District Court Overturns Unum’s Termination of LTD Benefits After Ten Years Because Plaintiff’s Health Had Not Improved and Unum Mischaracterized Plaintiff’s Work Experience to Find Gainful Occupations

In Iravani v. Unum Life Insurance Company of America, No. 21-CV-09895-HSG, 2023 WL 6048785 (N.D. Cal. Sept. 15, 2023), California Northern District Judge Haywood S. Gilliam, Jr. granted judgment to Plaintiff under a de novo standard of review, finding that there was sufficient evidence to establish by a preponderance of the evidence that Plaintiff remained disabled and entitled to ongoing long-term disability (“LTD”) benefits under the policy.

Plaintiff was a cosmetic beauty specialist at Saks Fifth Avenue in June 2010, when she stopped working and submitted an LTD claim asserting she was unable to work due to neck pain and migraine headaches. Unum approved and continued to pay Plaintiff’s claim for almost a decade, while requesting annual updates from Plaintiff and her doctors who treated her for an increasing range of medical conditions, including cervicalgia; cervical radiculopathy; cervical spondylosis; thoracic sprain/strain; lumbar radiculopathy; left “frozen” shoulder, migraines, and myofascial pain syndrome. Treatment over time consisted of medications, physical therapy, epidural steroid injections, acupuncture, and chiropractic care. Throughout the decade, Unum conducted repeated annual reviews, each time concluding that Plaintiff’s diagnoses and symptoms remained consistent with no improvement in functional capacity. In 2018, Plaintiff was awarded Social Security disability benefits after an Administrative Law Judge concluded that her impairments significantly limited her ability to perform basic work activities.

Toward the end of 2020, Unum’s in-house physician again conducted a conducted a review. Dr. Stewart Russell did not speak directly with Plaintiff or any of her providers, but nonetheless opined that he did not believe any functional restrictions were warranted based on Plaintiff’s medical records. He commented that since 2017 Plaintiff had been only taking Tylenol, which he believed was insufficient to support a claim of pain severe enough to prevent Plaintiff from working. Similarly, he opined that taking Excedrin for migraine headaches was insufficient to support a finding that her migraines caused any impairment. Dr. Russell also noted that Plaintiff had not undergone any recent imaging studies. Although he acknowledged that had been awarded Social Security disability benefits, he did not address any of the specific diagnoses or limitations the ALJ found. Dr. Russell also discounted the treating physicians’ prior opinions, stating that they were not supported by physical findings. Unum medical officer, Dr. James Lewis agreed with Dr. Russell’s opinion for the same reasons.

Notwithstanding the opinions of Dr. Russell and Dr. Lewis, Unum’s claim analyst stated that she was “unable to support a non-compensable determination” for Plaintiff’s benefits claim because the Unum doctors had not given sufficient weight to the ALJ findings and recommended further review. A subsequent “forum” of Unum employees concluded that an independent medical examination was needed to assess Plaintiff’s current functional capacity. However, Unum never asked Plaintiff to undergo this IME.

Thereafter, Plaintiff’s principal physician, Dr. Lin, responded to the reports of Unum’s doctors again confirming Plaintiff’s chronic pain from prolonged sitting and explicitly disagreeing with the findings that Plaintiff had light physical work capacity. A third Unum physician review by Dr. Chris Bartlett also agreed that Plaintiff did not have any functional limitations that precluded her from sedentary work.

Vocational reviewers in the past had classified Plaintiff’s occupation and experience and primarily the sales of beauty products. In 2020, however, Unum’s vocational person reinterpreted Plaintiff’s work experience and determined that prior vocational reviews did not accurately consider Plaintiff’s experience in training, management, event planning and personnel interviewing relevant to her beauty sales work. Unum reclassified Plaintiff as having “supervisory and managerial experience” that would allow her to perform a gainful occupation under the terms of the insurance policy and identified three occupations – Inside Sales Representative, Hotel Sales Representative, and Personnel Scheduler – that would meet the gainful wage requirement. Unum terminated benefits and upheld that decision on appeal.

On cross-motions for judgment Unum contended that Plaintiff had not provided sufficient evidence that she had a medical condition that prevented her from performing a gainful occupation. Echoing the opinions of its reviewing physicians, Unum argued that Plaintiff’s neck pain, back pain and migraines had improved and stabilized as of 2019, medical visits were infrequent, treatment remained conservative, Plaintiff used only over-the-counter medications for pain, and some of Plaintiff’s treating providers did not complete disability paperwork were all evidence of her improvement.

The Court did not find Unum’s reasoning persuasive or supported by the record and instead credited the opinions of Plaintiff’s treating physicians, particularly Dr. Lin given his extensive treatment history with Plaintiff and his expertise as a pain specialist. The Court also noted the ALJ decision finding Plaintiff’s testimony credible and concluded that there was nothing in the record to suggest that Plaintiff’s degenerative disease had improved in the last few years or that her ongoing reports of pain were no longer credible.

Alternately, Unum argued that even if Plaintiff’s medical conditions had not improved, her significant managerial and supervisory experience had been previously overlooked on vocational analysis and established that Plaintiff could perform full-time sedentary work even accepting significant functional limitations. The Court also disagreed with Unum’s effort to recharacterize Plaintiff’s work experience finding that her limited experience in beauty product sales and interviewing or training new salespeople at the beauty counter did not translate to any specialty training or business administration experience sufficient to be considered managerial or supervisory.

The Court concluded that the record established by a preponderance of the evidence that Plaintiff suffered from degenerative spinal disease and other conditions that cause her severe pain making it impossible for her to work in any gainful occupation and granted judgment for the Plaintiff.

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