Unum’s Termination of LTD Benefits for MS Claimant Reversed After 11-Year Payment History

In Serrata v. Unum Life Insurance Company of America, No. 24-cv-02421-HSG, 2026 WL 849298 (N.D. Cal. Mar. 27, 2026), the United States District Court for the Northern District of California, applying de novo review by stipulation of the parties, granted the plaintiff’s motion for judgment under Federal Rule of Civil Procedure 52 and denied Unum’s cross-motion, finding that the plaintiff had established by a preponderance of the evidence that he remained disabled from any gainful occupation due to physical symptoms of multiple sclerosis (“MS”) at the time Unum terminated his long-term disability (“LTD”) benefits.

The plaintiff worked for Sherwin Williams Company as a National Account Sales Manager until July 2011, when progressive MS symptoms — including fatigue, leg pain and weakness, paresthesias, vision problems, and balance difficulties — forced him to stop working. Unum approved LTD benefits effective January 4, 2012, “to the maximum duration” through May 24, 2026, after its own retained neurologist concluded that the plaintiff had reached maximal medical improvement and had no sustained predictable work capacity for any occupation. The claim converted to the “any gainful occupation” standard after the initial 24-month period, and Unum continued paying benefits for more than nine years under that standard while regularly obtaining medical updates and monitoring the plaintiff’s social media activity. On April 13, 2023, Unum terminated benefits on the ground that the plaintiff was capable of performing sedentary occupational demands based on: (1) a form signed by his treating neurologist, Dr. Yana Kriseman, on March 10, 2023 checking a box indicating he could perform sedentary work; (2) stable MRI scans and unchanged MS treatment; and (3) the plaintiff’s reported activities, including volunteering as a high school baseball coach and participating in golf. The plaintiff appealed, submitting new documentation from Dr. Kriseman, and Unum upheld the termination on March 15, 2024. The plaintiff filed suit to recover benefits from the date of termination to the date of judgment.

The court addressed three issues. First, the court found that the plaintiff met his burden of establishing disability by a preponderance of the evidence. It credited the opinions of Dr. Kriseman and plaintiff’s retained neurologist, Dr. Peter Cassini — who conducted an in-person neurological examination after reviewing over 2,700 pages of medical records — that the plaintiff’s MS symptoms, particularly his inability to sit for more than ten to fifteen minutes at a time before needing to stand and move around for approximately ten minutes to relieve leg paresthesias and pain, precluded him from performing sedentary occupational demands on a full-time basis. The court also relied on Unum’s own pre-approval file note that the plaintiff had “no sustained predictable work capacity for any occupation,” the eleven-year history of benefit payments under the any gainful occupation standard, and the supporting vocational analysis confirming no suitable jobs existed given the plaintiff’s restrictions. The court noted that Unum’s decade-plus approval of benefits weighed in favor of continuing disability, citing Muniz v. Amec Construction Management, Inc., 623 F.3d 1290 (9th Cir. 2010), and Iravani v. Unum Life Insurance Co. of America, 692 F. Supp. 3d 904 (N.D. Cal. 2023).

Second, the court rejected each of Unum’s stated rationales for termination. As to the March 10, 2023 form, the court found that Dr. Kriseman’s March 1, 2024 letter plainly negated Unum’s reliance on it, explaining that she had not intended to indicate that the plaintiff could return to work or was no longer disabled, and that the symptoms underlying her changed assessment — fatigue, balance problems, and leg weakness — had been documented in her own records as far back as March 2021, refuting Unum’s suggestion that the plaintiff had manipulated the form by self-reporting new symptoms afterward. As to MRI stability, the court held that Unum had pointed to no policy provision or legal authority requiring the plaintiff to demonstrate progressive worsening to maintain entitlement, and that the absence of degeneration, after more than nine years of benefit payments during a period of stable imaging, weighed in favor of continued disability rather than against it, citing Saffon v. Wells Fargo & Co. Long Term Disability Plan, 522 F.3d 863 (9th Cir. 2008). As to the coaching and golfing activities, the court found the social media screenshots and website printouts insufficient to establish sedentary work capacity, as they said nothing about the frequency, duration, or physical and cognitive demands of those activities. The court accorded them little weight and instead credited letters from the Hillsdale High School athletic director and a parent volunteer establishing that the plaintiff’s coaching role was entirely voluntary, limited to observing and giving verbal instructions from the dugout, capped at seven to eight hours per week during a three-month season, and frequently curtailed by his symptoms. The court further noted that Unum had been aware of both the coaching and golfing activities as early as 2018 and 2020, yet continued to pay benefits and affirmed eligibility in February 2021, rendering those activities inconsistent with the termination rationale. The court gave minimal weight to the opinions of Unum’s four retained reviewing physicians — Dr. Haller, Dr. Snyder, Dr. Chilungu, and Dr. Lin — because each relied on flawed inferences from the plaintiff’s activities, none conducted an in-person examination, and they variously failed to account for Dr. Cassini’s findings, Dr. Kriseman’s March 2024 clarifying letter, and the third-party letters describing the actual scope of the plaintiff’s coaching role.

Third, the court rejected Unum’s additional litigation arguments. Unum’s contention that the initial 2012 approval was premised on a more serious form of MS (Secondary Relapsing-Remitting) and that a 2023 diagnosis of Relapsing-Remitting MS justified termination was barred under Collier v. Lincoln Life Assurance Co. of Boston, 53 F.4th 1180 (9th Cir. 2022), because Unum had not raised that rationale at the administrative level; the argument also failed on the merits because Unum’s own retained physicians documented a diagnosis of Relapsing-Remitting MS since 2006. Unum’s reliance on a 2020 form from the plaintiff’s family medicine physician indicating no restrictions was likewise barred under Collier and, in any event, was entitled to minimal weight because that physician did not treat the plaintiff’s MS. The court also rejected Unum’s argument that the ability to make positional changes within a sedentary job description accommodated the plaintiff’s sitting limitations, finding that needing to stand and move for ten minutes after every ten to fifteen minutes of sitting meant the plaintiff was required to be on his feet approximately half the workday — incompatible with a requirement of “mostly sitting,” consistent with Armani v. Northwestern Mutual Life Insurance Co., 840 F.3d 1159 (9th Cir. 2016).

The court granted judgment in favor of the plaintiff for LTD benefits from April 13, 2023 to the date of judgment and directed the parties to meet and confer regarding attorneys’ fees and costs.