A Federal Court recently found that UNUM wrongfully terminated LTD benefits for a Michigan nurse with lymphedema. In DeRoo v. UNUM, the Court held that Ms. DeRoo is disabled under the terms of the policy. She is entitled to continued payment of long term disability benefits.
Ms. DeRoo was a registered nurse (“RN”) who was forced to stop working due to lower left extremity lymphedema. Her condition causes extreme swelling and pain in her left leg. As a result, she could not stand for any length of time. Also, if she sat for more than 30 minutes she needed to elevate her leg above the waist.
Ms. DeRoo was paid LTD benefits for nearly 5 years. That means UNUM found she was disabled from her own occupation. Then, after two years of benefits, she passed the stricter standard of the any occupation test. UNUM found she was disalbed from work in any occupation.
UNUM terminated her benefits based on its determination that her condition improved. UNUM also cited two alternate occupations that it said she could perform - triage nurse and medical claims review nurse. Both of these occupations were sedentary. This means she would be required to sit for about 6 hours out of an 8 hour work day.
No Medical Improvement
In reality, however, her condition had not improved. And there was no job that could accommodate her need to elevate her leg as frequently as was necessary. UNUM’s reviewing doctors (who did not examine her in person) found that she could sit for the majority of the day and elevate her leg during usual breaks. Yet, her medical records and the opinions of her doctors said the opposite. She needed frequent breaks to elevate her leg often.
The Court pointed out that UNUM wrongfully concluded she had improved. In fact, her medical records said her condition was “stable” and “unchanged. Her doctors also indicated that she reached maximum medical improvement.
The Court also examined the Social Security Admintiaraiton’s (“SSA”) Administrative Law Judge's favorable decision. The SSA found her severely imparied due to lymphedema. It also found there were no jobs she could perform.
The Court concluded that UNUM made the wrong determination. Under the terms of the policy, Ms. DeRoo was entitled to benefits because she was disalbed and unable to perform any kind of work. This case is a good example of a combination of strong medical facts and good lawyering.
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