Can Unum Deny My LTD Benefits After Paying For 15 Years?
In the case of Michael J. Christoff v. Unum Life Insurance Company of America (Unum), plaintiff was a partner in the firm of Spencer Stuart. He was a high-level executive, generating one to two million dollars a year in revenue, “developing a network of contacts, constant availability to clients, and extensive travel.” In November 2001, Plaintiff became disabled due to severe fibromyalgia and received long term disability (LTD) benefits.
Through the years, Unum conducted periodic reviews of Plaintiff’s medical records and on occasion, subjected him to an independent medical exam (IME). Unum continued to find him disabled from working in his regular occupation according to the terms of his Unum plan. After paying him for 15 years, Unum terminated Plaintiff’s LTD benefits.
Plaintiff appealed the termination of benefits and when that appeal was denied, he filed this ERISA lawsuit in the United States District Court for the District of Minnesota. He raised several issues concerning the medical review of his files and ways in which Unum abused its discretion.
The August 18, 2016 determination that Plaintiff was still disabled was based on a statement by Plaintiff submitted in March 2016. Additionally, a June 2016 report by a Vocational Rehabilitation Counselor (VRC) concluded that the job requirements of Plaintiff’s regular occupation had not changed in the intervening years. After the roundtable discussion, Dr. Antaki reported “that improvement in Christoff’s condition was not expected and recommended as ‘next steps’ that Christoff’s records be updated in one year.”
Just days later, on August 25, 2016, a new review began when the same VRC changed the physical demands of Plaintiff’s occupation to “sedentary” with only occasional demands to walk and determined that “only occasional” travel would be required, ‘likely done locally and by vehicle.’ She did not define “local.”
Dr. Antaki was given this new job description and Unum hired other physicians to conduct a medical file review. In November 2016, another IME was done.
Although the opinions of Plaintiff’s treating physicians had not changed, and all still believed he could not work, Unum’s reviewing physicians thought otherwise and determined that after all the years of receiving disability, without much change in his condition, on June 15, 2017, Unum notified Plaintiff it upheld its decision to terminate his LTD benefits. After exhausting his administrative remedies, Plaintiff filed this ERISA lawsuit.
The United States District Court for the District of Minnesota agreed with Plaintiff that Unum abused its discretion when it terminated his LTD benefits and ordered Unum to reinstate benefits, pay prejudgment interest from the date of the termination until the date of the court order, and to pay attorneys’ fees and costs.
Although Plaintiff raised a number of issues in the Court, the Court was concerned with the timing of the termination, Unum’s change in the Plaintiff’s occupation, and its analysis of the medical evidence.
Timing of the Termination
The Court asked the parties to provide briefing to answer the question of, “What prompted Unum’s most recent decision to re-evaluate Christoff’s disability status?” Unum had determined on August 18, 2016, that Plaintiff was still disabled, yet opened another review just days later.
The best answer Unum could come up with is that a new worker was likely assigned to the file and decided to revisit the decision. The Court commented that, “While this does not necessarily indicate wrongdoing, it bolsters the Court’s conclusion, based on the entire record before it, that Unum’s process was indeed arbitrary and capricious.”
The Change in Plaintiff’s Occupation
The Court agreed that Unum could interpret Plaintiff’s own occupation as it is normally performed in the national economy, instead of how the tasks are performed for the specific employer. But, Unum did abuse its discretion by “arbitrarily changing the level of physical demand without any substantial evidence, or even any reasoning beyond one VCR’s flat assertion that it would be reasonable to change it.”
The Court continued, finding that “the balance of the medical evidence overwhelmingly shows that Unum’s evaluators ignored the seriousness of Christoff’s limitations and that he would be unable to perform any occupation on a full time, regular basis.”
Unum’s Analysis of the Medical Evidence
The Court concluded that Unum abused its discretion in “relying heavily on its independent reviewers’ opinions and in-house physician’s review of the record in concluding that Christoff was not disabled under the terms of the LTD plan.”
