Costco Front-End Supervisor With Multiple Sclerosis Wins Oregon Unum Long-Term Disability Insurance Appeal After Paying Benefits for Over 7 Years
Unum paid our client’s long-term disability benefits for more than seven years. Then, without a single new examination and without any improvement in her health, it cut her off. She had worked as a Front-End Supervisor for Costco Wholesale Corporation in Oregon until relapsing-remitting multiple sclerosis and chronic pain forced her out of the workforce.
Our office has seen insurers turn on long-paid claims many times, and we have beaten that move many times. This case was no different. After we filed her administrative appeal, Unum reversed its decision and reinstated her benefits.
How this termination came apart holds real lessons for anyone whose benefits were stopped after years of payments, especially anyone living with a chronic, incurable condition. If Unum or any other disability insurance company has terminated your claim, speak with one of our long-term disability insurance lawyers. We represent claimants nationwide, and there is no fee unless we recover your benefits.
Table Of Contents
- 1. Why this case matters for every Unum claimant
- 2. More than seven years of payments, then a cutoff
- 3. Unum’s denial: two paper reviews and a list of household chores
- 4. What her treating doctors actually documented
- 5. The Functional Capacity Evaluation Unum never ordered
- 6. Building the appeal: stability is not recovery
- 7. Unum reverses its decision
- 8. Talk to a long-term disability insurance lawyer about your Unum termination
Why This Case Matters for Every Unum Claimant
Before the full story, here are the lessons from this case that any Unum claimant can put to work.
- Years of payments do not protect you from a sudden termination. Unum ended our client’s multiple sclerosis disability benefits after more than seven years, most of them paid under its stricter any-occupation standard, even though nothing in her medical picture had changed. When an insurer reverses itself on the same evidence, the question that wins is simple: what changed?
- “Stable” is not the same as “recovered.” Unum turned an unchanged MRI into proof she could work. For long-term disability claimants with multiple sclerosis, stability means the disease is still there, not that it has stopped disabling you.
- A paper review can be beaten with in-person evidence. No Unum doctor ever examined our client. A Functional Capacity Evaluation measuring how long she could actually sit put hard numbers against the reviewers’ assumptions.
- What you say on a status call becomes evidence. Unum built its activity argument from her own descriptions of gardening, pet care and errands. Protecting an approved Unum claim means describing what you do accurately, including how long it lasts and what it costs you afterward.
- Invisible symptoms need a specialist on the record. Unum dismissed her fatigue and cognitive problems because she had never taken a formal memory screening test. Her treating neurologist’s written disagreement with Unum’s reviewers filled that gap.
More Than Seven Years of Payments, Then a Cutoff
Her Diagnosis
Our client supervised the front end of a Costco warehouse, a demanding job she was proud of. Multiple sclerosis ended it. Her symptoms traced back years before a brain MRI and spinal fluid testing finally confirmed the diagnosis, and once the disease took hold, she could no longer keep up. An attempt to return part time did not last.
Relapsing-remitting multiple sclerosis is a form of MS in which the immune system attacks the protective coating around nerve fibers in the brain and spinal cord, causing symptoms that flare, partially settle, and often leave lasting damage behind. For our client, that damage reached nearly every part of daily life. Her treating records documented:
- Relapsing-remitting multiple sclerosis, with disabling fatigue and cognitive dysfunction (trouble with memory, focus and finding words)
- Diplopia (double vision) and visual strain
- Hand spasms, numbness and incoordination that limit typing and other fine motor tasks
- Impaired balance and leg weakness
- Bladder dysfunction, with urgency, frequent urination and repeated urinary tract infections
- Chronic pain syndrome, including MS-related neuropathic (nerve) pain
- Chronic low back pain following lumbar spine surgery, along with sacroiliac joint pain (where the spine meets the pelvis)
- Chronic right leg nerve pain from an old injury that required extensive surgery
How Her Unum Policy Defined Disability
Her coverage came through a group long-term disability policy her employer provided, insured by Unum Life Insurance Company of America. That policy changed the definition of disability partway through the claim.
An own-occupation definition of disability asks whether you can perform the duties of your own job; an any-occupation definition asks whether you can perform any job you are reasonably qualified for, which is a far harder standard to meet.
Not every Unum policy waits 24 months: some, like this one, switch from own-occupation to any-occupation after only 9 months of payments. From that point on, Unum would pay only if she could not perform any gainful occupation.
