Unum wrongly terminated a Michigan nurse’s disability benefits after paying her for five years, according to a Michigan District Court.
Carianne DeRoo, a former hospital clinical registered nurse, was insured by Unum through a long term disability policy she obtained through her employer. Unum approved the claim and paid Ms. DeRoo benefits for five years before terminating her claim. In order to receive disability benefits during the first two years of her claim, Ms. DeRoo had to prove she was disabled from her own occupation as a nurse. In order to receive further disability benefits Ms. DeRoo had to prove she was unable to work in any gainful occupation, she could do based on her education, training, or experience.
Nurse DeRoo’s Disability
Ms. DeRoo applied for long term disability benefits in 2012 due to left lower extremity lymphedema. As a result, she could not sit or stand for long periods of time and her pain and swelling increased with activity. All of Ms. DeRoo’s treating physicians opined she could not work due to the limitations caused by her medical condition. Specifically, Ms. DeRoo had to wrap her leg two to four times per week, elevate her leg to waist level for 30 minutes a day.
In 2014 Ms. DeRoo was awarded Social Security Disability benefits retroactive to her date of disability. That same year, Unum terminated Ms. DeRoo’s disability claim alleging she could work in a sedentary job involving nurse triage or nurse consulting. Ms. DeRoo appealed Unum’s termination. Unum reversed its decision and paid her benefits for two more years. In 2016, Unum again terminated Ms. DeRoo’s benefits, this time claiming her medical condition had significantly improved. Unum also claimed there were jobs she could perform that would accommodate her restrictions and limitations. Again, Ms. DeRoo appealed the termination. When Unum denied the appeal, she filed a lawsuit under ERISA.
The Court’s Decision
Reviewing Ms. DeRoo’s case de novo, a Michigan District Court held Unum wrongly terminated her disability benefits. Under this standard of review in ERISA disability cases, a court takes a “fresh look” at the facts of the case and determines whether the insurance company was wrong. The court pointed to several pieces of evidence that supported Ms. DeRoo’s continued entitlement to disability benefits including:
- Social Security Administration's disability approval;
- Ms. DeRoo’s consistent statements about her condition and restrictions:
- Unanimous opinions of Ms. DeRoo’s two treating physicians;
- Medical evidence supporting Ms. DeRoo’s restrictions and limitations;
- Opinion of the Social Security Administration's examining physician; and
- Opinion of Ms. DeRoo’s Independent Vocational Consultant.
Ultimately, the Court found there were no jobs that existed for which Ms. DeRoo was reasonably fitted based on her training, education, and experience that would accommodate her necessary restrictions and limitations. The Court ordered Unum to reinstate Ms. DeRoo’s disability claim.
Disability Insurance Companies Have Lawyers. Shouldn’t You?
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