District Court Affirms Unum’s Denial of Long-Term Disability Benefits for Attorney with Long COVID Symptoms

In J.J.H. v. Unum Life Insurance Company of America, No. 23-CV-02288-CNS-JPO, 2025 WL 1896456 (D. Colo. July 9, 2025), on a joint motion for determination on the administrative record, Colorado District Judge Charlotte N. Sweeney affirmed Defendant Unum Life Insurance Company of America’s denial of ERISA-governed long-term disability (LTD) benefits for a transactional attorney suffering from post-COVID-19 complications. Despite the plaintiff’s documented symptoms of fatigue, cognitive slowing, and postural orthostatic tachycardia syndrome (POTS), the court found that Unum’s benefits determination was supported by substantial evidence and was not arbitrary or capricious under ERISA.

The plaintiff, identified only as J.J.H., worked as a transactional attorney at an international law firm. While her occupation was physically sedentary, it required high-level cognitive functioning, including planning, decision-making, and client communication. After contracting COVID-19 in January 2022, J.J.H. experienced a range of persistent symptoms, most notably fatigue, brain fog, and heart irregularities—which she attributed to long-COVID. She initially received the maximum short-term disability (STD) benefits through her firm’s self-funded plan, administered by Unum. When her condition persisted, she filed a claim for LTD benefits under the firm’s group policy with Unum.

Unum denied the LTD claim and upheld its decision after several appeals, which included review by multiple clinicians—an in-house nurse practitioner and a board-certified internist, and two independent medical reviewers, a neurologist and another internist both retained through Dane Street. Although treating physicians, particularly her neurologist Dr. Katalin Pocsine, had diagnosed J.J.H. with POTS and recommended limitations, such as capping her workweek first to 30 hours and then 20 hours, while also requiring remote work, Unum concluded that the objective medical evidence did not support a finding that J.J.H. was unable to perform the material duties of her occupation on a full-time basis.

Unum’s reviewers cited Plaintiff’s ability to continue part-time work, participate in physical therapy, exercise and do weightlifting, and improvement in symptoms over time. They also pointed to a lack of documented cognitive impairment in her medical records and absence of further diagnostic testing such as Montreal Cognitive Assessments (MoCAs) or neurocognitive assessments.

Applying the deferential arbitrary and capricious standard of review, the court sided with Unum. The court emphasized that ERISA plan administrators are not required to defer to treating physicians and may rely on internal or independent medical reviews so long as their conclusions are supported by substantial evidence. The court rejected Plaintiff’s argument that Unum failed to adequately consider her treating physicians’ opinions. The court noted that Unum had consulted directly with Dr. Pocsine and evaluated her letters and treatment records on multiple occasions. While it would have been prudent to obtain an in-person exam in response to Dr. Pocsine’s third and most detailed letter, the court declined to find Unum’s reliance on a records review arbitrary and capricious, especially in light of extensive physician input.

The court further rejected J.J.H.’s argument that Unum had impermissibly relied on her ability to work post-infection as evidence against disability. The court clarified that a claimant’s attempt to work through a disability does not automatically disprove a later claim but may be considered among other factors. The court also found no inconsistency in Unum’s approval of STD benefits but denial of LTD benefits. It reasoned that the LTD review involved a more in-depth medical assessment after she had resumed part-time work. The court’s decision illustrates the challenges ERISA plaintiffs face when discretionary clauses are in play, and the evidentiary threshold rests on “substantial evidence” (more than a scintilla but less than a preponderance). If Unum or your disability insurer has denied or otherwise limited your ERISA benefits claim, contact us for assistance.