District Court Awards Long-Term Disability Benefits to ERISA Claimant, Rejecting Unum’s Demand for Objective Evidence in Long-COVID Case

In Waldron v. Unum Life Insurance Company of America, No. 3:24-CV-05193-TMC, 2025 WL 949028 (W.D. Wash. Mar. 28, 2025), an action to recover long-term disability benefits pursuant to the Employee Retirement Income Security Act of 1974 (“ERISA”), Washington Western District Judge Tiffany M. Cartwright granted judgment to Plaintiff and against Unum Life Insurance Company of America finding that Plaintiff had demonstrated by a preponderance of the evidence his entitlement to LTD benefits.

Ryan Waldron, an employee of James Hardie, began experiencing severe chronic fatigue and other debilitating symptoms following his first dose of the COVID-19 vaccine in May 2021. Despite extensive medical consultations, including visits to neurologists, infectious disease specialists, and participation in the Mayo Clinic’s post-COVID program, Waldron’s symptoms persisted, severely limiting his ability to perform his job. Unum approved and paid short-term disability benefits for the maximum duration but denied his claim for LTD benefits, arguing lack of objective medical evidence to substantiate ongoing disability. Waldron appealed Unum’s decision, providing extensive medical documentation that confirmed his ongoing symptoms and limitations. These included reports of chronic fatigue, headaches, dizziness, and cognitive impairments like brain fog, which were consistently documented by multiple healthcare providers. Unconvinced by the subjective symptom reports, Unum upheld the denial on appeal, and the instant action ensued.

On cross-motions for judgment, the court’s analysis centered on several key ERISA principles and decisions in the evaluation of disability claims where the medical conditions lack objective diagnostic tests, such as chronic fatigue syndrome (CFS) and long-COVID. Applying a de novo standard of review, as stipulated by the parties, the court independently evaluated whether Waldron was disabled under the plan terms, which defined disability as being unable to perform the material and substantial duties of his regular occupation due to sickness or injury. A significant portion of the court’s analysis focused on the reliance on subjective evidence to establish disability. Citing multiple precedents stemming from the Ninth Circuit’s ruling in Salomaa v. Honda Long Term Disability Plan, the court emphasized that conditions like CFS and long-COVID are often diagnosed based on self-reported symptoms, as no definitive objective tests exist. The court found that Waldron’s consistent medical documentation and his treating physicians’ assessments provided credible evidence of his disability. The court rejected Unum’s insistence on objective proof, aligning with case law that does not impose such requirements for conditions inherently subjective in diagnosis as well as plan language that did not explicitly require objective evidence to prove disability. The court gave significant weight to the treating physicians’ opinions, who directly observed Waldron’s symptoms over time, and critiqued Unum for relying heavily on file reviews by its internal doctors who had not personally examined Waldron, noting that such reviews were less persuasive compared to the treating physicians’ consistent observations and diagnoses. Finally, the court also considered medical assessments from Waldron’s treating providers which were conducted after the elimination period, reasoning that these evaluations provided relevant context and substantiated Waldron’s ongoing disability.

The court concluded that Waldron met his burden of proving his disability under the plan terms by a preponderance of the evidence. It granted Waldron’s motion for judgment, denied Unum’s cross-motion, and instructed the parties to determine the amount of LTD benefits owed. This decision underscores the reliance on subjective medical evidence in ERISA disability claims, particularly for conditions that are not objectively verifiable. It also highlights the necessity of scrutinizing plan terms and insistence on objective evidence where none is required or feasible, reaffirming the role of treating physicians’ opinions in substantiating disability claims.

If Unum or your disability insurer has denied or otherwise limited your ERISA benefits claim, contact us for assistance.