Christoff v. Unum Life Ins. Co. of Am., No. CV 17-3512, 2019 WL 4757884 (D. Minn. Sept. 30, 2019).
A federal court in Minnesota found that Unum Life Insurance Company of America (“Unum”) abused its discretion in terminating the long-term disability (“LTD”) benefits of a high-level executive with fibromyalgia.
Mr. Christoff’s Disability Claim
For fifteen years, Mr. Michael Christoff received LTD benefits from Unum due to his disability from fibromyalgia, a condition characterized by variable pain and fatigue. During this time, Unum conducted several independent medical examinations and numerous file reviews. All agreed Mr. Christoff was unable to return to work in his own occupation as a high-level executive at an international executive search and leadership consulting company.
In the summer of 2016, Unum reviewed Mr. Christoff’s claim, as it had many times before. This included two different occupational analyses and a medical review. The medical review concluded that Mr. Christoff remained disabled, improvement was not expected, and recommended another review in one year’s time.
However, inexplicably, Unum again reviewed Mr. Christoff’s claim a mere few weeks later. Another vocational review changed the classification of his own occupation. Another medical review by the same Unum medical professional who had done the previous review suddenly determined that he was no longer disabled. Mr. Christoff also attended an independent medical examination at Unum’s request. By the end of this review, Unum terminated his benefits in November 2016. Mr. Christoff submitted his mandatory pre-suit appeal. Unum denied the appeal, and Mr. Christoff filed the lawsuit.
The Court’s Analysis and Decision
In reviewing the record, the court had to determine whether Unum abused its discretion in terminating Mr. Christoff’s benefits. The court looked at several things. First, it looked at the timing of the reviews and noted that there was no new information or reason for a second review so close to the completion of the first one. It found that subjecting Mr. Christoff to another review was a serious procedural irregularity.
Next, the court looked at the medical evidence and how Unum treated it. It found that Unum’s exclusive reliance on its own medical reviews was misplaced. Although Unum is allowed to rely on its own medical reviews, the reviews must be complete and logically flow from the medical evidence. Unum’s did not. Thus, the court found Unum abused its discretion.
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