In Holden v. Unum Life Insurance Company of America, No. 20-6318, __F.App’x__, 2021 WL 2836624 (6th Cir. July 8, 2021), the Sixth Circuit affirmed Unum Life Insurance Company’s decision to deny Plaintiff-Appellant Lisa Holden’s claim for long-term disability benefits on the basis that her inability to work was specific to conditions at her employer, Williams & Connolly, and she did not demonstrate she was precluded from performing the job “as it is normally performed in the national economy.” Following a series of alleged workplace mistreatment and harassment, Holden went on disability leave for stress-related anxiety. She was later diagnosed by a psychiatrist as having PTSD given an abusive relationship at work. Her psychiatrist opined that Holden could not perform the demands of her occupation for her employer or for a different employer. Unum obtained a few file reviews from doctors but did not have Holden evaluated in person. Based on the reviews, Unum determined that Holden could perform the material and substantial duties of her regular occupation. Holden appealed Unum’s decision and Unum upheld its decision in reliance on additional file reviews.
The Sixth Circuit found that Unum did not abuse its discretion in denying Holden’s LTD benefits because substantial evidence supported the claim that her complaints were specific to Williams & Connolly and that she could perform a similar job for another employer at another location. Her doctors consistently opined that her problems were workplace specific. Her psychiatrist’s opinion that she could not work for another employer was not consistent with his documented contemporaneous evaluations of her where he initially stated that she could not function “at her current work situation.” Unum is not required to defer to her psychiatrist’s opinion and could rely on its reviewing physicians’ opinions, especially where they explained their disagreement with the treating doctor and were provided with all of Holden’s records. It was also not an abuse of discretion for Unum to not have Holden evaluated in person because Unum did not deny benefits based on a credibility determination and their evaluation was based on a comprehensive medical record. Further, the court has never held that if a psychiatric determination is at issue that it is necessarily arbitrary and capricious to fail to conduct an in-person evaluation. The court also rejected Holden’s arguments that Unum’s review involved procedural irregularities, including shifting reasons for denial. Lastly, the court explained that just because Unum approved Holden’s short-term disability claim it did not mean that it had to approve her long-term disability claim. Unum considered her short-term disability claim for two weeks but considered her long-term disability claim for several months. As the court explained, “Unum is not required to come to the same conclusion. A rule to the contrary would, in effect, require any plan administrator to grant long-term disability benefits if it had previously granted short-term benefits. This would vitiate the distinction between the two, and, perhaps, make plan administrators less likely to grant short-term benefits (or, at minimum, make that process take more time).”
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