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Sun Life’s Denial of Disability Insurance Benefits for Illinois Attorney Suffering from Fibromyalgia Was Unreasonable

Since 1998, Mr. Murch was a practicing transactional attorney. Unfortunately, Mr. Murch stopped working on November 7, 2018, due to his extreme fatigue and other conditions. Subsequently, Mr. Murch submitted a long-term disability (“LTD”) claim to his insurance company, Sun Life.

Mr. Murch continued to develop numerous symptoms. Although his doctors hadn’t diagnosed him with any specific condition, Mr. Murch provided evidence of his debilitating symptoms such as medical records, diagnostic imaging and testing, letters from his doctors and more.

On April 19, 2019, Sun Life denied Mr. Murch’s claim for disability stating that the medical information provided did not support disability.

Mr. Murch timely appealed the denial of his LTD benefits and enclosed reports from his doctors confirming his fibromyalgia and other conditions that limit him from working, medical records and a notice from the Social Security Administration finding that Mr. Murch is only capable of “light; unskilled work.”

Sun Life sent Mr. Murch to an independent medical examination with a rheumatologist to assess his fibromyalgia. Sun Life’s medical examiner opined Mr. Murch’s fibromyalgia was stable and medically managed.

On June 15, 2020, SunLife denied Mr. Murch’s appeal stating the medical evidence does not support restrictions/limitations. Following the denial of the appeal, Mr. Murch filed an ERISA lawsuit against SunLife.

The Court reviewed SunLife’s decision under the stricter arbitrary and capricious standard of review. The Court explained that:

“[A]rbitrary-and-capricious review turns on whether the plan administrator communicated specific reasons for its determination to the claimant, whether the plan administrator afforded the claimant an opportunity for full and fair review, and whether there is an absence of reasoning to support the plan administrator's determination.”

Mr. Murch presented four arguments to the Court: (1) SunLife denied his claim because his doctors did not diagnose him; (2) SunLife ignored the policy’s Own Occupation provision; (3) SunLife failed to consider all of Mr. Murch’s symptoms combined; (4) SunLife ignored evidence of disability and (5) SunLife improperly requested objective evidence.

The Court rejected Mr. Murch’s first three arguments but found that SunLife did ignore evidence of disability when it failed to evaluate Mr. Murch’s psychiatric and cognitive conditions. The Court concluded SunLife did not provide a full and fair review of Mr. Murch’s case by not considering his psychiatric and cognitive conditions.

The Court also found it unreasonable for SunLife to deny Mr. Murch’s claim because he lacked objective evidence of his fibromyalgia and other conditions that cannot be confirmed through labs or testing.

The Court ruled SunLife’s decision to deny Mr. Murch’s LTD claim was arbitrary and capricious.

All ERISA insurers must provide a full and fair review of your claim. A full and fair review constitutes considering all of your conditions and symptoms and how it affects your ability to do your own occupation.

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