A federal court in Tennessee ruled Unum was wrong to deny long-term disability benefits of director of operations disabled from fibromyalgia. The court required Unum to pay the claimant her long-term disability (“LTD”) benefits.
Background
Before her disability, Ms. Boersma worked for FleetCor as a director of operations. In 2017, Ms. Boersma began to suffer from joint and muscle pain and fatigue. These symptoms are related to her diagnoses of fibromyalgia and rheumatoid arthritis.
No longer able to continue working, Ms. Boersma filed for disability benefits. Her short-term disability benefits were awarded by her company. She then applied for LTD benefits. Unum denied Ms. Boersma’s claim for LTD benefits, relying in large part on a medical examination it required Ms. Boersma to attend.
Ms. Boersma appealed Unum’s denial of benefits and submitted the following evidence in support of her claim:
- Letters from her treating physicians stating she cannot perform the demands of a full-time job;
- A functional capacity evaluation (“FCE”) report revealing she did not have the physical ability to work a full-time job;
- Personal declaration describing her symptoms and the resulting limitations
- Declarations from her husband, mother-in-law, and a former coworker/supervisor
Still, Unum denied Ms. Boersma’s appeal based on a record review completed by Unum’s in-house physician. After Unum denied her appeal, Ms. Boersma filed a lawsuit to recover her benefits.
The Court’s Decision
After reviewing the facts of the case, the court ruled for Ms. Boersma and found Unum was wrong to deny benefits.
The court recognized Unum’s argument to be that Ms. Boersma’s claims were unsupported (outside of her own subjective complaints) due to unremarkable physical examinations and lack of evidence supporting impairment. The court rejected Unum’s argument.
Unum and its physicians agreed that Ms. Boersma suffers from fibromyalgia. However, Unum did not agree that the condition results in her disability and dismissed her subjective complaints. However, the court found Ms. Boersma’s subjective account of her symptoms is a legitimate source of information for the purposes of assessing limitations. The court was persuaded by the declarations of family members, the opinions of her doctors who have treated her for many years, and the results of the functional capacity evaluation, as supporting her subjective complaints.
In short, the court held the evidence submitted supports Ms. Boersma’s complaint. In contrast, the court was not persuaded by Unum’s assertion that a lack of objective evidence of physical impairment established that the Ms. Boersma’s condition is not disabling. The court dismissed Unum’s doctor’s suggestion that fibromyalgia can never be disabling. The court held that there was no support for such a suggestion.
Ultimately, the court found Unum’s emphasis on the lack of objective findings insufficient to deny benefits in light of all the evidence submitted by Ms. Boersma. Ms. Boersma was found to have documented her disabling condition sufficiently to support her claim and so the court ruled in her favor.
Help from an Attorney with Expertise in Disability Insurance
Disability insurance law is complicated. Insurance companies tend to minimize the impact of fibromyalgia and similar conditions difficult to prove through objective medical evidence. If your claim for long term disability benefits was denied or being delayed by an insurance company, it is important to get help from a lawyer with expertise in disability law.
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- 1. Our lawyers specialize in disability insurance;
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Because federal law applies to most disability insurance claims, we do not have to be located in your state to help.
Dabdoub Law Firm represents clients nationwide with:
- Submitting a disability insurance claim;
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Call to speak with a disability insurance attorney. No fees are costs unless clients are paid.
