Court Finds Unum Improperly Rejected Plaintiff’s Subjective Symptoms in ERISA LTD Claim For Presumed COVID-19 Disability

In Whitehouse v. Unum Life Ins. Co. of Am., No. CV 22-1736 (JWB/ECW), 2024 WL 1209230 (D. Minn. Mar. 21, 2024), Minnesota District Judge Jerry W. Blackwell granted Plaintiff’s Motion for Judgment on the Administrative Record finding that Plaintiff remained partially disabled under the Unum long-term disability policy, and retroactively reinstating benefits.

Plaintiff was a licensed physician employed as an addiction specialist. In March 2020, Plaintiff was working full-time at St. Joseph’s Hospital, which had been designated as a COVID-19 patient deployment center. On March 31, 2020, Plaintiff became ill with nausea, fatigue, abdominal pain, and widespread body aches. She was diagnosed virtually with presumed COVID. Because testing was not widely available at that early stage of the pandemic, the illness was not confirmed to be COVID-19.

Plaintiff returned to work after a week of recovery, but after about three weeks she became increasingly short of breath, so much so that she had trouble talking or walking without losing her breath. She also felt extraordinarily fatigued. Plaintiff’s shortness of breath and fatigue worsened so much that her primary care physician directed her to seek emergency room treatment on May 7, 2020. After that point, Plaintiff experienced a range of symptoms and conditions for which she sought examination and treatment, including viral cardiomyopathy, vocal cord dysfunction, fatigue, chronic pain, anxiety, depression, and post-traumatic stress disorder. She was evaluated regularly by her PCPs and saw various specialists. Plaintiff could not work until January 2021, when her PCP authorized a gradual return to work plan. Plaintiff began working two half days per week, increased to two full days per week in February 2021, and eventually increased to three full days per week by the end of March 2021. Her physician held Plaintiff to the three full days per week (60% capacity) through May 2021, as Plaintiff continued to report symptoms and stated that she felt incapable of working more hours. During this time, her physicians also found that Plaintiff met the criteria for chronic fatigue syndrome, and she participated in the Mayo Clinic’s three-week pain management program to engage in treatment and learn how to manage her symptoms. In July 2021, her providers recommended a gradual work increase from three half days to three full workdays per week over the five weeks following the program. Plaintiff continued working at 60% capacity for the rest of 2021 and returned to full-time work in January 2022.

Unum paid STD benefits for the full 180-day period ending on November 2, 2020. However, Unum denied Plaintiff’s LTD claim finding that work restrictions were not supported for the 180-day LTD elimination period (which overlapped with the STD benefits period), claiming contrary to its STD reviewers that from May 7, 2020 forward, the medical records did not support a finding that Plaintiff’s conditions were so severe that she could not perform her job full time. Unum upheld its decision on appeal after a review by in-house physician Dr. Scott Norris in which he opined that Plaintiff’s conditions either had sufficiently improved or were not sufficiently supported by medical evidence to warrant further work restrictions.

Under a de novo standard of review, the Court found that Dr. Norris’s rationale for denying benefits was not persuasive. The Court found that Dr. Norris treated Plaintiff’s subjective reports inconsistently, accepting reports of improvement while rejecting reports of setbacks and ongoing symptoms. Moreover, the Court stated that although Dr. Norris analyzed each component of Plaintiff’s condition individually, he failed to specifically analyze their collective effect. Further, the Court found that Dr. Norris focused too strictly on the lack of specific work restrictions, while ignoring the major ongoing restriction (not working more than 60% of a full work week). Finally, the Court criticized Dr. Norris in faulting Plaintiff for failing to provide objective evidence to verify symptoms that Unum defines as unverifiable. The Court noted that Unum’s policy separately permits self-reported, non-verifiable symptoms to serve as the primary basis for a disability claim for up to 24 months. And yet, Dr. Norris improperly rejected Plaintiff’s diagnosis of chronic fatigue syndrome because it lacked objective evidentiary support. The Court concluded that the record supported a benefits award and that Plaintiff remained disabled under the Unum policy until returning to full-time work in January 2022.

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