When the File Reviewers Win: N.D. Ohio Upholds Unum’s Denial of ERISA Long-Term Disability Benefits for a Claimant with Epilepsy

In DiGeronimo v. Unum Life Insurance Company of America, No. 1:22-cv-00773, 2026 WL 2718210 (N.D. Ohio Sept. 14, 2026), United States District Judge David A. Ruiz granted judgment on the administrative record to Unum and denied Plaintiff’s cross-motion, upholding the denial of long-term disability benefits under an ERISA-governed group plan to a former construction-company vice president with a decades-long history of epilepsy.

What was Plaintiff’s medical history and claim?

Plaintiff worked at his employer for nineteen years, rising to vice-president of demolition, and had a seizure history dating to 1999, when he was diagnosed with right temporal lobe epilepsy at age eighteen. He underwent multiple temporal lobe surgeries over the years and experienced periods of seizure freedom, including several years after a 2006 surgery during which he discontinued seizure medication. His seizures returned and, over time, occurred primarily at night. He continued working full-time throughout, treating his condition with Lamictal.

Plaintiff applied for long-term disability benefits in July 2020, alleging a disability onset date of June 5, 2020. He reported difficulty staying awake and a lack of the alertness and cognitive sharpness his work required, attributing his nocturnal seizures and resulting sleep deprivation to impaired daytime functioning. His treating neurologist, Dr. Nancy Foldvary-Schaefer, submitted a disability form and a series of letters supporting restrictions.

How did Unum evaluate the claim?

Unum denied the initial claim in November 2020 after file reviews by an internal medical consultant, Dr. Joseph Antaki, and a board-certified neurologist, Dr. Michael Chilungu, both of whom concluded the record did not support functional neurologic impairment. Dr. Chilungu noted consistently unremarkable neurological examinations, stable brain imaging with no tumor recurrence, and the absence of detailed cognitive testing substantiating the claimed impairment.

Plaintiff appealed in December 2021, submitting his own affidavit, additional letters from Dr. Foldvary-Schaefer, a vocational report from Kathleen Reis, and more than twenty years of medical records. Physician consultant Dr. Scott Norris reviewed the expanded record and concluded that Plaintiff’s seizure pattern was stable compared to periods when he was working full-time, that the type and intensity of treatment had not changed substantially leading up to the alleged onset date, and that the medical evidence did not support restrictions precluding his occupation. Unum denied the appeal in March 2022.

What standard of review did the court apply?

The court applied the deferential arbitrary-and-capricious standard, which Plaintiff did not dispute, because the plans delegated discretionary authority to the administrator. Under that standard, Plaintiff bore the burden of proof, and the court explained that a benefits decision supported by a reasoned, principled explanation and substantial evidence must be upheld even where the record could also support a finding of disability.

Did Unum properly address the treating physician’s opinions?

The court held that it did. It characterized Dr. Foldvary-Schaefer’s July 2020 opinion as conclusory, noting that it did not advise Plaintiff to stop working, did not identify specific work-related restrictions, and did not discuss the frequency, duration, or lasting effects of his seizures. The court observed that her October 2020 letter was silent on seizure frequency and was written during a period when Plaintiff’s own statement indicated he had been seizure-free from October 2020 to January 2021, and at a time when she had not personally examined him in approximately nineteen months. The court found that Dr. Norris adequately addressed her opinions and that her brief March 2022 letter, which merely expressed disagreement without explanation, required no further response.

The court also rejected Plaintiff’s cherry-picking argument, explaining that crediting reviewers who disagreed with a treating source is not cherry-picking, and that the argument cut both ways because Plaintiff’s own position discounted objective evidence such as stable imaging, normal neurological examinations, and Karnofsky Performance Status scores.

Did the structural conflict of interest change the outcome?

No. The court acknowledged that Unum operated under a structural conflict as both administrator and payor, but treated the conflict as one factor in the analysis rather than a change in the standard of review. It found that Plaintiff offered no evidence that the conflict materialized to influence the decision, and it declined to give weight to Plaintiff’s criticism of Dr. Norris based on his performance in unrelated cases, consistent with the court’s earlier ruling denying discovery into other claims.

Did Unum have to order an in-person examination or produce reviewer credentials?

No on both points. The court reiterated that a file review by a qualified physician is not inherently objectionable, that administrators need not give treating physicians controlling weight, and that under the circumstances, including symptoms not readily confirmable by physical examination and two recent brain MRIs already in the record, the decision to forgo an in-person examination did not render the denial arbitrary and capricious. The court also rejected Plaintiff’s argument that ERISA required Unum to produce its reviewers’ curriculum vitae, finding no authority that a reviewer’s CV is a document relied upon or generated in making a benefit determination. It further held that the reviewers, including a board-certified neurologist, had appropriate training and experience, and that ERISA does not require an administrator to retain the narrowest of specialists.

What did the court decide?

The court granted Unum’s motion for judgment on the administrative record and denied Plaintiff’s cross-motion, upholding the denial of benefits.