In Abrams v. Unum Life Insurance Company of America, No. C21-0980 TSZ, 2022 WL 17960616 (W.D. Wash. Dec. 27, 2022), District Judge Thomas S. Zilly determined on de novo review that Plaintiff William Abrams established by a preponderance of evidence that he was disabled from his own occupation due to symptoms of brain fog, fatigue, decreased attention and concentration, and fevers resulting from diagnoses of long-COVID and Chronic Fatigue Syndrome (“CFS”), and awarded long term disability benefits under the Employee Retirement Income Security Act of 1974 (“ERISA”).
Prior to his disability, Mr. Abrams had been working as a trial and appellate lawyer and was a partner at his firm. He had been responsible for complex patent cases, which required significant analytical ability, legal acumen, and mental energy to manage. In his personal life, Mr. Abrams also ran marathons, with three planned in 2020. In April 2020, Mr. Abrams began to experience almost daily fevers, accompanied by “severe fatigue” and “mental fogginess.” His colleagues attested to the effect of his symptoms on his ability to perform legal work, noting that Mr. Abrams could not continue to perform as a lawyer. His doctors were unable to alleviate his symptoms, and in July 2020, Mr. Abrams filed for long-term disability (“LTD”) benefits from Unum Life Insurance Company of America (“Unum Life”). Unum Life insured Mr. Abrams’ employer’s long-term disability plan.
In denying the claim, Unum Life’s medical reviewers concluded that impairment was not supported because Mr. Abrams had recently been afebrile, clinical exams did not note any focal neurologic deficits or cognitive difficulty, and the treatment plan of medications, hematology evaluation and pulmonary function tests could be provided concurrently while performing his sedentary occupation. On appeal, Mr. Abrams saw seven different medical doctors, three who diagnosed long-COVID, and four who diagnosed CFS. He also submitted a neuropsychological evaluation that found only mild deficiencies but no compelling evidence of mild cognitive impairment. However, the neuropsychologist determined that Mr. Abrams was not malingering.
In July 2021, Unum Life upheld the denial concluding that Mr. Abrams’ reported disability was “primarily based on fatigue and other somatic complaints,” but that mental status and physical exams were unremarkable, and the neuropsychological tests demonstrated essentially normal cognitive functioning. Unum Life’s medical consultant further opined that Mr. Abrams did not meet the criteria for CFS because the records did not demonstrate significant cognitive impairment.
The Court disagreed and concluded that Mr. Abrams had established entitlement to benefits. The Court noted that Mr. Abrams’ family, his doctors, and his colleagues all saw a significant shift in his demeanor and abilities. He went from training for a marathon and working 12-hour days to being housebound. He suffered almost daily fevers, brain fog, decreased attention and concentration, and malaise. The Court further reasoned that while doctors did not coalesce around a unifying diagnosis, they all agreed on one thing—that Mr. Abrams was sick. His primary physician consistently noted that Mr. Abrams would be unable to work for more than 0-2 hours per day and would not be able to put together 1-2 workdays or partial workdays in a given week. As such, the Court found that Mr. Abrams could not be expected to plan out trial strategies for multiple complex cases.
As this case demonstrates, it can be difficult to convince insurers of disability due to conditions which primarily consist of subjective symptoms or somatic complaints. If Unum Life has denied your disability insurance claim based on long COVID or CFS, contact us for assistance.
*Please note that this blog is a summary of a reported legal decision and does not constitute legal advice. This blog has not been updated to note any subsequent change in status, including whether a decision is reconsidered or vacated. The case above was handled by other law firms, but if you have questions about how the developing law impacts your ERISA benefit claim, the attorneys at Roberts Disability Law, P.C. may be able to advise you so please contact us.
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