The Eleventh Circuit Court of Appeals held that Unum’s conclusion that the claimant had no cognitive limitations was not supported by the record.
Sonja Sisung worked as a pharmacist. One day while at work, she fell backward off a rolling metal stool and injured her back. She was treated with prescription pain medication, physical therapy, and injections but nothing helped.
She eventually filed for disability benefits with her insurance company, Unum Life Insurance Company of America. Unum approved her long-term disability benefits and paid benefits for 24 months, acknowledging that she was disabled from her own occupation as a pharmacist.
After 24 months, Unum conducted a review to determine if Ms. Sisung was disabled from any occupation based on her education, training, and experience. During the review, Ms. Sisung reported the pain remained unchanged, and she experienced medication side effects such as dizziness and cognitive impairments.
However, based on Unum’s medical review and vocational review—which identified three sedentary pharmacy level jobs—Unum terminated her claim after 24 months and denied any future benefits.
Ms. Sisung appealed the denial to Unum. As part of her appeal, she included a neuropsychological evaluation that documented cognitive impairments and declines, which the neuropsychologist attributed to pain and medication side effects. Nonetheless, Unum disagreed that Ms. Sisung had any cognitive limitations and denied the appeal.
The Appellate Court Found Ms. Sisung Disabled
Following the denial of her appeal, Ms. Sisung filed a lawsuit in federal court. The trial court found that the basis for the denial was reasonable and sided with Unum. Ms. Sisung appealed to the Eleventh Circuit Court of Appeals.
On appeal, the Court disagreed. The Court reviewed the record and noted that it did not contain any contradictory statements or information to dispute the results of the neuropsychological evaluation. Moreover, the Court addressed Unum’s argument that Ms. Sisung was not cognitively disabled because office visit examinations were normal, she could manage her finances, and used a computer with some proficiency. The Court disagreed and stated that those activities were not inconsistent with the neuropsychologist’s conclusion that she could not work as a pharmacy manager or pharmacist.
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