Under this Unum policy, a gainful occupation is one expected to pay more than 60% of the claimant’s indexed monthly earnings (her pre-disability earnings, adjusted each year by the lesser of 10% or the rise in the Consumer Price Index) within 12 months of returning to work. Our guide explains how Unum defines disability in more detail.
Years of Unum’s Own Findings
Unum evaluated the claim under that stricter standard and kept approving it, year after year, for more than six years. Its own claim reviews recorded that “return to work in a gainful capacity is unlikely. Improvement not expected.” Its most recent annual review, completed roughly three months before the termination, reached the same conclusion.
Then Unum changed its mind. Nothing in her medical records explains why.
Unum’s Denial: Two Paper Reviews and a List of Household Chores
Unum’s termination letter, signed by Benefits Specialist Mariel, announced that our client no longer met the policy’s definition of disability: “We have determined you are not precluded from performing the duties of alternative, gainful occupations.” The decision rested on the opinions of two physicians who never met her.
A paper review, also called a file review, is a medical opinion written by a doctor who reads a claimant’s records but never examines the claimant in person. We see disability denials built on a paper review constantly, and we see them collapse on appeal. Unum ordered two of them here.
Dr. Stephen Kirsch’s File Review
Dr. Stephen Kirsch, a Unum medical consultant board-certified in Family Medicine, reviewed the file first. He leaned on the activities our client had described during routine status calls, treating each one as evidence that she could work:
- Driving to medical appointments and running errands
- Household chores, shopping and reading
- Caring for her pets and doing some gardening
- Walking and using an exercise machine
He also pointed out that her neurologist saw her only about every six months and that her treating providers had not recorded abnormal mental status findings. He reached his conclusion even though the file showed her treating neurologist had already stated she could not perform sedentary work.
Dr. Vaughn Cohan’s Designated Medical Officer Review
Dr. Vaughn Cohan, board-certified in Neurology and serving as Unum’s Designated Medical Officer, then concurred. His review acknowledged ongoing problems with sensation, motor control, fatigue and cognition, yet concluded that none of it prevented full-time sedentary work. Like Dr. Kirsch’s review, Dr. Cohan’s Designated Medical Officer review was a file review by a physician working for Unum; he never examined our client either. Unum’s denial letter adopted that reasoning almost point for point:
- Her last brain MRI showed stable lesions and no spinal cord lesions.
- She had not been on disease-modifying therapy, the class of medications used to reduce MS relapses and slow the disease, for several years.
- She saw her neurologist about every six months, and her pain treatment was characterized as conservative.
- Her providers had never recorded a MoCA or Folstein Mini-Mental score, and she had never been referred for neurocognitive testing.
- Her reported daily activities were, in Unum’s view, inconsistent with her reported symptoms.
The MoCA and the Mini-Mental are short screening questionnaires a doctor can use to check memory and thinking in a few minutes. Unum treated their absence as proof that her cognitive complaints did not matter. It also treated the end of her disease-modifying therapy, after several of those drugs were stopped because of side effects, as evidence that her disease no longer impaired her.
Unum’s letter further claimed that her treating neurologist did not respond to its calls or follow-up letter. Yet the same letter conceded that the neurologist “did not support your ability to perform the above occupational demands on a full-time basis.” Unum knew exactly where her treating specialist stood. It simply chose its own reviewers instead.
Three Clerk Jobs and a 23-Cent Margin
With the medical reviews in hand, Unum’s vocational consultant performed a transferable skills review. A Transferable Skills Analysis is a vocational review that uses a claimant’s education, training and work history to identify other jobs the insurer says she can perform. Unum’s consultant assumed she could handle work within these demands:
- Mostly sitting, with standing or walking for brief periods
- Lifting, carrying, pushing and pulling up to 10 pounds occasionally
- Frequent reaching, handling, fingering and keyboard use
From there, the consultant identified three jobs, each measured against a gainful wage threshold of $20.50 per hour:
- Payroll Clerk, at $23.89 per hour
- General Clerk, at $21.17 per hour
- Order Clerk, at $20.73 per hour
The Order Clerk position cleared Unum’s own threshold by 23 cents an hour. More importantly, every one of these jobs demands sustained attention, accuracy, memory and constant hand use, precisely the abilities her MS had taken from her.
The Social Security Award, Brushed Aside
Our client had been approved for Social Security Disability Insurance (SSDI) benefits. Unum acknowledged the award and conceded it did not dispute that she was impaired when Social Security approved her. It then argued that newer records showed an improvement the Social Security Administration never saw. As the appeal would demonstrate, those newer records showed no such thing.
