Amazon Senior Manager With Traumatic Encephalopathy Syndrome Wins Florida Unum LTD Insurance Appeal After Denial Over Cognitive Testing
Unum told a man whose memory was failing him that he could go back to running a 60-person organization. Our client was a Senior Manager at Amazon Transportation Services in Florida when Traumatic Encephalopathy Syndrome from repeated college football concussions, together with several neurological, psychiatric and spinal conditions, forced him to stop working. Unum denied his individual long-term disability insurance claim anyway.
Our office has taken apart denials like this one many times, and we know exactly where an insurer’s reasoning cracks when a brain injury is involved. Attorney Stephen Jessup filed the appeal, and Unum overturned its decision and approved our client’s Total Disability benefits.
How this appeal came together is a road map for anyone whose cognitive symptoms have been brushed aside by an insurer. If Unum or any other disability insurance company has denied your claim, speak with one of our disability insurance lawyers. We represent claimants nationwide, and there is no fee unless we recover benefits for you.
Table Of Contents
- 1. Why this case matters for every Unum claimant
- 2. From leading 15 managers to losing track of familiar places
- 3. Unum’s denial: invalid tests, normal office visits, and a generic job title
- 4. The appeal that rebuilt the record
- 5. Unum reverses its decision
- 6. Your brain injury claim deserves more than a paper review
Why This Case Matters for Every Unum Claimant
A flagged validity score does not mean you faked your testing. Unum threw out an entire neuropsychological evaluation because some scores fell outside recommended cutoffs. An independent review of the raw data showed our client passed every formal effort test. In long-term disability insurance claims built on cognitive limitations, the raw data decides whether testing is valid, not the insurer’s summary of it.
Normal office visits do not prove you can work a full day. Unum leaned on brief mental status exams and short therapy sessions. A four-hour Functional Capacity Evaluation showed what happened when our client had to sustain mental effort: slower typing, more errors and a racing heart.
Your job is what you actually did, not the title an insurer assigns. Unum’s vocational consultant treated a senior manager with Traumatic Encephalopathy Syndrome, who led 15 managers and oversaw tens of thousands of carriers, as a generic performance manager. Under a regular occupation definition of disability, the real duties decide the claim.
Self-reported symptoms need objective anchors. Unum dismissed the neurologist’s restrictions as resting on our client’s own complaints. The appeal tied those complaints to brain imaging, nerve testing and a sleep study that do not depend on what a patient says.
An approval from another insurer belongs in your file. Our client’s group long-term disability insurance carrier had already approved his benefits on the same medical records. We made sure Unum’s appeal reviewers saw that approval.
From Leading 15 Managers to Losing Track of Familiar Places
A Level 7 Role Built on Judgment and Stamina
Our client’s Level 7 role at Amazon was what the appeal called a leader of leaders. His job required:
- Leading 15 managers and roughly 60 employees in total
- Oversight of more than 64,000 transportation carriers across North America
- Direct ownership of budget and P&L, including commitments made in corporate planning cycles
- Writing strategic reports and presenting performance updates to senior leadership
- Rapid, high-stakes decisions in ambiguous situations
- Travel about 20 days a month for audits, executive reviews and field oversight
In plain terms, the job ran on sustained judgment, memory and stamina. Those were exactly the abilities his condition took away.
A Diagnosis Rooted in Repeated Concussions
Our client suffered multiple concussions playing college football. Years later, the damage surfaced: headaches, an unsteady gait, trouble focusing and putting thoughts into words, poor sleep and memory lapses that kept getting worse. He left the refrigerator door open several times a week, missed due dates at work and for bills at home, and forgot how to get to places he knew well.
Traumatic Encephalopathy Syndrome (TES) is the clinical diagnosis given to living patients who develop progressive problems with memory, thinking, mood or behavior after years of repeated head impacts. Under the consensus diagnostic criteria for Traumatic Encephalopathy Syndrome published in Neurology, TES is the clinical picture linked to chronic traumatic encephalopathy (CTE), which can only be confirmed at autopsy.
