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.

Read more about Unum lawsuits on this page.

DISABILITY INSURANCE COMPANY INFORMATION
Videos, Questions, Resolved Cases, Lawsuit Summaries & Company Reviews

disability insurance companies complaints

View videos, articles, resolved cases and claimant reviews about your specific disability insurance company.

FAQ

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

Reviews

Bruce R. (Arizona)

Steve Dell has done an exceptional job with my disability application process. The firm is extremely well managed. They have acquired an incredible amount of experience over many years. I recommend them for disability insurance claims without reservation. 

Don (Florida)

I called this firm a few months ago completely disparaged due to a company cutting off disability benefits at a time that nearly caused me to lose everything.

Attorney Alex Palmera and Danielle worked hard to reach an amicable settlement and my case was settled a few months later. This is a good firm and the specific expertise in disability claims saved me countless hours of hassle at a time when an already fragile state existed.

Thank you Mr. Palamara and Danielle.

Sandra B. (Arkansas)

I have nothing but good things to say about how my buyout was handled with my disability claim. The level of professionalism was amazing. All of my questions and concerns were answered either by Danielle L. or Alex P. in such a timely manner and with such care I would recommend them in a heartbeat to anyone needing to approach their provider with buyout options.

They did a fantastic job communicating between the provider and me, always keeping my best interest at heart and always answering my many many questions. They really did take most of the stress out of this whole situation. I would give them a 10 out of 10 for every step of this crazy journey. Thank you so much for helping me through this.

Brenda R. (New York)

I needed assistance with an appeal for a LTD claim that was initially denied. Stephen understood what needed to happen to win the appeal and he did win the appeal for me.

Michael C. (Virginia)

Greg Dell and his assistant Anneli have been extremely responsive and helpful, not only our initial consultations, but in follow-ups 1 and 2 years later with the insurance company to ensure that they comply with their agreements (which they did), as well as a separate and only slightly-related inquiry about our health insurance. I always hear back from them very quickly, which is rare and greatly appreciated.

Speak With An Attorney Now

Request a free legal consultation: Call 800-682-8331 or Email Us