What Her Treating Doctors Actually Documented
Unum’s reviewers described a stable, capable patient. The treating records described someone else entirely. In everyday terms, her neurologist was documenting a woman who runs out of energy quickly, loses track of what she is doing, sees double when her eyes tire, and cannot rely on her hands or her balance.
The Neurologist’s Findings
Her neurologist’s most recent examination, completed after the termination, recorded:
- Slowed coordination on finger-to-nose and hand-tapping tests (simple bedside checks of how smoothly the brain controls movement), with mild to moderate slowing on toe tapping
- Balance on either leg lasting only 3 to 4 seconds, with significant wobbling
- Fatigue, cognitive dysfunction and chronic pain as her most disabling symptoms
- Diplopia and hand spasms that limit activities like typing
- Ongoing urinary problems and frequent infections
- Continued use of modafinil, a wakefulness medication prescribed for her MS fatigue
The neurologist wrote that our client was stable but remained disabled, and that her problems had not resolved. The same note recorded a telling example of her cognitive decline: she had recently been scammed into giving someone access to her bank account and could barely remember how it happened. She had also missed her granddaughter’s birthday because she was too unwell to attend.
None of this is unusual for MS. Peer-reviewed research on cognitive impairment in multiple sclerosis identifies deficits in complex attention, processing speed, executive function and long-term memory as common features of the disease. Those are exactly the abilities a payroll or order clerk needs every hour of the workday.
The Pain Management Records
Her pain management physician documented the other half of the picture. Despite daily opioid therapy and pregabalin (a medication for nerve pain), his records showed:
- MS-related nerve pain that pregabalin did not adequately control
- Quadriceps weakness (the large muscles at the front of the thigh) and instability in her legs
- Bladder irritability with frequent urination
- Numbness in her face and hands
- Episodes of dizziness and fatigue
Written Opinions Unum Set Aside
Her treating neurologist also put her opinion in writing. Weeks before the termination, she stated that our client could not perform sedentary work. Days after it, she wrote again to make clear she disagreed with the conclusions of Unum’s reviewers. The termination gave her earlier statement no meaningful weight.
The Functional Capacity Evaluation Unum Never Ordered
If Unum genuinely believed our client’s condition had changed, it had a simple way to find out: examine her. The policy gave Unum the right to require an examination by a physician or vocational expert of its choosing. Unum never used it. So during the appeal, we obtained the in-person evidence Unum had chosen not to gather.
A Functional Capacity Evaluation (FCE) is a standardized, hands-on assessment in which a licensed clinician measures how long a person can sit, stand and walk and how much physical activity they can sustain across a workday. Our client’s FCE was performed by a licensed physical therapist, and it tested the precise assumption at the heart of Unum’s denial: that she could sit at a desk all day.
Social Security regulations define sedentary work as work involving lifting no more than 10 pounds at a time in a job performed mostly while sitting. The FCE found that our client could not meet even that baseline:
- She walked with a limp, a shortened stride and reduced push-off on her right leg.
- When seated, she had to brace her torso with her arms and shifted her weight frequently.
- She could sit in a supported chair for only about 10 minutes before pain forced her to adjust.
- She stood up roughly every 5 minutes to relieve pressure on her lower back.
The therapist concluded that she was not capable of working an 8-hour day and could not tolerate the 5 to 6 hours of daily sitting that sedentary work requires. In practical terms, she could not sustain even a basic desk job.
Anyone facing one of these exams should understand whether a Functional Capacity Evaluation helps or hurts a disability claim before going in. Here, it gave the appeal the objective, performance-based evidence that Unum’s paper reviews lacked.
Building the Appeal: Stability Is Not Recovery
ERISA, the Employee Retirement Income Security Act, is the federal law that governs most employer-provided disability insurance plans. Under ERISA’s claims procedure rules, a claimant whose benefits are denied is entitled to a full and fair review by the insurer, and that administrative appeal generally must be completed before a federal lawsuit is possible.
An administrative appeal is a written request asking the insurer to reconsider its own decision, supported by new evidence. Unum’s letter allowed one administrative appeal and 180 days to file it. Attorney Jason Macri used that window to build the appeal around a single theme: Unum had not shown that anything changed.
What Changed in Three Months?
The appeal put the central question to Unum directly: “What changed in three months? The answer, clearly, is nothing…” For more than seven years, Unum’s own reviews had acknowledged her disability. The appeal argued that after so long, Unum needed evidence of a material improvement in her condition before cutting her off, and there was none in the file.