His neurologist diagnosed post-concussive syndrome (ICD-10 code F07.81), also called post-concussion syndrome, with persistent neurocognitive impairment, along with TES. Post-concussion syndrome is a cluster of symptoms, such as headaches, dizziness, poor concentration and memory problems, that persists long after a concussion, which is itself a mild traumatic brain injury (TBI). The full picture of his health included:
- Traumatic Encephalopathy Syndrome and post-concussive syndrome
- Mild neurocognitive disorder, documented on formal neuropsychological testing
- Chronic migraine-type headaches
- Major depressive disorder, generalized anxiety disorder, PTSD and ADHD
- Gait instability and worsening balance, with near falls
- Lumbar spinal stenosis with radiculopathy (narrowed nerve passageways that send pain into the legs)
- Peripheral neuropathy in both legs
Repeated concussions have ended careers for other clients of ours too, including a sales executive whose fifth concussion led to an Aetna long-term disability insurance denial, a denial we also reversed.
Restrictions No Senior Manager Could Work Around
His neurologist told him to stop working. The restrictions that followed left very little room for a demanding job:
- No more than 4 hours of work a day, and no more than 20 hours a week
- Single-task analytical duties only
- A 10-minute rest break after every 30 minutes of concentrated mental work
- No high-stress, quota-driven assignments with same-day or hourly deadlines
- No rapid decision-making under time pressure and no supervising large teams
- No long-distance driving and no more than 30 minutes at a computer screen without a break
His psychiatric nurse practitioner went further, concluding that no accommodation would allow sustained competitive employment. As attorney Jessup later wrote in the appeal, “Such restrictions are a total barrier to employment in a Senior Management Capacity, where constant multitasking, rapid decision-making, and the supervision of large teams are essential.”
Unum’s Denial: Invalid Tests, Normal Office Visits, and a Generic Job Title
Nearly 10 months after our client stopped working, Unum denied the claim through its subsidiary, Provident Life and Accident Insurance Company. The letter was signed by Courtney, a Lead Benefit Specialist. Behind it sat a stack of file reviews by Unum’s consultants:
- A licensed clinical psychologist
- A board-certified psychiatrist
- A physician board-certified in family medicine
- A neurologist board-certified in neurology, sleep medicine and vascular neurology
- A consulting neuropsychologist
- A vocational consultant
A paper review, also called a file review, is a claim decision made by insurer-hired consultants who read the medical records without ever examining the claimant. That is what happened here. Unum’s consultants also wrote to our client’s psychiatric nurse practitioner and his neurologist, giving each 10 business days to respond to their opinions. When no answers came back, Unum moved ahead.
Throwing Out the Neuropsychological Testing
A neuropsychological evaluation is hours of standardized testing that measures memory, attention, processing speed, language and executive function against norms for a person’s age and education. A neuropsychologist had tested our client over two days and found a mild neurocognitive disorder with significant decline from his prior level of functioning. Unum’s consulting neuropsychologist pointed to several performance validity indicators that fell outside recommended cutoffs and declared that the results “cannot be considered a valid and reliable characterization of his cognitive capacities.”
What does it mean when a disability insurance company calls your neuropsychological testing invalid? In most cases, it is questioning your effort. Performance validity indicators are checks built into neuropsychological testing to confirm that a person is giving full effort. Calling testing invalid on that basis comes close to accusing a claimant of malingering without using the word.
Unum even conceded that his brain MRI and testing showed abnormal findings. Its neurology reviewer simply decided the testing “supports mild impairment only, which does not inherently preclude judgement, decision making, planning, interpersonal interaction, or adherence to work standard.” That is an assumption, not a fact.
Mild neurocognitive disorder is a measurable decline in memory, attention or other thinking skills from a person’s prior level, one that forces extra effort or workarounds for daily tasks but stops short of dementia. In that diagnosis, mild describes the distance from dementia, not the ability to lead 15 managers.
With the testing set aside, Unum dismissed the neurologist’s restrictions as well, writing that the neurology visit “noted only self-reported symptoms and the prior neuropsychological testing was deemed invalid.” The entire denial was built on that one flawed foundation.
