Legal Summary: Boersma v. Unum Life Ins. Co.

Boersma v. Unum Life Ins. Co. 

546 F.Supp.3d 703 (M.D. Tenn. 2021)

Our client served her employer as a top executive before she became disabled due to severe pain that caused her to stop working. Boersma v. Unum Life Ins. Co., 546 F.Supp.3d 703, 706 (M.D. Tenn. 2021). Her pain appeared to be mostly attributable to two conditions. Id. at 706. Because of her conditions, our client received short term disability benefits through her employer’s plan, administered by Unum. Id. at 705-06. 

Later, our client applied for long-term disability (LTD) benefits, but Unum denied her request, finding that there was not enough evidence to corroborate her disability. See id. at 706. Unum’s reviewing physician talked to our client’s treating physician who explained why she thought our client’s medical conditions rendered her unable to work. See id. at 706-07. Nevertheless, Unum’s physician still doubted our client’s disability and ordered an independent medical examination (IME). See id. at 707.

The doctor who conducted the IME concluded that our client could still work, despite evidence to the contrary. See id. at 707-08. For example, the doctor concluded that our client experienced pain throughout her body, needed “good support system[s] at home and work” due to her medical condition, and required “frequent breaks with stretching exercises [and] relaxation techniques to carry out her day at work and home.” See id. at 707-08. To make matters worse, the doctor physically palpated only one part of our client’s body during the examination, even though she made conclusions about our client’s pain in other areas. See id. Based on this IME, Unum’s vocational rehabilitation specialist concluded that our client could continue her job. Id. at 708. As a result, Unum denied our client’s claim for LTD benefits and leave without pay. Id. 

Our client appealed this decision, providing more information supporting her disability. Id. at 708-09. Notably, her appeal included a functional capacity examination, in which the evaluator concluded that our client would be unable to work for at least 30% of an eight-hour work day. Id. at 709. In addition, the appeal contained statements from multiple treating doctors supporting our client’s claim as well as sworn declarations from our client’s husband, mother-in-law, and former supervisor stating that our client was a dedicated employee before she began experiencing extreme symptoms from her disability. See id. at 709-10.

Unum responded to our client’s appeal with another denial letter, restating its position that our client was not disabled and could continue to work. Id. at 710. The denial was based upon Unum’s reviewing doctor’s opinion that our client’s “claim of disability was not supported,” but rather, the “lack of observable physical symptoms and [our client’s] failure to respond to therapies” was still consistent with a non-disabling medical condition. See id. We sued challenging Unum’s denial. Id. 

First, the court noted that our client’s record discussed multiple potentially-disabling conditions, and with respect to at least one condition, every physician who reviewed our client’s case concluded that our client’s symptoms were consistent with that particular condition. See id. at 711. 

Further, the medical condition at issue was one that is difficult to physically diagnose; it requires individuals to self-report symptoms from which physicians can conclude that the condition exists. Id. at 711-12. Despite this, Unum tried to argue that relying on our client’s description of her symptoms was not a valid foundation for concluding that she suffered from the medical condition at issue. See id. at 712. The court rejected that argument, because as noted, the nature of the medical condition required self-reporting and Unum had “not presented any evidence that would suggest that any other source of diagnostic information…is so comprehensive and reliable as to render self-reporting of symptoms to be beside the point.” Id. at 711-12.

In addition, the court emphasized the fact that our client didn’t rely exclusively on self-reported evidence; she also offered corroborating evidence of her medical condition in the forms of medical records, treating physician opinions, and statements from family members. Id. at 712. Our client additionally submitted a functional capacity evaluation that supported her disability, which was important according to the court, because the Sixth Circuit has held that such evaluations are valuable objective evidence of a disability in cases involving the condition our client suffered from. See id. at 712. On top of that, even one of the physicians who was skeptical of our client’s claim acknowledged physical evidence of multiple symptoms that are consistent with one of our client’s medical conditions. Id. 

Given the solid evidence of an existing medical condition, the court addressed whether or not the condition rendered our client unable to perform her job. See id. at 713. Our client’s evidence, according to the court, confirmed that our client’s symptoms made “it effectively impossible for her to reliably work complete days, even in a sedentary position.” See id. at 713. Unum’s evidence, on the other hand, was “mostly unpersuasive and based on the unsupported and conclusory” legal contention that our client could not be disabled given the lack of physical markers. See id. 

Notably, the court also highlighted that our client’s “history of professional success and dedication to her career tends to weigh against any inference that she would falsify or exaggerate her symptoms to avoid her career responsibilities.” Id. at 713.

Lastly, Unum tried to convince the court not to give too much weight to our client’s treating physicians. See id. at 713. While it is true that “the opinion of a treating physician ‘does not have to be afforded special deference,’” the court explained that there are also cases, such as our client’s, where “a treating physician’s greater experience with a plaintiff may…provide that physician with a superior basis for making certain determinations.” Id. at 714. Our client’s condition made opinions from treating physicians particularly valuable, because the condition requires relying upon self-reported symptoms to diagnose. Id.

Overall, the court concluded that based on the administrative record, our client had “carried her burden of establishing her disability,” and Unum’s arguments were “simply insufficient to rebut [our client’s] case…” Id. at 714. On that basis, the court reversed Unum’s denial and awarded our client benefits. Id. at 714-15.