back pain despite conservative treatment. Following his departure from work, Mr. Boykin submitted a long-term disability (“LTD”) claim to Unum.
Unum denied Mr. Boykin’s claim and subsequent appeal. Mr. Boykin filed a lawsuit against Unum in the Eastern District of California for recovery of his LTD benefits under the Policy pursuant to ERISA.
The Court ruled that Mr. Boykin was disabled from his own occupation as a maintenance specialist and remanded the case back to Unum to determine if Mr. Boykin was disabled from any occupation.
The Court reviewed Mr. Boykin’s case under the de novo standard. Under this standard, the Court will examine the facts to determine whether Plaintiff (Mr. Boykin) is disabled.
The Court highlighted the following key facts in supporting their decision:
- Mr. Boykin’s medical records demonstrate the deterioration of Plaintiff’s physical health and abilities through the Elimination Period and after.
- Mr. Boykin’s condition persisted despite physical therapy, acupuncture and spinal injections.
- Mr. Boykin’s primary care physician had been treating him since the car accident and supported his claim for LTD benefits.
- Mr. Boykin underwent a functional capacity evaluation that provided objective data that he cannot work.
The Court concluded that Mr. Boykin was a credible witness. Further, Mr. Boykin worked for years with back pain and only ceased working after multiple attempts at pain management had failed.
The medical evidence and support of your treating physicians are essential for LTD claims. Insurance companies have their own team of doctors and medical professionals who review your claim and make a decision.
Making sure your treating team is aware and supports your disability claim will ensure a strong claim. Further, when it comes to chronic pain claims, objective evidence such as diagnostic images or functional capacity evaluations will make your claim much stronger.
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Disclaimer: Dabdoub Law Firm did not handle this case.