Leaning on Routine Office Visits and Rehab Notes
Why would an insurer deny a cognitive claim when your doctor’s notes say you seem fine? Because those notes usually come from a mental status exam. A mental status exam is a brief observation of appearance, mood, speech, memory and thinking that a clinician records during an office visit, often in just a few minutes. Unum built this part of its denial on moments like that:
- Mental status exams during routine psychiatric visits that recorded intact memory and judgment
- A normal EEG (a test of the brain’s electrical activity) and a normal DaTscan (a brain scan for Parkinson’s-type disorders)
- Speech therapy discharge notes reporting 100% accuracy on tasks
- Discharge from physical therapy, gym attendance and travel
- Treatment that Unum’s reviewers called conservative
Unum’s own letter admitted that “EEG (electroencephalogram), DaTscan, and lumbar puncture can be unremarkable in CTE.” It relied on those normal results anyway. And there was nothing conservative about monthly psychiatric care, therapy, speech therapy, migraine medication and Spravato, a supervised nasal spray treatment for depression that has not responded to other medications. Every item on Unum’s list was a snapshot of a good moment. None measured whether our client could think clearly for eight hours a day while running an organization.
A Generic Job Title From Unum’s Vocational Consultant
Unum’s vocational consultant decided that our client’s occupation in the national economy was “consistent with a performance manager.” The 64,000 carriers, the budget ownership and the 20 travel days a month disappeared into a generic list of demands such as dealing with people and making judgments and decisions.
That shortcut matters. A regular occupation definition of disability, similar to what many policies call own occupation, asks whether you can perform the material and substantial duties of the job you held when you became disabled, not whether you could do some other job. Our client’s policy applied that standard for the first 12 months of payments, which is why your actual job duties carry so much weight in a long-term disability insurance claim.
The Appeal That Rebuilt the Record
Unum’s letter allowed exactly one administrative appeal and pointed to a federal lawsuit under ERISA if that appeal failed. ERISA, the Employee Retirement Income Security Act, is the federal law that governs most employer-sponsored disability insurance, and the ERISA claims procedure statute requires a full and fair review of any denied claim.
An administrative appeal is the insurer’s internal review of its own denial. Because courts in ERISA cases usually look only at the record built during the claim and appeal, the appeal is the last real chance to add evidence.
Attorney Stephen Jessup used it to rebuild the record on every front Unum had attacked. The appeal included 13 exhibits, from updated neurology, psychiatry, primary care, sleep and rehabilitation records to new evidence aimed squarely at Unum’s reasoning.
A Forensic Psychologist Reviewed the Raw Data
We had a forensic psychologist review the complete neuropsychological testing data, validity measures and clinical history. His report took Unum’s validity argument apart:
- Every formal performance validity measure fell within acceptable limits, including the Test of Memory Malingering (TOMM), the Dot Counting Test, Reliable Digit Span and the CVLT-II Forced Choice
- The Wisconsin Card Sorting Test indices Unum relied on were never designed as validity measures
- The failure to maintain set (losing track of a sorting rule he had already figured out) and the reduced number of categories completed on that test are common in people with damage to the brain’s frontal networks, and reflected genuine executive dysfunction
- The profile showed preserved strengths alongside focal deficits, a hallmark of neurologically based decline that is inconsistent with malingering
In everyday terms, our client passed every test designed to catch someone who is not trying. The “failures” Unum pointed to came from a problem-solving task that people with his kind of brain injury are expected to struggle with. The expert confirmed clinically significant decline in executive functioning, processing speed, visuospatial skills, memory and fine motor coordination: the planning, quick thinking, spatial judgment, recall and hand precision his job demanded every day.
As attorney Jessup wrote in the appeal, “In patients with Traumatic Encephalopathy Syndrome, the inability to maintain consistent effort on exhausting, multi-hour cognitive testing is not an indication of malingering but is instead a direct clinical manifestation of the disease itself.” We have written before about how neuropsychological testing in disability insurance claims can win or lose a case, and this appeal shows why.
A Four-Hour FCE Measured What Office Visits Miss
A Functional Capacity Evaluation (FCE) is a standardized, hours-long assessment, usually performed by a physical therapist, that measures what a person can sustain rather than what they can do once. Our client completed a four-hour FCE with a licensed physical therapist who tracked his heart rate throughout. Not every FCE helps a claimant, and we explain what a Functional Capacity Evaluation measures and whether you should attend one in a separate guide.
