Ohio federal court ruled that Unum unfairly terminated neuroradiologist, Dr. Robert Bulas, LTD benefits and failed to consider all the doctor’s evidence during the appeal.
Dr. Bulas began to have blurry vision and “floaters” in his eyes beginning in 2011. On April 14, 2017, Dr. Bulas experienced a sudden loss of vision in his right eye. He underwent surgery the next day following a diagnosis of retinal detachment with multiple retinal tears and a posterior vitreous detachment.
Shortly after surgery, Dr. Bulas submitted a total disability claim to Unum. On July 11, 2017, Unum approved Dr. Bulas claim for total disability benefits.
A brief history of the claim reviews demonstrates how Unum recognized he was disabled:
- Unum reviewed Dr. Bulas’ file around September 2018 and concluded he was improving but still remained unable to perform his occupation.
- Unum reviewed Dr. Bulas’ file again around April 2019 and concluded he was not getting better and “will likely only worsen.”
- Unum reviewed Dr. Bulas’ file again around September 2019 and moved his file to the “Special Benefits Unit.” (a department dedicated to handling claims for people who will likely never improve).
On November 19, 2019, Dr. Bulas underwent a cataract extraction procedure on his right eye. The surgery was successful however Dr. Bulas continued to report double vision and floaters.
On May 7, 2020, Dr. Bulas underwent a vitrectomy procedure in his right eye in an attempt to remove the floaters.
Around March 2021, Unum requested a status of Dr. Bulas’ conditions and Dr. Bulas stated his vision remained the same. Dr. Bulas’ treating doctor also completed a form for Unum and confirmed Dr. Bulas’ conditions remained the same.
On June 14, 2021, Dr. Bulas’ followed up with his doctor. The medical record noted Dr. Bulas’ “vision has remained the same” but Dr. Bulas “is overall happy with his vision.”
Because of this medical record, Unum reviewed Dr. Bulas’ claim again. Unum had three of its doctors review Dr. Bulas’ claim and conclude that Dr. Bulas’ is no longer totally disabled.
Unum then had a vocational review done on Dr. Bulas’ file. Unum’s vocational reviewer determined that Dr. Bulas’ can perform the work duties of a Diagnostic Radiologist.
On August 18, 2021, Unum terminated Dr. Bulas’ disability benefits alleging he was no longer totally disabled and stated “we have determined you are able to perform the substantial and material duties of a diagnostic radiologist, which was the dominant portion of your pre-disability occupation.”
Dr. Bulas’ timely appealed Unum’s termination of benefits by letter dated November 4, 2021. Included in the appeal were two statements he prepared, two statements from his treating doctors, and the American Board of Medical Specialties 2020 Guide to Medical Specialties. Dr. Bulas argued that Unum was wrong when it concluded his occupation was “diagnostic radiologist” and that he could perform diagnostic radiology.
Unum denied Dr. Bulas’ appeal on January 3, 2022. Following this denial, Dr. Bulas’ filed a lawsuit.
The Ohio court ruled that Unum’s decision to terminate benefits was not the result of a deliberate, principled reasoning process and was accordingly, arbitrary and capricious.
The Court concluded the following:
- Unum’s vocational review during the appeal failed to consider the creditable statements Dr. Bulas provided with the appeal;
- Unum’s doctors were not independent examiners and did not examine Dr. Bulas; and
- Unum’s reliance on the June 14, 2021 note that Dr. Bulas’ was overall happy with his vision was taken out of context and does not support the proposition that Dr. Bulas is not disabled.
The Court ruled in favor of Dr. Bulas and ordered the reinstatement of his total disability benefits.
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