• Menu
  • Skip to right header navigation
  • Skip to main content
  • Skip to primary sidebar
  • Skip to footer

Before Header

Has your disability claim been wrongfully denied or terminated? Call us today for help! (888) 321-8131

  • Facebook
  • LinkedIn
  • YouTube

Ortiz Law Firm

Ortiz Law Firm is dedicated to helping people recover the disability benefits they deserve. We handle group Long Term Disability (LTD) claims, individual disability insurance policy claims, ERISA disability claims, and Social Security Disability claims.

  • ABOUT US
    • Nick Ortiz
    • Our Team
    • Case Results
    • Testimonials
  • PRACTICE AREAS
    • Long Term Disability
      • Long-Term Disability Appeals
      • Long-Term Disability Lawsuits
      • Lump Sum Buyouts/Settlements
    • ERISA Disability Claims
    • Individual Disability Insurance
    • Social Security Disability Claims
      • Initial Applications for Social Security Disability
      • Request for Reconsideration
      • Hearing Before an Administrative Law Judge
    • Long Term Care Insurance Claims
    • Personal Injury Claims
  • DISABLING CONDITIONS
    • Long Term Disability
    • Social Security Disability
  • INSURANCE CARRIERS
    • View All
    • Insurance Company Tricks And Tactics
  • RESOURCES
    • Blog
    • eBooks, Guides, and More
    • Lump Sum Disability Buyout Calculator
    • Long Term Disability FAQs
    • Social Security Disability FAQs
    • Long Term Disability Glossary
    • Individual Disability Insurance Policy Analysis
    • Abbreviations in Social Security Disability Claims
  • Search
  • CONTACT

Mobile Menu

  • HOME
  • OUR FIRM
    • Nick Ortiz
    • Case Results
    • Testimonials
  • PRACTICE AREAS
    • Long Term Disability
      • Long-Term Disability Appeals
      • Long-Term Disability Lawsuits
      • Lump Sum Buyouts/Settlements
    • ERISA Disability Claims
    • Individual Disability Insurance
    • Social Security Disability Claims
      • Initial Applications for Social Security Disability
      • Request for Reconsideration
      • Hearing Before an Administrative Law Judge
    • Long Term Care Insurance Claims
    • Personal Injury Claims
  • DISABLING CONDITIONS
    • Long Term Disability
    • Social Security Disability
  • INSURANCE CARRIERS
    • View All
    • Insurance Company Tricks And Tactics
  • RESOURCES
    • Blog
    • eBooks, Guides, and More
    • Lump Sum Disability Buyout Calculator
    • Long Term Disability FAQs
    • Social Security Disability FAQs
    • Long Term Disability Glossary
    • Individual Disability Insurance Policy Analysis
    • Abbreviations in Social Security Disability Claims
  • CONTACT US
You are here: Home / Case Summary Blog / Abrams v. Unum – It’s the Disabling Symptoms That Matter, Not the Exact Medical Label

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

July 12, 2023 //  by Ortiz Law Firm//  Leave a Comment

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.”

  1. 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.

  1. 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.

FacebookTweetPinLinkedInPrintEmail

Category: Case Summary Blog, Long Term DisabilityTag: Unum

About Ortiz Law Firm

Ortiz Law Firm is a national disability law firm based in Pensacola, FL. Our mission is to provide the highest level of legal representation possible to disability claimants through our diligence, perseverance, accessibility, experience, skilled advocacy, and superior knowledge. Call (888) 321-8131 for a free case review.

Previous Post: «Do You Have to Pay Back Long Term Disability? Do You Have to Pay Back Long Term Disability?
Next Post: Brown v. LINA – Can A Peer Review Doctor Outweigh My Doctor’s Opinion? »

Reader Interactions

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *

Primary Sidebar

Top Ten Mistakes That Will Destroy Your Long Term Disability Claim

View All Resources


Our Clients Love Us

"I highly recommend Ortiz Law Firm. Very friendly staff. They helped me win my appeal against Liberty Mutual. Thank you all for being the best!!"

Lavanda T.

View All Testimonials

Learn More About Long Term Disability

  • Areas We Serve
  • Frequently Asked Questions
  • Denials and Appeals
  • Your Chances of Getting Approved
  • Medical Eligibility
  • Additional Parts That Do Not Happen in Every Case
  • Medical Conditions That May Qualify
  • Long Term Disability Insurance Carriers
  • Occupations That May Qualify

Footer

Contact Us

Our experienced disability law firm is ready to fight for you. Contact us today for a free case evaluation.

(888) 321-8131
316 S Baylen St., Ste 590
Pensacola, FL 32502

  • Email
  • Facebook
  • LinkedIn
  • YouTube

Claims We Handle

  • Group Long Term Disability
  • ERISA Disability Claims
  • Individual Disability Insurance
  • Social Security Disability Claims
  • Long Term Care Insurance
  • Florida Personal Injury

Quick Links

  • About Us
  • Free Resources
  • Client Testimonials
  • Case Results
  • Nationwide Representation
  • Refer a Case

Site Footer

© 2023 Ortiz Law Firm

Sitemap | Disclaimer | Privacy Policy

Share this ArticleLike this article? Email it to a friend!

Email sent!