The results showed a body and brain straining against basic desk work:
- His heart rate jumped 10 points while typing, a task that takes almost no physical effort
- His typing slowed and his errors increased as the test went on
- During a simulated working memory task, his speed dropped as his heart rate climbed
- His heart rate spiked when he moved from sitting to standing and during multitasking
- He could not operate a computer for extended periods or complete simulated travel activities
- He showed deficits in working memory, sequencing and recall, with visible fatigue on motor tasks
- He walked with an antalgic gait (a limp to avoid pain), had reduced standing and walking tolerance, and pain limited prolonged sitting
The therapist concluded our client could not meet the demands of a Senior Manager position. His job was classified as light work, which the federal regulation on physical exertion levels defines as lifting no more than 20 pounds at a time, often with a good deal of walking or standing. A man who cannot sustain sitting, standing or walking cannot work at a light or even a sedentary level.
Objective Findings Behind Every Symptom
Unum said the neurologist was relying on self-report. The appeal answered with testing that does not depend on what a patient says:
- Brain MRI: scattered nonspecific white matter changes, which his neurologist linked to his head trauma because his young age made ordinary small vessel disease improbable. White matter is the brain’s wiring between regions, and damage there disrupts memory, focus and processing speed.
- EMG and nerve conduction study: abnormal, consistent with length-dependent, sensory-predominant peripheral neuropathy in both legs. In plain terms, nerve damage that helps explain his weakness, poor balance and near falls.
- Sleep study: an Epworth Sleepiness Scale score of 14, above the normal range of 10 or less, confirming excessive daytime sleepiness and fatigue.
- Updated neurology records: ongoing word-finding problems, constant headaches, left leg weakness, involuntary toe-walking and a referral to a specialized TES and CTE center.
The records also undercut Unum’s claim that rehab success showed recovery. Despite speech therapy, Spravato treatments and daily brain exercises, his primary care records noted that he had seen no improvement in his cognitive symptoms.
Another Insurer Had Already Said Yes
Our client also had group long-term disability insurance through his employer, insured by The Hartford. About four months before Unum’s denial, Hartford approved his benefits using the same medical information he had given Unum, under a definition of disability the appeal showed was substantially similar.
It is not unusual for one disability insurance company to approve a claim while another denies it. But when two insurers read the same records under similar policy language and reach opposite conclusions, one of them has some explaining to do. We put that question directly in front of Unum.
Unum Reverses Its Decision
Unum decided the appeal about seven weeks after we filed it. In a letter to attorney Jessup, Kevin, a Lead Appeals Specialist, wrote that Unum had “found support for his Individual Disability claim for Total Disability benefits.” The claim went back to Unum’s benefits center to calculate the benefits owed.
This did not happen by accident. Unum’s approval letter did not explain its change of position, but the record it faced had changed on every point the denial relied on: a validity argument that collapsed under expert review, an FCE that measured real endurance, and objective findings that matched every complaint Unum had called self-reported.
We have seen this pattern before. Our appeal for a software developer with post-concussion syndrome and a neurocognitive disorder followed a similar path, and we also won that case on appeal.
Your Brain Injury Claim Deserves More Than a Paper Review
Insurers rarely deny cognitive claims by saying a person is fine. They pick the test score, the office note or the job title that lets them say it for you. As attorney Jessup put it in the appeal, “These routine checks cannot capture the catastrophic failure of executive function that occurs when a patient is pushed to meet the demands of a full-time professional schedule.”
If you have received a denial, the clock is already running. Federal ERISA claims regulations give disability insurance claimants at least 180 days to appeal, and that window closes quickly when records, testing and expert reviews all have to be gathered.
If Unum or any other disability insurance company has denied your claim, contact our office for a free consultation. Our long-term disability lawyers represent claimants nationwide, and you pay no fee unless we recover benefits for you.
Since 1979, our firm has helped tens of thousands of claimants and collected more than $2 billion in disability insurance benefits. Your appeal deserves the same work this one received.
