Nurse With Post-COVID Neurocognitive Disorder Wins Virginia Unum Long-Term Disability Insurance Appeal
A Certified Registered Nurse Anesthetist spends her entire career making split-second, life-or-death decisions in an operating room. After a COVID-19 infection left our client unable to trust her own memory and concentration, she did the responsible thing and stopped administering anesthesia. Unum paid her long-term disability benefits for nearly four years — and then abruptly decided she had recovered and shut the claim down.
Our client worked as a nurse anesthetist for VCU Health in Virginia until the cognitive effects of long COVID — along with relentless daily headaches and crushing fatigue — made it unsafe for her to keep working. Insurers love to argue that a claimant who can refinish a piece of furniture or drive her kids to school can also return to a demanding profession. It is a pattern we have seen, and beaten, many times.
We appealed, and Unum reversed its decision and reinstated her benefits in full. How that reversal happened — and what finally forced this insurance company to confront the evidence it had spent months ignoring — holds lessons for anyone fighting a long-term disability denial. If Unum or any other disability insurance company has cut off your benefits, you can speak with one of our disability insurance attorneys anywhere in the country, at no cost and no fee unless we recover your benefits.
Table Of Contents
- 1. Why this case matters for every Unum claimant
- 2. A nurse anesthetist whose mind no longer kept pace with the operating room
- 3. Unum’s termination: a paper review and a claim that she had recovered
- 4. Why “average” test scores did not mean our client could work
- 5. The evidence Unum’s reviewers chose to discount
- 6. The demand that changed everything: an in-person medical exam
- 7. Denied disability benefits by Unum? Speak with our disability insurance attorneys
Why this case matters for every Unum claimant
This case turned on a handful of principles that apply far beyond one nurse anesthetist. If your benefits have been terminated, keep these in mind.
- “Average” test scores do not mean you can do your job. Unum’s reviewers pointed to normal-range cognitive scores as proof our client had recovered. But for a professional whose baseline ability was well above average, a decline to “average” is a real and disabling loss — and the only question that matters is whether the deficits prevent the safe performance of your own occupation.
- A denial built on a paper review can be turned around. Unum cut this long COVID disability insurance claim off using consultants who read records but never examined our client. We forced an in-person exam — and the insurer’s own examining physician concluded she could not safely return to work.
- Your daily activities are not proof you can return to a profession. Refinishing furniture, caring for two small children, and driving are not the same as administering anesthesia for hours without a break. Insurers blur that line constantly, and it can be exposed.
- Objective, un-fakeable testing defeats accusations of exaggeration. Built-in validity checks on her cognitive testing and a cardiopulmonary exercise test that cannot be faked dismantled Unum’s suggestion that her limitations were merely self-reported.
A nurse anesthetist whose mind no longer kept pace with the operating room
For more than six years, our client worked full time as a Certified Registered Nurse Anesthetist for VCU Health, providing anesthesia across a busy slate of operating rooms. It is among the most cognitively demanding jobs in medicine. A nurse anesthetist sets and adjusts the equipment that regulates a patient’s oxygen and anesthetic, monitors vital signs second by second, and makes continuous judgments where the consequence of a single error can be fatal.
Then she contracted COVID-19. The fatigue never fully lifted, and something more frightening took its place. She became forgetful, slow to process, and unreliable in exactly the ways her work could not tolerate. She once forgot how to administer a dye to a patient — a routine procedure she had performed many times. Colleagues told her she “wasn’t herself.” She tried to push through on a reduced schedule, but the harder she pushed, the worse it got.
Her treating neuropsychologist diagnosed a mild neurocognitive disorder with post-COVID-19 neurologic sequelae — in plain terms, measurable damage to her thinking. Mild neurocognitive disorder (ICD-10 F06.70) is a documented decline in thinking skills such as attention, memory, processing speed, and executive function — significant enough to show up on formal testing while still allowing a person to manage basic daily tasks.
Layered on top were a post-COVID-19 condition (ICD-10 U09.9), disabling cognitive fatigue, and new daily persistent headaches (ICD-10 G44.52) that proved resistant to one treatment after another. Recognizing the danger, her neuropsychologist advised that she should not return to work as a nurse anesthetist, and she was taken out of work.
This was an own-occupation claim. Under an own-occupation policy like this one, a claimant is disabled when illness or injury prevents her from performing the material and substantial duties of her own regular occupation — here, the specific work of a nurse anesthetist, not some hypothetical desk job.
