Unum Denial of Disability to Claimant with Lyme Disease Remanded by Washington ERISA Judge
Author: Attorney Gregory Dell
In Bunger v. Unum Life Insurance Company of America, the plaintiff was a Web Content specialist for Costco when he became ill and unable to work. His treating physician diagnosed him with Lyme disease and he received short term disability benefits for a period of time. He had numerous visits with his treating physician who also diagnosed him with chronic fatigue syndrome. He suffered from a multitude of symptoms, which were noted in his medical records, including anxiety and an inability to concentrate. He was prescribed a large number of medications, some with side effects that affected and diminished his cognitive functioning.
Bunger’s treating physician, as well as her colleague, frequently treated Bunger over a several month period of time. Both doctors clearly believed Bunger was disabled and could not work in any gainful occupation. His treating physician sent a report to Unum in support of Bunger’s application for long term disability benefits.
In evaluating Bunger’s request for short term and long term disability benefits, Unum hired two different experts who reviewed the records and concluded the medical evidence did not support Bunger’s claim that he was disabled. His short term benefits were terminated and his application for long term benefits was denied. After Bunger exhausted his administrative remedies, he filed this ERISA lawsuit.
The Court conducted a detailed and extensive review of the medical records and findings of Unum’s experts and remanded to Unum since, “The Court cannot determine whether Mr. Bunger is disabled, because Unum has failed to sufficiently develop the record.”
Unum’s Errors Identified by the Court
In denying Bunger benefits, Unum did not tell him what the problems were with his application and did not give him an opportunity to provide more information. Specifically, the Court found:
• Unum’s reviewers concluded Bunger did not have Lyme disease but never told him nor his physician he should be retested.
• Despite Unum’s concerns about Bunger’s treatment, it never suggested he be referred to an infectious disease specialist, neurologist or behavioral health specialist.
• Unum never suggested to Bunger’s physician that Bunger undergo cognitive testing.
• Unum never ordered Bunger to submit to an independent medical exam (IME).
The Court noted that Unum conflated the issue of whether or not “Mr. Bunger is sick with the issue of whether Mr. Bunger had been properly diagnosed.” Unum never suggested that Bunger did not suffer from the multitude of disabling symptoms his treating physician reported, only that he had not been properly diagnosed. Unum should have shared this with Bunger and given him an opportunity to “obtain the necessary testing, diagnosis, and treatment,” not to simply deny his claim.
The Proper Remedy
Unum argued that the Court should only decide whether or not Bunger had “met his burden of proof to show he is disabled” and the manner in which Unum handled the claim was irrelevant. The Court disagreed and held that “It would be manifestly unjust for this Court to find for Unum based on Mr. Bunger’s failure to meet his burden of proof, when it is entirely possible that the only reason Mr. Bunger has not met his burden of proof is that Unum has failed to ask Mr. Bunger for the additional testing it considers so critical.” The Court remanded to Unum with instructions to inform Mr. Bunger of what additional testing or diagnostics it required “in order to make an informed decision as to whether Mr. Bunger is able to perform his job functions.
This case was not handled by our office, but it might be helpful to those who have been denied short term and long term disability benefits without being informed by their insurer of what information is needed for a proper evaluation. If you have any questions about any aspect of your disability claim, contact one of our attorneys at Dell & Schaefer for a free evaluation.