The Sixth Circuit Court of Appeals finds UNUM wrongfully terminated long-term disability benefits for Tennessee Nursing Home Administrator suffering from seizures. This decision reaffirmed the lower court’s decision that UNUM's behavior was unreasonable.
Ms. Evans’s Long-Term Disability Claim
Before her disability Ms. Evans was employed as a nursing home administrator with Sunbridge Health Care. Her job was demanding and stressful. She was responsible for the management of three nursing homes and was expected to make decisions on resident care, financial, budgetary, and personnel issues.
In 1995, Ms. Evans suffered a grand mal seizure. Despite suffering regular seizures, Ms. Evans continued to work. In February 1999, Ms. Evans was hospitalized and monitored for seizure activities. It was found that she had suffered from six seizures during her three-day hospitalization.
By September of 1999, Ms. Evans was no longer able to meet the demands of her job. Her doctors, concerned with the effects of workplace stress, recommend Ms. Evans stop working. She did so and filed for disability benefits. UNUM accepted her disability and made monthly disability payments from March 2000 through May 2003.
UNUM’s Termination of Benefits
On May 27, 2003, UNUM notified Ms. Evans that her LTD benefits were terminated. UNUM, and its internal physicians, dismissed Ms. Evans’ doctors’ recommendation that she avoid stress as merely preventative and not evidence of disability. UNUM also argued that her seizure activity was self-reported and not confirmed by any sort of monitoring.
For these reasons, UNUM felt Ms. Evans was capable of returning to full-time work and terminated her benefits.
Ms. Evan’s Appeal
Ms. Evans appealed UNUM's termination of benefits. As part of her appeal, she submitted a letter of support from her doctor. In his letter, the doctor made the following statements:
- Ms. Evans’ seizures were in fact monitored and documented during her hospital stay in 1999
- There were low odds that her seizures will come under complete control for a prolonged period of time
- Having intermittent seizures would make it impossible for her to perform the duties of her demanding occupation
- Stress is the most important provoking factor in seizure patients
Still, UNUM denied Ms. Evans’s appeal. UNUM again relied on its own internal doctors, while ignoring the opinions of Ms. Evans’s treating providers.
The Court’s Review of Ms. Evans’s Claim
Ms. Evans filed a lawsuit against UNUM. The court found that UNUM's decision to terminate benefits was wrong and unreasonable. In doing so, the court highlighted the following issues with UNUM's review:
- UNUM never sought an independent medical review and instead relied on its internal doctors
- UNUM ignored reliable medical evidence
- UNUM erroneously stated there was no monitoring showing seizure activity when there was – the 1999 hospitalization
- UNUM unreasonably discounted stress as merely preventative, despite her treating physician’s opinion that stress is the most important seizure-provoking factor.
The court ultimately concluded that UNUM failed to provide a reasoned explanation for the termination of benefits. Thus, Ms. Evans was awarded her past due benefits and UNUM was instructed to reinstate her benefits.
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