Unum accepted that she met that standard and paid her benefits for nearly four years. Long COVID claims built on cognitive impairment are difficult precisely because the symptoms are invisible on a casual look, which is the same reason we have helped so many claimants with long COVID disability insurance claims document what an insurer would rather not see.
It also mattered how the condition was characterized. Because her impairment was documented as an organic, post-viral neurocognitive disorder rather than a psychiatric condition, it fell outside the kind of mental-health limitation many policies use to cap benefits at 24 months — a distinction that can decide whether a long COVID claim is paid for two years or for as long as the disability lasts.
Unum’s termination: a paper review and a claim that she had recovered
After years of paying, Unum — through Senior Benefit Specialist Nickole — reversed course and terminated the claim, declaring that our client was no longer limited from performing the duties of her regular occupation. It reached that conclusion without anyone laying eyes on her.
The entire decision rested on a paper review. A paper review, also called a file review, is an evaluation in which an insurance company’s hired physician reads a claimant’s records and renders an opinion without ever examining — or even speaking with — the claimant.
A panel of reviewers who never examined her
Unum routed the file to a panel of in-house and contracted consultants — physicians board certified in psychiatry, physical medicine and rehabilitation, and neurology, including Dr. David Rosenthal, Dr. David Marino, Dr. Freeman Broadwell, and Dr. Michael Chilingu — and a neuropsychology reviewer, Dr. Malcolm Spica, to second-guess years of neuropsychological testing. Not one of them met our client.
This is the maneuver that should trouble every claimant: Unum first asked her own treating providers whether she could perform the mental demands of her job. Her providers said she could not. Unum then had a consultant phone those same providers; two deferred to her treating neuropsychologist, who held firm that her attention problems made a return to work a danger to patients. Unum terminated her benefits anyway. That is the difference between gathering evidence and shopping for an answer.
Turning her daily life into the case against her
To support the idea that she had recovered, Unum leaned on the ordinary business of staying alive as a young mother. It pointed to the fact that she could:
- refinish and resell furniture as a small hobby-turned-side venture;
- care for an infant and a toddler;
- cook, drive, and use a computer;
- take family trips; and
- keep her nurse anesthetist license active.
None of that answers the only question that mattered. Doing chores at her own pace, with rest breaks and the option to stop whenever she crashed, is nothing like sustaining flawless concentration through hours of surgery with a patient’s life in her hands.
As attorney Stephen Jessup wrote in the appeal, her ability to maintain “some semblance of normalcy in no way detracts from her cognitive deficits.” A maintained license is not a medical opinion, and a furniture hobby is not anesthesia.
Why “average” test scores did not mean our client could work
The intellectual core of Unum’s denial — and the argument we had to defeat — was deceptively simple. Its reviewers conceded that most of her cognitive scores fell within normal limits and concluded that “average” performance meant no disabling impairment. That is an assumption, not a fact.
Scoring “average” may sound reassuring, but for someone whose baseline ability was well above average, average represents a fall — the cognitive equivalent of a sprinter who can no longer outrun a brisk walk. Her own neuropsychological testing established superior premorbid functioning, so a slide into the average and below-average range on attention, working memory, and processing speed was not a clean bill of health. It was the measurable footprint of decline.
The relevant question is never whether a claimant scores “normal” against the general population; it is whether her remaining capacity can meet the material and substantial duties of her specific occupation.
Those duties are unforgiving. A nurse anesthetist’s role demands sustained concentration, precise judgment under stress, and effectively zero tolerance for error — the very functions her testing showed were compromised. The federal physical demand levels and occupational components set out in the U.S. Department of Labor’s Dictionary of Occupational Titles helped us anchor what her real occupation requires, rather than the watered-down version an insurer prefers.
We made the same point we have made for other professionals fighting this exact tactic, including a senior project manager whose cognitive limitations Unum tried to wave away — a denial we also reversed on appeal. When an insurer reduces a skilled professional’s mind to a percentile rank, it is minimizing the job, and cognitive limitations disability insurance claims live or die on putting that minimization back in its place.
The evidence Unum’s reviewers chose to discount
An appeal is your one chance to build the record, so we built it. Where Unum’s reviewers had cherry-picked, we put the full weight of the evidence in front of the insurer — and forced its appeal-level consultants, Dr. Staci Ross in neuropsychology and Dr. Arlen Green in physical medicine, to reckon with what they had skipped.
