The case of Stephanie Dorris v. Unum Life Insurance Company of America (Unum) is an example of how an inexperienced lawyer may make the difference in a Plaintiff obtaining or losing long term disability (LTD) benefits. Plaintiff, a former corporation president, was covered under her employer’s LTD insurance plan through Unum.
Under the terms of the policy, LTD benefits would be paid for two years if the insured person could show the inability to perform “each of the duties of her own occupation” due to an injury or sickness. After two years, the definition of disability changed and in order to receive LTD benefits, the employee needed to prove either: 1) She was unable to perform the material duties of any occupation for which she was “reasonably fitted by training, education, or experience;” or 2) She is performing at least one of the material duties of her regular occupation, or another occupation on a part-time or full-time basis and receiving at least 20 percent less than her previous full-time pre-disability income “due to that same injury or sickness.”
Beginning in 2002, Plaintiff received LTD benefits, and continued receiving them, for 13 years due to her inability to perform the duties of her regular occupation based on a diagnosis of endometriosis. Throughout the years, Unum periodically reviewed Plaintiff’s case. In 2007, the Social Security Administration found her totally disabled based on the diagnosis of endometriosis, Lyme disease and other impairments. In 2013, the review revealed the endometriosis was no longer an issue, but Plaintiff was disabled due to Lyme disease.
In 2015, Unum again reviewed Plaintiff’s case. Plaintiff’s Lyme disease treating physician, Dr. Steven Harris, informed Unum that she could not work at all and could not even do sedentary or light duty work due to “extreme fatigue” and “major memory and cognitive issues.” Plaintiff’s other treating physicians deferred to Dr. Harris.
Unum had two consulting physicians review Plaintiff’s medical records. When they both agreed she could return to her regular occupation, Unum again issued its disability insurance claim denial and terminated her benefits. Plaintiff then filed an appeal.
On administrative appeal, Unum had a third physician review her records who agreed she could perform the duties of her regular occupation. Meanwhile, Unum’s vocational consultant updated its definition of the material duties of corporation president to include working more than 40 hours a week and to require some travel. When Unum denied her appeal, she filed an ERISA lawsuit in the United States District Court for the Southern District of Illinois.
The District Court (DC) found Plaintiff was unable to perform the duties of her own occupation according to the definition now provided by the updated vocational consultant report. The DC then gave Plaintiff an opportunity to submit proof that she was also disabled under one of the other two prongs of the policy and therefore entitled to LTD benefits. She failed to carry her burden of proof, so the DC ruled the Unum disability claim denial was correct and issued its ruling in favor of Unum. Plaintiff appealed the Unum denied claimto the U.S. Court of Appeals for the Seventh Circuit.
Seventh Circuit Agrees Plaintiff Did Not Sustain Her Burden of Proof
The Seventh Circuit Court (CC) made it clear that “Plaintiff failed in proving she was entitled to the benefits she seeks.” The CC concluded:
“Stephanie Dorris did not fully recognize her burden. After her disability insurance provider, Unum Life Insurance Company of America, terminated her benefits, she fought hard to prove that Unum’s explanation for its decision was wrong. She convinced the district court that it was, so the court proceeded to decide whether Dorris was then entitled to benefits. It saw barely a thing in the administrative record going to that question, and no attempt from Dorris to supplement the record. Based on this lack of evidence, the court entered judgment in Unum’s favor. On appeal, Dorris contends that some evidence proved her entitlement to benefits, or alternatively, that the district court should have given her the opportunity to supplement the record after judgment. Because we see no clear error in the district court’s factual findings nor an abuse of discretion in its decision to limit itself to the record before it, we affirm the judgment.”
Seventh Circuit Identifies Plaintiff’s Specific Failures Made in the District Court
After the DC found that Unum erroneously denied Plaintiff benefits and that she was disabled from performing the duties of her regular occupation, the only issue left for the DC to resolve was whether she was entitled to receive benefits. The burden was upon Plaintiff to prove that entitlement.
The CC noted several areas where Plaintiff failed in the DC:
- When the Magistrate Judge denied Plaintiff’s request to depose certain witnesses for “clarification,” the Magistrate specifically ruled that she could request discovery under federal Rule 26. She never sought further discovery.
- She did not object to the Magistrate Judge’s denial of her request to depose witnesses.
- She argued that she was unable to work in any occupation for which she was “reasonably fit” and complained that there was no vocational evidence in the record to substantiate that she could work in those occupations. The CC noted that the burden of proof was on Plaintiff, and she offered nothing of her own “on these points.”
- She listed occupations for which Unum may say she was “reasonably fit,” but without evidence, asserted they all required working more than 40 hours a week, so she could not perform the material duties of any of them.
- As for the “20% less option,” her statements were conclusory. “She simply declared that she met that definition without identifying how.” The DC “noted that she provided ‘no evidence or explanation’ to support that assertion.'”
- Plaintiff never asked to reopen discovery until after the judgment. The CC stated that “A motion to amend the judgment under Rule 59 is not ‘a vehicle for a party to undo its own procedural failures.'” She should have moved to reopen discovery when Unum sought judgment, not wait until after Unum won.
The ruling against Plaintiff in this case could likely have been different if the attorney had submitted evidence as noted by both the DC and CC that was missing.
This case was not handled by our office, but we believe it can be instructive to those struggling with presenting evidence to a court in order to sustain their burden of proving they are entitled to either LTD or short-term disability (STD) benefits. If you have questions about this case, or any question about your disability claim, contact a disability lawyer at our disability insurance law firm of Dell & Schaefer for a free consultation.