The Court acknowledged that ERISA does not require more weight to be given to the opinions of treating physicians, but Unum’s own manual says that deference must be given to treating physicians. Here, according to the court, Plaintiff’s “medical records are extensive, detailed and consistent. This does not come down to only an abuse of discretion in weighing evidence, it also involves misstating the record… Unum’s interpretation of the records fabricated conflict and inconsistency where none existed… Unum’s in-house doctor ignored information unfavorable to the termination decision.”
The Court concluded, “Unum’s selective presentation of evidence to its reviewers and disregard for the adamant opinions of Christoff’s doctors leads the Court to conclude that it was an abuse of discretion.”
Court Orders Payment of Past Due Benefits, Reinstatement of the Policy and Attorneys’ Fees
In a case such as this, where there are no meaningful questions of fact, remand serves no purpose. Plus, the parties agreed there was no need for further proceedings and the Court found “that there would be nothing gained by remanding the matter. The Court awards Christoff the LTD benefits past due and orders Unum to continue his benefits so long as he qualifies under the Plan.”
The Court also ordered Unum to pay Plaintiff’s attorneys’ fees and costs finding that such an award “will have a beneficial deterrent effect in preventing Unum from abusing its discretion in future cases.”
This case was not handled by our office, but if you have been receiving LTD benefits for many years and are concerned about having your benefits terminated, or if you have any questions about your claim for disabilitybenefits, contact one of our attorneys at Dell & Schaefer for a free consultation.
Read more about Unum lawsuits on this page.
Resources to Help You Win Disability Benefits
Disability Benefit Denial Options
Submit a Strong Unum Appeal Package
We work with you, your doctors, and other experts to submit a very strong Unum appeal.
Sue Unum
We have filed thousands of disability denial lawsuits in federal Courts nationwide against Unum.
Protect Your Benefits
Get Your Unum Disability Application Approved
We help claimants throughout the entire application process.
Prevent a Unum Disability Benefit Denial
We manage every aspect of your disability claim following claim approval.
Negotiate a Unum Lump-Sum Settlement
Our goal is to negotiate the highest possible buyout of your long-term disability policy.
Unum Reviews
(650)
Policy Holder Rating
5
0%
4
0%
3
1%
2
54%
1
44%
Timely Payments
1.8out of 5
Handling Claim
2.1out of 5
Customer Service
2.0out of 5
Dependable
2.1out of 5
Value
1.9out of 5
Showing 8 of 650 Reviews
Unum
Unum Closed My Case Today
Unum will keep you around, if they pay you 100 a month. But as soon as have to pay more than 2700 a month, they will drop you. We will be going to the attorneys office fir... read more >
Unum
Low payments
I was injured at work. I did house keeping in a hospital. I tore just about everything imaginable in my knee. I was let go from my job, because I was no longer able to do ... read more >
Unum
They closed my claim and I have been without income since they closed it
Went off work on 9/26/22 due to back issues. Applied for Short Term Disability. On Jan 2023 switched over to Long Term Disability and Unum had me to apply for Social Secur... read more >
Unum
I feel like Unum is giving me the runaround!
I have contacted UNUM multiple times since I’ve needed them. I feel like they are giving me the runaround! Please help!
Reply
Unum
Unum terminated my benefits with no warning
I was told I was covered with Unum through my employer (continuum). I got an email today for my termination, no prior talks of infractions with attendance, no warnings, no... read more >
Reply
Unum
I've been trying to care care of my Unum benefits for over a year. They’ve been so rude
I have been trying to take care of my Unum benefits for over a year. I’ve called and back in November I did appeal letter, they say they never received. I did everything... read more >
Reply
Unum
I've paid for STD for 20+ years. Now, I'm actually sick and can't get paid
My employer uses unum for short-term disability. I was hospitalized back on june 13 and discharged on june 25. I was admitted for double pneumonia and hypoxia, which I end... read more >
Reply
Unum
Unum thought I was fine to work. I wasn't
48 yoa dentist POTs Dx aug 22. Attempted to return to work initially but got sick. Was going to go back 2 days/wk in September but could not. Then did go back part time as... read more >
Reply
Answered Questions by Our Lawyers
(99)
Showing 8 of 99 Answered Questions
Q: Requesting a Copy of my LTD ERISA Policy from UNUM
A: Whatever policy is in effect at the time of your disability is the one that applies. Read More >
Q: I am now concerned if I am not able to return to work after 6 months Unum will stop paying me.
