Can Unum Deny My LTD Benefits After Paying For 15 Years?

In the case of Michael J. Christoff v. Unum Life Insurance Company of America (Unum), plaintiff was a partner in the firm of Spencer Stuart. He was a high-level executive, generating one to two million dollars a year in revenue, “developing a network of contacts, constant availability to clients, and extensive travel.” In November 2001, Plaintiff became disabled due to severe fibromyalgia and received long term disability (LTD) benefits.

Through the years, Unum conducted periodic reviews of Plaintiff’s medical records and on occasion, subjected him to an independent medical exam (IME). Unum continued to find him disabled from working in his regular occupation according to the terms of his Unum plan. After paying him for 15 years, Unum terminated Plaintiff’s LTD benefits.

Plaintiff appealed the termination of benefits and when that appeal was denied, he filed this ERISA lawsuit in the United States District Court for the District of Minnesota. He raised several issues concerning the medical review of his files and ways in which Unum abused its discretion.

The August 18, 2016 determination that Plaintiff was still disabled was based on a statement by Plaintiff submitted in March 2016. Additionally, a June 2016 report by a Vocational Rehabilitation Counselor (VRC) concluded that the job requirements of Plaintiff’s regular occupation had not changed in the intervening years. After the roundtable discussion, Dr. Antaki reported “that improvement in Christoff’s condition was not expected and recommended as ‘next steps’ that Christoff’s records be updated in one year.”

Just days later, on August 25, 2016, a new review began when the same VRC changed the physical demands of Plaintiff’s occupation to “sedentary” with only occasional demands to walk and determined that “only occasional” travel would be required, ‘likely done locally and by vehicle.’ She did not define “local.”

Dr. Antaki was given this new job description and Unum hired other physicians to conduct a medical file review. In November 2016, another IME was done.

Although the opinions of Plaintiff’s treating physicians had not changed, and all still believed he could not work, Unum’s reviewing physicians thought otherwise and determined that after all the years of receiving disability, without much change in his condition, on June 15, 2017, Unum notified Plaintiff it upheld its decision to terminate his LTD benefits. After exhausting his administrative remedies, Plaintiff filed this ERISA lawsuit.

The United States District Court for the District of Minnesota agreed with Plaintiff that Unum abused its discretion when it terminated his LTD benefits and ordered Unum to reinstate benefits, pay prejudgment interest from the date of the termination until the date of the court order, and to pay attorneys’ fees and costs.

Although Plaintiff raised a number of issues in the Court, the Court was concerned with the timing of the termination, Unum’s change in the Plaintiff’s occupation, and its analysis of the medical evidence.

Timing of the Termination

The Court asked the parties to provide briefing to answer the question of, “What prompted Unum’s most recent decision to re-evaluate Christoff’s disability status?” Unum had determined on August 18, 2016, that Plaintiff was still disabled, yet opened another review just days later.

The best answer Unum could come up with is that a new worker was likely assigned to the file and decided to revisit the decision. The Court commented that, “While this does not necessarily indicate wrongdoing, it bolsters the Court’s conclusion, based on the entire record before it, that Unum’s process was indeed arbitrary and capricious.”

The Change in Plaintiff’s Occupation

The Court agreed that Unum could interpret Plaintiff’s own occupation as it is normally performed in the national economy, instead of how the tasks are performed for the specific employer. But, Unum did abuse its discretion by “arbitrarily changing the level of physical demand without any substantial evidence, or even any reasoning beyond one VCR’s flat assertion that it would be reasonable to change it.”

The Court continued, finding that “the balance of the medical evidence overwhelmingly shows that Unum’s evaluators ignored the seriousness of Christoff’s limitations and that he would be unable to perform any occupation on a full time, regular basis.”

Unum’s Analysis of the Medical Evidence

The Court concluded that Unum abused its discretion in “relying heavily on its independent reviewers’ opinions and in-house physician’s review of the record in concluding that Christoff was not disabled under the terms of the LTD plan.”

The Court acknowledged that ERISA does not require more weight to be given to the opinions of treating physicians, but Unum’s own manual says that deference must be given to treating physicians. Here, according to the court, Plaintiff’s “medical records are extensive, detailed and consistent. This does not come down to only an abuse of discretion in weighing evidence, it also involves misstating the record… Unum’s interpretation of the records fabricated conflict and inconsistency where none existed… Unum’s in-house doctor ignored information unfavorable to the termination decision.”

The Court concluded, “Unum’s selective presentation of evidence to its reviewers and disregard for the adamant opinions of Christoff’s doctors leads the Court to conclude that it was an abuse of discretion.”

Court Orders Payment of Past Due Benefits, Reinstatement of the Policy and Attorneys’ Fees

In a case such as this, where there are no meaningful questions of fact, remand serves no purpose. Plus, the parties agreed there was no need for further proceedings and the Court found “that there would be nothing gained by remanding the matter. The Court awards Christoff the LTD benefits past due and orders Unum to continue his benefits so long as he qualifies under the Plan.”

The Court also ordered Unum to pay Plaintiff’s attorneys’ fees and costs finding that such an award “will have a beneficial deterrent effect in preventing Unum from abusing its discretion in future cases.”

This case was not handled by our office, but if you have been receiving LTD benefits for many years and are concerned about having your benefits terminated, or if you have any questions about your claim for disabilitybenefits, contact one of our attorneys at Dell & Schaefer for a free consultation.