Abrams v. Unum – It’s the Disabling Symptoms That Matter, Not the Exact Medical Label

Today we review Abrams v. Unum Life Insurance Company of America that was decided by the United States District Court for the Western District of Washington.

William Abrams was a trial and appellate lawyer for the Schwabe law firm. His disabilities were described as debilitating symptoms from an illness. Although the exact medical condition was not definitively diagnosed or named, he was diagnosed by various doctors with “long COVID” and chronic fatigue syndrome (CFS). The symptoms which caused his inability to work are described as almost daily fevers, brain fog, decreased attention and concentration, malaise, and being housebound.

He sued his former employer’s benefits administrator, Unum Life Insurance Company of America (hereinafter “Unum”) under ERISA. He challenged Unum’s denial of his long term disability insurance claim.

Legal Arguments

The main arguments by the Plaintiff can be summarized as follows:

Inability to perform duties of regular occupation: The Plaintiff argued that he was unable to perform the material and substantial duties of his regular occupation (as a trial lawyer) throughout a 90-day elimination period and beyond due to his health condition.

Deterioration in health: The Plaintiff details the significant shift in his health and abilities observed by his family, doctors, and colleagues since April 2020. He states he went from training for marathons and working 12-hour days on complex legal matters to being housebound.

Confirmation of illness by doctors: The Plaintiff argues that multiple medical doctors have confirmed his illness, diagnosing him with “long COVID” and chronic fatigue syndrome (CFS). Further, neuropsychological testing revealed that he was not malingering or pretending to be sick.

Significant lifestyle changes due to illness: The Plaintiff argues that his inability to work due to his illness led him to exhaust his savings, sell his house, and draw on his retirement savings, implying the seriousness and severity of his condition.

The Court Rules in Favor of Abrams

The ruling makes several important findings and determinations:

1. The court concluded that the plaintiff was unable to perform the material and substantial duties of his regular occupation as a trial lawyer due to the severe symptoms he suffered. The Court focused on the plaintiff’s subjective symptoms and not on the plaintiff’s formal diagnoses or objective medical findings. His symptoms included daily fevers, decreased attention and concentration, and general malaise. Tellingly, the Court said:

“If Plaintiff cannot follow movie plots … and suffers daily fevers, … then Plaintiff cannot be expected to plan out trial strategies for multiple, complex cases.”

Therefore,

“The Court finds, by a preponderance of the evidence, that Plaintiff was unable to perform the material and substantial duties of his occupation throughout the elimination period, and he is not capable of performing his duties today.”

2. Despite conflicting diagnoses from the plaintiff’s doctors (including “long COVID” and chronic fatigue syndrome (CFS), the court emphasized that it’s the disabling symptoms causing an inability to work that matter, not the exact medical label for these symptoms:

“The accuracy of Plaintiff’s diagnoses is not, however, the question before the Court. As observed in another matter involving Unum,

‘Unum may be correct that [the plaintiff] has not been correctly diagnosed. But that does not mean he is not sick. If [the plaintiff’s] complaints, and [the doctor’s] assessments, are to be believed, [the plaintiff] cannot focus for more than a few minutes at a time, making it impossible for [the plaintiff] to perform the varied and complex tasks his job requires. ’”

This aligns with the court’s reliance on the precedent case Bunger v. Unum Life Ins. Co. of Am., where the judge stated that a lack of a correct diagnosis does not imply that the plaintiff is not sick.

3. Additionally, the court clarified that a doctor’s recommendation for “light physical activity” did not equate to the ability to return to the demanding nature of trial work:

“Defendant argues that one of Plaintiff’s doctors encouraged him to return to work. Defendant overstates the evidence. One of Plaintiff’s physicians encouraged him to resume “light physical activity.” AR 3903. “Light physical activity” does not automatically mean that Plaintiff can engage in the grueling practice of trial work.”

Overall, the court ruled in favor of the plaintiff on the issue of his disability and entitlement to benefits.

Click here for the full PDF copy of the Abrams v. Unum decision.