The Northern District of Illinois determined that Unum's denial of a nurse manager's long-term disability claim was both incorrect and unreasonable. So, the court ruled against Unum and ordered payment of unpaid long-term disability benefits.
Ms. Debra Warner’s Disability Claim
Before her disability, Ms. Warner was employed by Tyson Foods as a nurse manager. She stopped working in January 2011 due to the combined effects of fibromyalgia, osteoarthritis, chronic low back pain, and other medical conditions. Unable to work, Ms. Warner filed a claim for long-term disability benefits with Unum.
Unum denied Ms. Warner’s claim for benefits – prompting her to file an appeal against Unum. With her appeal, Ms. Warner submitted additional medical evidence supporting disability, including a functional capacity evaluation (“FCE”) and support letters from her treating providers.
Unum denied Ms. Warner’s appeal relying heavily on a medical records review completed by a consulting physician. Following the denial of her appeal, Ms. Warner filed a lawsuit against Unum.
The Court’s Decision
The court ruled for Ms. Warner finding Unum unreasonably ignored evidence of disability. Specifically, the court found that Unum “improperly disregarded the FCE that Warner submitted.”
Indeed, the court recognized that Unum did not dispute Ms. Warner’s medical conditions. Instead, the only question was whether the conditions prevented her from working as a nurse manager.
The court acknowledged the importance of the Functional Capacity Evaluation (FCE) as key evidence. The comprehensive tests clearly demonstrated that Ms. Warner couldn't perform her job.
However, the court found fault with Unum for not addressing the FCE report and dismissing its findings without providing a reason. Additionally, the court argued that Unum had a duty to explain why the FCE didn't support a disability, which it failed to do. Notably, the court stated:
“Unum did not question the FCE methodology, the qualifications of the physical therapist administering the testing, or any aspect of the examination. Nor did Unum assert, much less establish a basis to infer, that Warner was malingering or otherwise attempting to manipulate the results of the FCE.”
Because of this, the court concluded Ms. Warner must win the lawsuit because Unum was unreasonable in denying her claim without addressing the evidence of disability.
Disability Insurance Companies Have Lawyers. Shouldn’t You?
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