A: Unum will review your medical records and likely focus on the progress of your surgery recovery. It is importa... Read More >
Q: Can receiving a Unum group LTD benefit settlement lower my SSDI benefit?
A: Jeff,The acceptance of a Unum Lump Sum Buyout offer should not reduce your ssdi benefit. You should contact ... Read More >
Q: Do we have any legal action against Unum?
A: I am sorry to hear of Unum’s actions here and how they have treated your claim, especially in their long del... Read More >
Q: Is it normal for “UNUM” to ask for a police report?
A: Derrick, a simple answer to your question is Yes, if there was some sort of MVA accident which caused or contr... Read More >
Q: Unum stopped my COLA benefits at age 65
A: Unum policies usually only pay COLA increases until you turn 65 even if the policy pays longer. Read More >
Q: Survivor's benefits
A: Cindy: A few things come to mind. Your disability policy will have a section called deductible sources of inco... Read More >
Q: FMLA and my LTD claim
A: Unum doesn’t consider FMLA as they only care if you meet the terms of your disability policy with Unum. Read More >
Helpful Videos
(902)
Showing 12 of 902 Videos
Disability Benefit Tips
(331)
Showing 8 of 331 Benefit Tips
Is UNUM a Good Insurance Company?
One common question the attorneys here at Dell Disability Lawyers receive comes from policyholders with UNUM long term disability policies. These claimants want to know, “Is UNUM a "good" insurance company?” But what is this question really asking? Learn more about what claimants may be able to expect when filing a&nbs... Read More >
How Long Does UNUM Long Term Disability Last?
When it comes to long term disability (LTD) insurance, every UNUM disability insurance policy is written a little differently. But while many disability insurance claimants may mainly be focused on the maximum benefit period - or the maximum amount of time the claimant can receive benefits under the policy, often age 65 - this benefit period may carry less... Read More >
Can You Sue UNUM?
If UNUM denies your long term disability insurance claim, can you sue? Generally, the answer is yes - but with some qualifications. Learn more about what a claimant may expect from the administrative procedures and appeal process they'll need to pursue after UNUM has denied their disability insurance claim.What to expect in a Group Policy... Read More >
How Does UNUM Define Disability?
UNUM Group - the Tennessee-based Fortune 500 insurance company that includes UNUM US, UNUM UK, and Colonial Life - defines disability in its own unique way. This means that the most commonly-accepted interpretations of "disabled" or "disability" may not quite gel with what UNUM considers disabled. What should long term disability insurance claimants know ab... Read More >
Beware of Traveling While on Disability with Unum
In the past several months our office has been hired by two separate clients who had individual disability policies purchased privately through insurance agents; that had received benefits for an extended period of time; and that were denied by Unum, in part, on the basis that their ability to travel was indicative of the ability to work. The first client, a doctor had coverage with Paul Revere Life Insurance ... Read More >
If I Sue Unum for a Disability Insurance Denial, What Should I Anticipate?
