What You Should Know:
A federal court ruled in favor of Dr. Pooja Mundrati, a physician who sued Unum for denying her long-term disability (LTD) benefits after a traumatic brain injury and spinal complications.
The court found Unum misclassified her occupation, ignored critical medical evaluations, and relied on an unreasonable record review process without conducting an independent medical exam.
The judge emphasized Unum’s failure to consider time-relevant evidence and selectively discounted treating physician input in favor of biased internal reviews.
Dabdoub Law Firm focuses exclusively on disability and life insurance claims and has a track record of success against insurers like Unum nationwide.
Background: A Devastating Setback for a Skilled Specialist
Dr. Pooja Mundrati, a Physical Medicine and Rehabilitation physician with fellowship training in interventional spine procedures, sustained a traumatic brain injury (TBI) and cervical spinal injuries from a motor vehicle accident in 2018. Though she attempted to return to work under modified schedules and restrictions, her condition worsened.
Despite years of documented symptoms such as chronic migraines, visual impairment, cognitive fatigue, and severe cervical spine stenosis, Unum denied her LTD claim. Unum asserted she was capable of performing her “light duty” job as a physician during the required elimination period.
The Court’s Findings: Why Unum’s Denial Didn’t Hold Up
The Pennsylvania Federal Court ruled that Unum's denial was arbitrary and capricious under the Employee Retirement Income Security Act (ERISA). Three core findings highlight why:
1. Misclassification of Occupation as “Light Duty” Was Arbitrary
Unum identified Dr. Mundrati's occupation generally as “physician,” a light-duty role, rather than the specialty of interventional spine physician (ISP), a specialty with great physical and cognitive demands.
“Unum has not explained why it chose to categorize Dr. Mundrati as a ‘physician,’ a light-duty occupation, rather than as an ISP or physiatrist… according to the DOT, a medium-duty occupation ‘as performed in the national economy.’”
This misclassification allowed Unum to understate the physical demands of her actual job, such as performing spinal injections while wearing heavy lead aprons and standing for long durations.
2. Refusal to Consider “Time-Irrelevant” Evidence Was Unreasonable
Unum dismissed evaluations like a 2023 psychological vocational exam (PVE) and functional capacity exam (FCE) as “not time-relevant,” claiming they occurred after the 90-day elimination period.
However, the court ruled that:
- There was no intervening medical event that changed her condition;
- The tests directly corroborated earlier documented symptoms;
- Dismissing them solely based on timing ignored their evidentiary value.
“Unum provides no reasoned basis for completely excluding the results of the PVE and FCE that post-dated the elimination period.”
This common tactic—discounting medical evidence as “too late”—is one we frequently see and successfully challenge in our clients’ appeals.
3. Unreasonable Reliance on Internal Reviews Without an IME
Unum based its decision on paper reviews by internal physicians, especially Dr. Scott Norris, who never examined Dr. Mundrati. Of note, Dr. Norris is a familiar name in Unum files, as a doctor they turn to for medical reviews that very rarely support disability. The court found the lack of in-person examination concerning given her subjective symptoms like pain and fatigue often require in-person evaluation.
The court properly found that “Dr. Norris appears to have required Dr. Mundrati to produce an objective test result to explain a subjective symptom. This undermines the decision not to examine her in person or arrange for an IME.”
The court also faulted Unum for disregarding the treating opinions of her neurologist and other specialists who directly observed her symptoms.
What This Case Means for Other Disability Insurance Claimants
This ruling highlights several key takeaways for anyone facing a long-term disability insurance denial, especially from companies like Unum:
Key Lessons:
- Your occupation matters. If your job has specialized physical or cognitive demands, insurers cannot generalize it to fit a denial narrative.
- Timing shouldn’t negate relevance. Medical evidence, even if it post-dates a key timeframe in your disability claim, can still support your claim.
- IME omission is telling. When insurers refuse to conduct independent medical exams and rely solely on internal paper reviews, it often signals an unjustified denial.
- Subjective symptoms are real. Pain, migraines, and cognitive fatigue deserve fair evaluation and insurers cannot simply dismiss them for lack of “objective” proof.
How Dabdoub Law Firm Can Help in Similar Cases
At Dabdoub Law Firm, we focus exclusively on disability and life insurance claims. We’ve taken on every major insurance company, including Unum, and won. This case echoes challenges we tackle every day:
- Arguing time-relevant evidence
- Forcing insurers to honor ERISA standards
- Fighting back when claims are denied based on flawed internal reviews
We’re a litigation powerhouse, and we’ve built a nationwide reputation for getting real results through appeals, settlements, and wins in federal court.
If your long-term disability insurance claim was denied you don’t have to face it alone. Reach out to Dabdoub Law Firm for a free consultation. We’re here to make sure insurers play by the rules and pay the disability benefits you deserve.