In the case of Gwendolyn Byrd vs. UNUM Life Insurance Company Of America, the plaintiff filed a lawsuit in Texas federal court to challenge the Unum Life Insurance Company’s (Unum) decision to terminate her long term disability benefits after paying for 5 years. In the review for the abuse of discretion, the District Court granted summary judgment to Unum. The plaintiff is appealing this decision by the District court.
The Facts of the Case Against Unum filed by a Disability Attorney
The plaintiff Gwendolyn Byrd was employed by Accenture LLP as a chargeback associate / accounting assistant. On Match 26th 2003, the plaintiff suffered a repetitive-trauma work-related hand injury which was later diagnosed as carpal tunnel syndrome. She later also complained that she suffered from bulging discs in her lower back, lumbar radiculopathy, cervical discogenic pain, cervical spondylosis, and other associated ailments.
In July 2004, the plaintiff applied for disability benefits and was paid benefits by Unum under the Accenture’s group long term disability program from September 2003 through July 2008. Unum later terminated the plaintiff’s disability benefits after concluding that the plaintiff no longer was physically unable to return to her occupation. The decision to terminate the plaintiff’s disability benefits was only made after Unum consulted three (3) independent physicians and two (2) occupational experts to review the plaintiff’s full medical history. The experts all agreed that the plaintiff is physically able to perform her former occupation.
After all the plaintiff’s ERISA appeals had been denied by Unum, the plaintiff filed a lawsuit through a Texas disability lawyer under the Employee Retirement Income Security Act seeking past damages including unpaid long-term disability benefits, a declaratory judgment that she is entitled to future benefits under the policy, and attorney’s fees. The District Court however ruled that Unum did not abuse its discretion and denied the plaintiff her claims in the lawsuit. She appealed the District Court ruling to the Court of Appeal.
The Court of Appeal Ruling
In the plaintiff case, she raised two (2) arguments:
The plaintiff argued that Unum improperly failed to consider her lumbar radiculopathy. The plaintiff argued that Unum’s decision relied on an independent medical examination performed on April 25th 2008 that did not evaluate her spine.
The Court of Appeal ruled that the district court had correctly noted that administrative record indicated that the plaintiff’s cervical and lumbar conditions were reviewed thoroughly by three board-certified orthopedic surgeons and considered by two vocational specialists. One of those doctors had explicitly addressed the plaintiff’s specific lumbar complaints and noted that her lumbar problems did not justify an “overly restrictive” work designation.
The plaintiff argued that Unum also failed to consider her cervical and upper extremity impairments. Her brief stated that “Byrd is limited to lifting 5 pounds and cannot do repetitive motion….” Since Unum concluded that Byrd could exert up to 10 pounds of force or double the amount of force Byrd believes she can exert, the plaintiff argued that Unum had abused its discretion.
The Court of Appeal disagreed and ruled that Unum’s experts had reviewed the plaintiff’s full medical records carefully and each of them concluded that the plaintiff could return to her previous sedentary occupation. One physician even concluded that the plaintiff could exert 20 pounds of force occasionally and 10 pounds of force frequently. Hence, Unum’s decision took into account the plaintiff’s cervical and upper extremity impairments, and its decision is supported by substantial evidence presented in the record. As such, Unum did not abuse its discretion in denying the plaintiff further long-term disability benefits.
Under ERISA, the Court will not disturb the Plan Administrator determination if it is shown that the Plan Administrator did not abuse its discretion. This is even so if the decision made is not the best possible outcome or if the Court can reach a better outcome.