Fifth Circuit Upholds Unum’s Termination of Long-Term Disability Benefits Under Abuse of Discretion Review

In Black v. Unum Life Insurance Company of America, No. 25-10140, 2025 WL 2083808 (5th Cir. July 24, 2025), the Fifth Circuit affirmed a district court’s ruling that Unum did not abuse its discretion in terminating long-term disability (LTD) benefits for a claimant who had previously been approved for coverage due to chronic pain and vertigo. The court concluded that Unum’s decision was supported by substantial evidence, despite plaintiff’s arguments relying on a later diagnosis and surgery.

C. Black, a former administrative assistant for Paycom Payroll, was approved for LTD benefits by Unum in 2015 following multiple surgeries and continuing vertigo. Under her ERISA-governed plan, she qualified for benefits during the first 24 months if she could not perform her “regular occupation” and beyond that period only if she could not engage in “any gainful occupation” suited to her education, training, or experience.

Black continued to receive benefits for six years. However, in 2021, after undergoing spinal surgery, she submitted updated records identifying three treating providers. Two of them—her primary care provider and neurologist—indicated she could return to sedentary work. A third provider did not respond. Based on this feedback, Unum determined she no longer met the plan’s definition of disabled and terminated her benefits.

Shortly thereafter, Black was diagnosed with thoracic outlet syndrome by a vascular surgeon, Dr. Gregory Pearl, and underwent surgery in early 2022. She submitted these records in her administrative appeal, which Unum reviewed but ultimately denied. After the district court initially remanded the matter for further review by qualified specialists, Unum consulted a physical medicine specialist and a vascular surgeon—both of whom concluded that Black was not functionally limited from performing sedentary work. Unum upheld its termination decision, and the case returned to district court, which ruled in Unum’s favor.

The Fifth Circuit affirmed. Applying the abuse-of-discretion standard appropriate for ERISA plans with delegated authority, the court emphasized that it would uphold any decision that “falls somewhere on a continuum of reasonableness.”

The court found that Unum’s decision was supported by substantial evidence: two of Black’s own providers had cleared her for sedentary work, and Unum’s consulting physicians found no clinical findings that would preclude such work. Although Black pointed to Dr. Pearl’s operative report as evidence of disabling pain, the court observed that even Dr. Pearl noted “excellent temporary relief” and near-complete alleviation of symptoms after surgery.

The court rejected Black’s assertion that her own evidence of disability should have prevailed, reiterating that it is not enough for a plaintiff to offer some supporting evidence. Instead, the question is whether the plan administrator’s decision is backed by substantial evidence—which it was. The court also reaffirmed the principle that weighing conflicting medical opinions falls within the administrator’s domain, not the court’s.

This case highlights the challenges ERISA claimants face when appealing terminations of long-term disability benefits under plans granting discretion to the administrator. Even with a significant history of treatment and a new diagnosis, Black could not overcome the deference afforded to Unum’s decision—especially where multiple medical professionals supported the denial.

For claimants, this underscores the importance of consistent and compelling medical documentation, particularly when appealing terminations after many years of approved benefits. For practitioners, it’s a reminder that while the abuse-of-discretion standard is not insurmountable, it sets a high bar that often favors insurers unless there is a clear procedural or evidentiary failure.