Disability insurance Attorneys Gregory Dell and Stephen Jessup discuss the numerous issues that a long term disability claimant should expect when filing an ERISA disability lawsuit against UNUM. This video provides some basic information about the lawsuit process. Our lawyers have helped thousands of claimants nationwide to obtain long term disability benefits.... Read More >
Unum Disability Benefit Denial Trends, A Legal Perspective
In this video we discuss the recent trends they have observed with regard to Unum Insurance Company's denial of long term disability benefits. We offer some tips that can either help you to avoid a claim denial or possibly improve your chances to stay on claim. Contact any of our disability insurance lawyers for a free consultation to discuss your disability cla... Read More >
A New Bait and Switch Tactic by Unum Disability Insurance Company
Unum reached a new low today which displays absolute disregard for the rights of a UNUM insured. Our law firm advised Unum in a January 16, 2016 letter that we would be sending a videographer to record the Orthopedic Compulsory (Independent!) Medical Examination requested by UNUM. On January 18, 2016 Unum sent us a letter stating that they scheduled a videographer and that UNUM would pay for the videographer. ... Read More >
Dell Disability Cases
(375)
Showing 8 of 375 Dell Disability Cases
Transportation Manager with Brain Injury Wins Unum Disability Benefit Appeal
Unum unjustly terminated our client’s disability insurance claim after it had approved and accepted liability for six months. Unum unreasonably concluded, without any evidence of improvement, that the claimant had resumed the sustained work capacity to perform the material and substantial duties of her high level occupation as a Transportation Division Manage... Read More >
Louisiana State College Director Wins Unum LTD Appeal But Then Denied Again
Client was Regional Director for the State of Louisiana. She was diagnosed with cervical radiculopathy, spondylosis, lumbar spondylosis and bilateral carpal tunnel syndrome. In 2020 she underwent an anterior cervical discectomy and fusion. Unfortunately the surgery did very little to resolve her neck pain, radiculopathy and discomfort.She was a Regional Di... Read More >
Unum Approves LTD Benefits for Pharmacist with Eye Disorder
Rachel Alters of Dell Disability Attorney’s currently represents an Ambulatory Operations Pharmacy Manager at the University of Missouri who recently suffered an acute retinal detachment leading to multiple corrective surgeries which unfortunately failed. She is an accomplished medical professional and health system executive with not only a doctor of pha... Read More >
Billing Manager With Back Disorder Wins Unum Long Term Disability Denial Appeal
Despite suffering with chronic knee and back pain for 7 Years, Unum still needed to be convinced that their disability benefit denial was wrong.Prior to filing her claim for LTD benefits, our client had worked for 13 years as a Billing Manager for an Accounting Firm in New Hampshire. Unfortunately, for some time she suffered from lower back issues that mad... Read More >
Unum Lifts Mental Health Limitation on Disability Claim
When our client first contacted our office and spoke with Attorney Stephen Jessup her claim for long term disability benefits had been approved by Unum under the 24 month mental health limitation contained in most Unum group disability policies. Despite our client’s attempts to prove to Unum that she was suffering from epileptic seizures, which were the true cause of her inability to work, Unum held fast to ... Read More >
Unum Approves Long Term Disability Application to a Program Manager
Our client, a high level Program Manager for a large international aeronautics company, was involved in an automobile accident that resulted in physical and emotional injuries, which impacted her ability to meet the demands of her job. Prior to hiring our office she filed her application for short term disability benefits under her employer’s disability insurance plan with Unum. From the onset of her short t... Read More >
After appeal filed by Attorney Jay Symonds, UNUM overturned previous denial of long term disability benefits for South Carolina Nurse
Our client, Ms. L, formerly worked as a Registered Nurse for a nursing home. In November 2014 a number of chronic physical conditions and pain forced Ms. L to stop working and submit her claim for disability benefits first under her employer’s short term disability (“STD”) Policy then continuing under her employer’s Long-Term Disability (“LTD”) Policy both benefits were administered and funded by C... Read More >
Unum Overturns Original Decision to Deny Benefits to Disabled Account Manager Following Appeal Submitted by Dell Disability Lawyers Appeals Team
In 2016, Sarah, an Account Manager, began suffering severe abdominal pain accompanied by bloody diarrhea. The frequency and condition was so severe that she was diagnosed with anemia from the blood loss and profound fatigue from the nutrient loss. By the end of 2016 Sarah was no longer capable of effectively performing the material and substantial duties of her own occupation as an account manager and was forc... Read More >
Disability Lawsuit Stories
(765)
Reviews from Our Clients
