Court: United States District Court for the Middle District of Tennessee, Nashville Division
Insurance Carrier: Unum Life Insurance Company of America
Claimant’s Employer: Vanderbilt University Medical Center
Claimant’s Occupation: Nurse Practitioner and Instructor
Disclaimer: Please note that this claim was not handled by the Ortiz Law Firm. It is summarized here for educational purposes.
A Medical Professional’s Battle with Chronic Illness
Nicole Mercer, a dedicated nurse practitioner and instructor at Vanderbilt University Medical Center, stopped working full-time in September 2020 due to a combination of chronic health conditions, including fibromyalgia, chronic fatigue syndrome, postural orthostatic tachycardia syndrome (POTS), and autonomic dysfunction. Under Vanderbilt’s long-term disability plan, administered by Unum, Mercer applied for benefits after her hours were reduced, citing persistent fatigue, pain, and cognitive dysfunction as the symptoms qualifying her for benefits.
Her elimination period—the required 180-day window during which she had to show continuous disability before benefits actually start to be paid—began on September 25, 2020, and ended on March 23, 2021. Despite Mercer’s submission of medical records and a statement from her treating nurse practitioner supporting her claim, Unum denied her claim.
Insurer Points to Purported Inconsistent Medical Evidence
Unum’s internal review concluded that Mercer’s medical conditions were not disabling during the elimination period. Several of her own medical records described her symptoms as “tolerable,” “stable,” or “well controlled.” One doctor noted that she regularly biked, used a treadmill, and did weight training-activities. Unum found these activities to be inconsistent with Mercer’s claim of severe disability.
Three internal medical reviewers—all of whom conducted file reviews without examining Mercer—agreed that the record did not support any work restrictions. Although Mercer had some support from her nurse practitioner, Kathryn Hansen, and later treating physicians, Unum gave more weight to its internal reviews.
Mercer’s Appeal Offers Strong Support but Falls Short
On appeal, Mercer submitted new records and letters from several treating providers who emphasized that she could not sustain even part-time work due to her debilitating fatigue. A vocational expert also concluded she was totally disabled, but not until May 2021—after the elimination period had ended.
Mercer also included letters from her ex-wife and current partner describing her daily struggles. Unum, however, maintained its denial, emphasizing that much of the additional evidence either described events after the elimination period or did not provide objective data showing functional impairment during that critical period.
Court Upholds Unum’s Denial as Reasonable
Applying the highly deferential “arbitrary and capricious” standard under ERISA, the court ruled in favor of Unum. It found that the insurer’s decision was supported by substantial evidence and was the product of a “deliberate, principled reasoning process.”
The court emphasized that while Mercer had presented evidence of actual medical conditions, she did not meet the plan’s requirement of continuous disability during the elimination period. It also rejected her procedural challenges regarding conflicts of interest, finding no concrete evidence that Unum’s internal processes biased the outcome.
We Challenge Unfair Disability Denials
If your disability claim has been denied because the insurance company says your symptoms weren’t severe enough during the elimination period, the Ortiz Law Firm may be able to help. We understand how complex medical conditions like fibromyalgia and POTS can affect your ability to work—and we know how to challenge unfair denials. Contact us today to schedule a free consultation. Call (888) 321-8131 to get started.
Here is a PDF copy of the decision: Mercer v. Unum Life Insurance Company of America
