Long Term Disability Benefits

Anyone in Grand Prairie, Arlington, Irving, Mansfield, Dallas, Fort Worth, Cockrell Hill, Oak Cliff, De Soto, Duncanville, Lancaster, or any other place in Texas, who has disability insurance to help in a time of need, would be interested in the following case.
The case was decided by the The United States Court of Appeals for the Fifth Circuit. It is an appeal from a summary judgment in the district court in favor of the insurance company. The case is styled, Gwendolyn Byrd v. Unum Life Insurance Company of America. The opinion was issued on April 7, 2011.
The plaintiff, Gwendolyn Byrd, filed suit challenging Unim Life Insurance Company’s decision to terminate her long term disability benefits. The job of this appeals court was to review the case for an abuse of discretion by the district court. Here is some background.
Byrd was employed as a chargeback associate for Accenture LLP when, on March 26, 2003, she suffered a repetitive-trauma work related hand injury later dianosed as carpal tunnel syndrome. Her subsequent medical complaints include that she suffered from bulging discs in her lower back, lumbar radiculopathy, cervical discogenic pain, cervical spondylosis, and other associated ailments. Byrd alleged the conditions persisted at the time of trial.
Byrd participated in Accenture’s group long-term disability program administered by Unum. In July 2004, Byrd applied for and received disability benefits. Unum paid Byrd benefits under the program from September 2003 through July 2008, when Unum terminated Byrd’s benefits after concluding that Byrd no longer was physically unable to return to her occupation. Unum made its decision to terminate Byrd’s benefits after asking at least three independent physicians and two occupational experts to review Byrd’s full medical file. Those experts agreed that Byrd would be physically able to perform her former job.
After Unum’s appeals were denied, she filed suit in district court under ERISA, Section 502(a), 29 U.S.C., Section 1132(a), seeking past damages including unpaid long-term disability benefits, a declaratory judgment that she was entitled to future benefits under the policy, and attorney’s fees.
In arguing that Unum abused its discretion, Byrd raised two arguements. First, Byrd argued that Unum improperly failed to consider her lumbar radiculopathy. Byrd argued that Unum’s decision relied on an independent medical examination performed on April 25, 2008, that did not evaluate her spine. Byrd claimed that she was diagnosed on July 3, 2007, with lumbar radiculopathy, and that she received treatment for that condition from two treating physicians, whose opinions were improperly ignored by Unum. The district court in its ruling had correctly noted, the record indicated that Byrd’s cervical and lumbar conditions were reviewed thoroughly by three board certified orthopedic surgeons and considered by two vocational specialists. At least one of the doctors explicitly addressed Byrd’s specific lumbar complaints and noted that her lumbar problems did not justify an “overly restrictive” work designation. A second physician, explicitly addressed Byrd’s complaints and noted that those ailments would not preclude Byrd from performing an eight hour workday in a sedentary occupation. The court noted that Unum plainly considered Byrd’s lumbar problems and found them insufficient to justify further benefits and thus that arguement was rejected.
Second, Byrd contended that Unum failed to consider her cervical and upper extremity impairments. The written brief of Byrd states “Byrd is limited to lifting 5 pounds and cannot do repetitive motion ….” They argued that since Unum concluded that Byrd could exert up to 10 pounds of force – or double the amount of force Byrd believes she can exert – that Unum abused its discretion. This court disagreed saying, Unum’s experts reviewed Byrd’s full medical records carefully, and each concluded Byrd could return to her previous sedentary occupation. At least one physician concluded Byrd could exert 20 pounds of force occasionally and 10 pounds of force frequently. Unum’s decision took into account Byrd’s cervical and upper extremity impairments and the courts decision is supported by substantial evidence.
Someone can never know how these cases will turn out. Many times an insurance company denies a claim without good reasons. It is sometimes just a calculated denial in hopes the claimant will disappear. Other times it is based on good reason. Each of these cases have to be looked at carefully by an experienced Insurance Law Attorney with an eye toward finding an impropriety.