What You Should Know:
- A former full-time professional in Utah submitted a long-term disability (LTD) claim with Unum after developing debilitating symptoms from Postural Orthostatic Tachycardia Syndrome (POTS).
- An independent Functional Capacity Evaluation (FCE) confirmed her inability to perform even sedentary work due to dizziness, fatigue, and impaired balance.
- Her primary care provider also confirmed total disability and provided evidence that the condition was not pre-existing.
- Dabdoub Law Firm focuses exclusively on disability insurance claims and has nationwide experience handling complex cases involving POTS and similar conditions.
Independent Testing Confirms Total Disability from POTS
After developing severe symptoms consistent with POTS, a former Utah employee was forced to leave the workforce and file for long-term disability benefits under her employer’s group policy with Unum. Despite submitting extensive documentation and meeting all requests during Unum’s pre-existing condition review, the claimant received no clear resolution regarding her ongoing benefits.
To reinforce her claim, she underwent a Functional Capacity Evaluation (FCE) as part of the long term disability appeal workup. Conducted by a licensed occupational therapist, the FCE confirmed what her medical records had already suggested: her physical limitations were profound and incompatible with any type of sustained work.
Key Physical Limitations Identified in the FCE:
- Sitting: Occasional only
- Walking, squatting, forward bending: Never
- Head/body rotation: Never
- Balance and coordination: Severely impaired when fatigued
- Task tolerance: Could not complete the full FCE due to physical exhaustion, dizziness, and visual issues
The evaluator noted that during the 3-hour testing session, the claimant had to take frequent rest breaks, lie down to recover from symptoms, and was ultimately unable to complete all assessments due to exhaustion. These results were consistent with the hallmark features of POTS, a condition known for producing intolerance to exertion, orthostatic dysfunction, and severe fatigue.
Independent Validation of Test Results
To ensure that the evaluation could not be questioned, the claimant retained a second occupational therapist to review the FCE results. This expert confirmed:
- Full and consistent effort was demonstrated throughout the test.
- Objective testing protocols (ErgoScience) validated the reliability of the results.
- The claimant showed severe limitations across all tested physical domains.
- Both sitting and standing were limited to occasional use only, preventing full-time work in any capacity.
This independent review eliminated any doubt about whether the claimant was exaggerating symptoms or underperforming. The results showed a genuine inability to sustain the demands of a workday, even one that would typically be classified as sedentary.
Treating Provider Supports the Disability Claim
In addition to third-party assessments, the claimant’s primary care provider submitted a medical questionnaire confirming her total disability beginning in November 2024 and continuing through the present. The provider also affirmed that her condition, Postural Orthostatic Tachycardia Syndrome, was not pre-existing and thus not subject to exclusion under the policy.
This direct provider support carries significant weight under ERISA law, which gives deference to the opinions of treating physicians when assessing disability claims. Their regular interactions and long-term oversight provide a uniquely qualified perspective on a patient’s daily struggles and limitations.
The Nature of POTS and Why It Disables
POTS is a chronic autonomic nervous system disorder that interferes with the body’s ability to regulate blood pressure and heart rate in response to posture changes. Common symptoms include:
- Lightheadedness and dizziness upon standing
- Extreme fatigue, especially after minimal exertion
- Brain fog and concentration difficulties
- Visual disturbances (e.g., blurry vision, black spots)
- Heart palpitations and shortness of breath
- Temperature sensitivity and exercise intolerance
In this case, our client exhibited all of these symptoms, as confirmed by multiple professionals and testing protocols. The inability to maintain upright posture or perform sustained physical tasks, coupled with visual impairment and cognitive fatigue, rendered her unfit for any type of gainful employment.
Unum’s Fiduciary Duty to Conduct a Full and Fair Review
As a fiduciary under ERISA, Unum has a legal obligation to conduct a full and fair review of all submitted evidence, especially when that evidence comes from:
- Objective medical testing like FCEs
- Independent professional validation
- Treating physician assessments
With the pre-existing condition review completed and no contrary medical evidence submitted, Unum now has a clear path forward. The claim file contains comprehensive proof of total disability that cannot be credibly disputed.
Unum’s Opportunity to Get It Right for our Arkansas Client
This claimant has done everything right:
- Responded to all document requests
- Submitted medical records covering the look-back period
- Provided objective testing and third-party validation
- Obtained treating provider confirmation of both diagnosis and disability status
The evidence is overwhelming and consistent. Under the terms of the policy, and in accordance with federal disability law, this claimant meets the standard for long-term disability benefits.
Lawyers with Expertise in Disability Insurance Claims
This law firm has always focused only on disability insurance law. Because we specialize in long-term disability, our clients get the benefit of:
- Having an attorney who is an expert in long-term disability claims;
- Having an attorney who has experience with every major disability insurance company; and
- Being backed by a law firm that has a proven track record of winning tough disability lawsuits.
Call the Dabdoub Law Firm to get experienced disability lawyers on your side. We can help with:
- Submitting a disability insurance claim;
- Appealing a long-term disability denial;
- Negotiating a lump-sum settlement; or
- Filing a lawsuit against your disability insurance company.
The firm represents clients nationwide with disability claims governed by federal law, even if we are not located in your state.
Call (800) 969-0488 or contact us online to speak with an experienced disability attorney. Pay no fees or costs unless you get paid.