Five evaluations over four years told the same story
Our client did not undergo a single, convenient test. She completed five neuropsychological evaluations over roughly four years, and they were consistent: reduced auditory attention, working memory, and processing speed, with marked fatigue and worsening headaches for days after each round of testing. Crucially, the testing was valid. Her evaluations used embedded performance-validity measures — built-in checks that confirm a person is giving genuine effort and is not exaggerating — and she passed them.
Her treating neuropsychologist did not mince words about Unum’s contrary reviewer, describing the insurer’s analysis as what he called “cherry picking of results.” Consistent, validated findings repeated over years are not “normal variability,” and the medical literature confirms that long COVID produces objectively measurable cognitive and memory deficits that deepen with symptom severity. We have driven this point home before, including for a corporate attorney disabled by long COVID and cognitive limitations, whose denial we also won on appeal.
A heart-and-lung test that cannot be faked
Then we introduced evidence Unum could not argue away with talk of “self-report.” Our client underwent a cardiopulmonary exercise test. A cardiopulmonary exercise test (CPET) measures how the heart, lungs, and muscles respond to physical exertion, and it contains built-in physiologic markers that reveal whether the person is pushing to genuine, maximal effort. She gave full effort — and her body failed the way her symptoms predicted. Her heart could not speed up the way a healthy heart should during exertion, and it was slow to recover afterward.
In medical terms that is chronotropic incompetence and blunted heart-rate recovery; in human terms, it is the physiology behind why pushing herself for even a few hours triggered days of fatigue, worsened headaches, and deeper cognitive fog. Published research links exactly these cardiopulmonary exercise abnormalities to long COVID, and unlike a questionnaire, a CPET cannot be coached.
The headaches and fatigue Unum’s reviewer acknowledged, then ignored
Unum’s physical-medicine reviewer, Dr. Arlen Green, did something self-defeating: his own report repeatedly acknowledged our client’s daily persistent headaches and ongoing fatigue, and then he concluded she could work full time as a nurse anesthetist without a single restriction. Those two findings cannot coexist.
Headache claims are notoriously hard because the suffering rarely shows up on a scan, which is why headache and migraine disability insurance claims demand careful documentation of functional impact. At a minimum, headaches and fatigue of the severity Green himself recorded would produce absenteeism no employer in the national economy would tolerate — a reality we have leveraged before for a law firm recruiter whose migraines Unum refused to credit, a termination we also overturned on appeal.
The demand that changed everything: an in-person medical exam
After dismantling each paper reviewer, attorney Stephen Jessup made a direct request: if Unum still doubted our client, it should stop hiding behind file reviews and send her for an examination. An independent medical examination is an in-person evaluation by a physician the insurance company selects and pays — but unlike a paper review, the doctor actually examines the claimant. Insurers often resist this, because a doctor who sits across from a claimant frequently sees what a stack of records cannot convey. You can read more about how insurers use, and misuse, paper reviews and insurer-ordered medical exams to justify denials.
Unum sent our client to its own examining physician, an occupational medicine specialist, Dr. Ikenna Ibe. He examined her, reviewed her history and records, and reached the opposite conclusion from the insurer’s paper reviewers. Despite the absence of dramatic findings on a routine physical, Dr. Ibe credited the post-COVID neurocognitive sequelae documented across her records and concluded that her cognitive limitations “would preclude her from safely performing the work of a CRNA.” Unum’s own chosen examiner had confirmed what her treating providers, five evaluations, and a CPET had been saying all along.
Faced with the opinion of the very physician it had hired, Unum reversed. Its Lead Appeals Specialist, Betty, found that our client remained eligible for long-term disability benefits, set aside the prior decision, and returned the claim for payment of the benefits she was owed. A termination that began with doctors who never met her ended with the one doctor Unum chose to examine her — and that single decision to force an exam is what turned the case.
Denied disability benefits by Unum? Speak with our disability insurance attorneys
If Unum has terminated your benefits with a paper review, do not mistake an insurer’s confidence for the final word. The reviewers who never examined you can be answered, the picture of your daily life can be corrected, and the right evidence — validated testing, physiologic proof, an in-person exam — can change the outcome, just as it did here.
Our firm has fought these battles since 1979. We have recovered more than two billion dollars in disability insurance benefits for tens of thousands of claimants nationwide, against every major carrier. We represent clients in every state, and there is no fee unless we recover your benefits. If Unum or any other disability insurance company has denied or terminated your claim, contact our office for a free consultation with one of our disability insurance attorneys, and let’s talk about the strategy that gets your benefits back.