The appeal also pointed to something Unum would rather forget. Before the termination, Unum had extended an $81,000 lump-sum settlement offer on the claim, a clear sign it expected the disability to continue. No internal review at that time suggested she was improving.
We have watched Unum make this same move before, including in our Unum appeal for a Cummins service supervisor with diabetes and kidney disease, whose benefits were cut off after nearly five years, a termination we also reversed. Our Unum appeal for a nurse anesthetist with long COVID, terminated after five years of benefits, ended the same way.
Does a Stable MRI Mean MS Is No Longer Disabling?
Unum’s denial described her latest brain MRI as showing “good stability” and treated that as evidence she could return to work. The radiology report itself told a different story: “Multiple chronic demyelinating plaques are again seen and remain unchanged. No new lesions are seen.”
Demyelinating plaques are areas of scarring where MS has stripped away the protective coating around nerve fibers. “Unchanged” meant the disease had not produced new damage during that period. It did not mean the existing damage had healed, and it said nothing about her fatigue, her cognition or her hands. In multiple sclerosis, a stable MRI means no new lesions have appeared; it does not mean the disease has improved or that existing symptoms have gone away. Stability is not recovery.
Insurers recasting a chronic neurological disease as manageable is something we confront often, including in our Prudential appeal for a United Airlines ramp serviceman with multiple sclerosis, whose benefits were reinstated in full.
Reviewers Who Skipped the Hallmark Symptoms
As the appeal pointed out, neither of Unum’s physicians meaningfully addressed the symptoms that make MS disabling: overwhelming fatigue, hand numbness and lost dexterity, and cognitive dysfunction. Dr. Kirsch, a family medicine physician rather than a neurologist, offered broad conclusions about a complex neurological disease. Dr. Cohan, a neurologist, never explained how she could sustain the pace, focus and fine motor control a clerical job requires.
The appeal made the point plainly: sedentary work is not just sitting in a chair. It demands reliable memory, attention and accurate use of the hands, all day, every day. And if Unum had real doubts about her cognitive symptoms, the obvious step was a neuropsychological exam or an independent medical examination, not more file reviews.
Can Unum Use Your Daily Activities to Deny Disability Benefits?
A status call is a periodic phone interview in which the insurer asks a claimant about symptoms, treatment and daily activities, and as this case shows, the answers can end up in a denial letter.
Unum’s activity argument fell apart on Unum’s own call notes. The same status calls it relied on recorded our client saying she had to use the bathroom roughly every 15 minutes, that she would write information down during a phone call and then lose the paper, and that even at a desk job she could not remember things or work accurately.
Short bursts of gardening or letting the dog in and out on a good day say nothing about whether someone can sit, concentrate and perform accurately for eight hours a day, five days a week. Add heat sensitivity, unpredictable energy crashes and constant bathroom needs, and the clerk jobs Unum identified were never realistic. That is the difference between a file review and reality.
Unum Reverses Its Decision
Unum’s Appeals Unit reversed the termination roughly seven and a half months after cutting our client off. Lead Appeals Specialist Lindsay wrote that “the available medical evidence does not demonstrate any significant improvement in [our client’s] condition, and we have reversed the claim decision on appeal.”
That is the appeal’s central argument, now in Unum’s own words. Unum’s Benefits Center was directed to calculate the benefits owed and to continue managing the claim.
The reversal also carries a warning. Unum’s letter noted that it may request periodic updates on her medical status to confirm continued eligibility. A claim that has been terminated once can be targeted again, which is why every status call, claim form and records request deserves the same care as the appeal itself.
Talk to a Long-Term Disability Insurance Lawyer About Your Unum Termination
As attorney Jason Macri wrote in the appeal, “this was not a medically driven decision, it was a financially motivated one.” When an insurer abandons years of its own findings without new evidence, that is the argument it has to answer, and the evidence submitted on appeal decides whether it can.
If Unum has terminated your benefits after years of payments, do not wait. ERISA-governed disability plans generally allow 180 days to appeal, and the record you build during that window is the record a court will review if you later need to file a lawsuit under ERISA. Treating physician statements and an FCE take time to arrange.
Established in 1979, our firm has helped tens of thousands of claimants collect more than $2 billion in disability insurance benefits. Whether your claim is with Unum or any other disability insurance company, speak with one of our lawyers for a free consultation. We represent claimants nationwide, and there is no fee unless we recover your benefits.
