District Court Finds Unum’s Termination of Disability Benefits for a Former Unum Employee It Found Disabled for 20 Years Was Arbitrary and Capricious

In Barnes v. Unum Life Ins. Co. of Am., No. 2:23-CV-00280-LEW, 2024 WL 4751710 (D. Me. Nov. 12, 2024), on Cross-Motions pursuant to FRCP Rule 52, Maine District Chief Judge Lance E. Walker granted judgment in favor of Plaintiff and against Unum finding that Unum abused its discretion in terminating long-term disability (“LTD”) benefits after more than 20 years based on revision of Plaintiff’s occupational duties, which Unum’s reviewing physicians improperly concluded Plaintiff was able to perform.

Plaintiff had been employed as an executive account manager for Unum since 1996 but continued to work for years until pain and radiculopathy secondary to childhood scoliosis, a 1992 lumbar laminectomy, a 1993 L5/S1 disc surgery, S1 nerve root impingement, and a 2002 L5/S1 discectomy became too much for her to manage. Unum approved and paid LTD benefits for nearly 20 years, with consistent periodic claim-reviews in which they continuously found that Plaintiff’s condition prevented her from performing her occupation, in particular relating to her inability to endure prolonged sitting due to back and leg pain. And for years Unum continued to approve benefits even after it revised the job duties by concluding that Plaintiff’s occupation required only sedentary exertional effort, despite a significant travel requirement. Unum’s medical consultants went so far as to state that they did not anticipate Plaintiff would ever return to work due to the permanence of her condition and inability to have “sustained capacity” due to chronic pain.

In August 2022, Unum requested an updated attending physician statement (“APS”) directly from Plaintiff’s primary care physician (“PCP”)n along with a written update of her condition. From these updates Unum concluded that Plaintiff was able to care for herself, did not need assistance with her daily activities, required no assistive device to walk, had a social media presence, donated to a fundraiser, likely had ridden in a boat at some point in time, and socialized with others. Plaintiff also reported to her physician that she was working out regularly on core strengthening and did some walking. At this point, Unum once again tasked a vocational consultant to reassess the vocational requirements of Plaintiff’s job. This time, Unum again described the occupation as sedentary, acknowledging the occupation required frequent sitting but allowed for positional changes, as well as frequent travel. However, the vocational assessment overlooked whether the exertional demands of frequent travel required prolonged sitting without changing position, or whether travel was itself sedentary or a light duty endeavor. A nurse consultant reviewed the claim and concluded that Plaintiff had not provided Unum with sufficient evidence of ongoing disability. She authored a letter seeking the input of Plaintiff’s PCP. The PCP responded, selecting the “no opinion” option. Unum then terminated benefits. On appeal, despite a clarifying letter from Plaintiff’s PCP, Unum’s physician reviewer was not convinced by the available medical record and asserted that “appropriate ergonomic desk arrangement/ergonomic control would be reasonably expected to mitigate the concerns surrounding functional impairment due to prolonged sitting.” Unum enlisted two additional medical consultants, both of whom agreed with the initial reviewer. In the final stages of the appeal, Plaintiff retained counsel who reiterated that the demands of travel exceeded sedentary levels, but Unum’s vocational consultants still disagreed. The instant action followed.

Under an abuse of discretion standard of review, the Court found that Unum’s concerted effort first to tilt and then reject the record presented by Plaintiff (as well as its own, long-standing, contrary record of finding disability year after year, which is never addressed) was not only unreasonable but also arbitrary and capricious. The Court noted that individuals administering the claim understood that the primary challenges for Plaintiff lie in prolonged standing and sitting, and it was evident that frequent long-distance travel is not suited to someone who cannot endure prolonged standing or sitting. The Court stated: “So skilled are Unum personnel at assessing these kinds of considerations that their effort to emphasize positional changes in the work area as the fix can only reasonably be viewed as obfuscatory.” The Court remarked that the positional change accommodation Unum articulated was more a tacit acknowledgment of disability than a fix. In ruling for Plaintiff, the Court concluded, “It is disappointing to review such an approach to claims handling by one of the nation’s leading providers of long-term disability plans. All that I can assume on this record is that Unum hoped that nobody would notice ….”

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