ERISA “Any Occupation” Standard Defeats MS Claimant: N.D. Illinois Court Upholds Unum’s Long-Term Disability Denial on De Novo Review

In Scorzo v. Unum Life Insurance Company of America, No. 23-cv-3836, 2026 WL 2070002 (N.D. Ill. July 17, 2026), United States District Judge Jeffrey I. Cummings granted judgment to Unum and denied Plaintiff’s cross-motion, holding that Plaintiff, a former Starbucks store manager with multiple sclerosis, failed to prove by a preponderance of the evidence that she was unable to perform any gainful occupation under the ERISA-governed long-term disability plan. The decision illustrates how the two-tiered “own occupation” to “any occupation” definition of disability operates against a claimant even when the underlying diagnosis is undisputed and review is de novo.

What was Plaintiff’s medical and claim history?

Plaintiff was diagnosed with multiple sclerosis in January 2016 and worked as a Starbucks store manager until August 2020, when she stopped working due to symptoms she attributed to her MS. She submitted a claim under the Starbucks long-term disability plan, which was funded by a group policy Unum issued to Starbucks. Unum approved the claim with benefits effective February 13, 2021, and paid benefits for approximately two years. On January 31, 2023, Unum notified Plaintiff that it would discontinue benefits as of February 13, 2023, explaining that based on her work history, education, and experience, she was qualified to perform alternative gainful sedentary occupations.

Plaintiff’s treating neurologist, Dr. Hernandez-Peraza, an MS specialist, completed an Attending Physician Statement in September 2020 indicating that Plaintiff had not recovered sufficiently to return to her store manager role and could not perform certain job functions, including lifting heavy weights and maintaining the fast pace her job required. Over the next several years, the neurologist’s records reflected a mixed clinical picture. At a December 2021 visit, Plaintiff denied new symptoms and her attention and coordination were assessed as normal, though the neurologist noted problems with verbal recognition and impaired processing speed and executive function. Plaintiff declined disease-modifying therapies. Subsequent 2022 telehealth visits documented reports of spasms after walking and word-finding difficulties, while neurological reviews were largely negative for pain, weakness, numbness, and vision problems.

Plaintiff underwent neuropsychological testing on multiple occasions. A four-day evaluation in October and November 2020 by Drs. Armstrong and Tucci concluded that her testing likely suggested a mild neurocognitive disorder due to MS, with the most consistent difficulties in verbal reasoning. Updated testing in June 2023 by Dr. Song found that her cognitive and intellectual skills were generally within expectations, showed clinically significant improvement in verbal skills compared to 2020, and noted progressive cerebral volume loss on MRI. A series of MRIs between 2020 and 2024 showed periods of new and enhancing lesions early on, followed by findings described as stable with no active disease, though with continued atrophy. Throughout, the record reflected that Plaintiff repeatedly declined disease-modifying therapy and remained off MS medication.

What standard of review applied, and why does it matter?

The parties agreed the case would be decided on the administrative record under Federal Rule of Civil Procedure 52(a), and they agreed that de novo review applied because the Plan did not grant Unum discretionary authority. Under de novo review, the court independently determined whether Plaintiff was entitled to benefits, and Plaintiff bore the burden of proving her entitlement by a preponderance of the evidence. The court emphasized that any doubts or gaps in the evidence had to be resolved against Plaintiff, because she was obligated to prove she was entitled to benefits rather than merely that the administrator erred.

What did the Plan require Plaintiff to prove?

The Policy set out a two-tiered definition of disability. For the first twenty-four months, Plaintiff qualified if she could not perform the material and substantial duties of her regular occupation, and Unum paid benefits during that period. After twenty-four months, the definition became more rigorous, requiring Plaintiff to show she was unable to perform the duties of any gainful occupation for which she was reasonably fitted by education, training, or experience. The dispute turned entirely on this second, general disability standard as of the February 13, 2023 determination date.

Did the court adopt Plaintiff’s “station in life” construction of “gainful occupation”?

No. Plaintiff argued that a gainful occupation had to maintain her prior standard of living and asked the court to import a 60% replacement income threshold that Unum used internally. The court rejected this construction for three reasons. First, the California authority Plaintiff relied on, including Erreca and Hangarter, involved non-ERISA breach of contract claims and is preempted in the ERISA context. Second, even setting preemption aside, the Erreca standard was designed to soften harsh “any work whatsoever” clauses, whereas this Policy already limited “any occupation” to those Plaintiff was reasonably fitted for. Third, Plaintiff produced no evidence of actual reliance to support a reasonable-expectations argument. Citing O’Reilly v. Hartford, the court held that Unum’s internal use of a 60% income figure did not import a replacement income standard into the Policy, though the court would consider Plaintiff’s ability to earn 60% of pre-disability income as one factor.

Why did Plaintiff’s treating physician evidence fall short?

Plaintiff relied primarily on the opinions of her treating neurologist, Dr. Hernandez-Peraza. The court found that the neurologist never actually opined that Plaintiff could not work in any capacity. Her 2020 Attending Physician Statement addressed only Plaintiff’s ability to perform her store manager position, which had limited probative value on the any-occupation question. Her later responses to Unum, including a terse “No” and a statement that she was “unable to certify” whether Plaintiff could learn a new task and perform full-time work, raised doubts but did not amount to an opinion that Plaintiff could not perform any gainful occupation. Under binding Seventh Circuit precedent, those doubts had to be resolved against Plaintiff.

How did the court weigh Unum’s reviewing physicians and vocational experts?

Unum’s four reviewing physicians, Drs. Kohli, Leverett, Cohan, and Geraci, all concluded that Plaintiff’s MS and related impairments did not preclude sedentary work. The court found their fuller opinions well-reasoned and supported by the record, noting that Plaintiff’s MRIs suggested no active disease, that she had repeatedly declined disease-modifying therapies, and that examinations frequently showed normal findings. The court rejected Plaintiff’s criticisms that the reviewers performed file-only reviews, carried an inherent conflict as in-house doctors, or cherry-picked the record, finding no factual support for those arguments under Black & Decker and Davis v. Unum. Unum’s vocational consultants identified several sedentary occupations Plaintiff could perform, including employment interviewer, telemarketing supervisor, call center supervisor, and account supervisor.

What role did the Social Security denial and self-reported symptoms play?

The court treated the Social Security Administration’s denial as one factor weighing against Plaintiff. An ALJ had found that Plaintiff, despite her relapsing-remitting MS, retained the functional capacity to perform representative occupations including mail clerk, merchandise marker, and office helper, each paying more than 60% of Plaintiff’s stated gainful wage. As for Plaintiff’s self-reported symptoms of fatigue, weakness, numbness, and cognitive difficulty, the court acknowledged them but held that subjective reports are not a trump card and that the record as a whole, including normal presentations and Plaintiff’s refusal of DMTs, counterbalanced those complaints.

What was the outcome?

The court held that Plaintiff failed to prove by a preponderance of the evidence that she was unable to perform any gainful occupation for which she was reasonably fitted as of February 13, 2023. The court denied Plaintiff’s motion for judgment and granted Unum’s cross-motion for judgment.