In Dardick v. Unum Life Insurance Company of America and First Unum Life Insurance Company, Unum succeeded in denying the claimant long-term disability insurance benefits.
Dardick filed a lawsuit after Unum Life Insurance Company of America denied his claim for benefits under a group disability benefits plan provided by his previous employer, Westcon Group, Inc. The U.S. District Court ruled in favor of Unum at the lower Federal Court level. On appeal, the Tenth Circuit Court of Appeals also ruled in favor of Unum.
The Plaintiff’s Medical History and Claim History
Mr. Dardick worked for Westcon as a Vice President of Cloud Services. He stopped working on August 21, 2015, due to chronic coronary artery disease and other related medical conditions.
Dardick applied for disability benefits in early August 2015.
Unum approved Dardick’s claim for short-term disability (“STD”) insurance benefits through December 23, 2015. The STD approval was based on Dardick’s coronary artery disease and the recovery periods required for two surgeries in late 2015.
Dardick subsequently applied for long-term disability (“LTD”) insurance benefits based on the opinions of Dr. Bradley Fanestil, an internist, and Dr. Nelson Trujillo, a cardiologist. These physicians opined that Dardick could not perform his job due to his chronic coronary artery disease, angina, stress, depression, and anxiety.
Unum denied the LTD claim, concluding that the medical records did not support restrictions that would prevent Dardick from performing his regular sedentary (primarily sit-down, or desk) occupation.
Dardick filed an administrative appeal and provided another opinion report from Dr. Fanestil.
Unum had the claim file reviewed by Susan Grover, a nurse clinical consultant. Nurse Grover found no support for a finding of disability. Unum also sought opinion evidence as to Dardick’s job requirements from Richard Byard, a vocational consultant. Mr. Byard changed the original classification of Mr. Dardick’s vocational position as Systems Project Manager to that of a Cloud Solution Manager, and he determined that this position only required sedentary exertional activity. Mr. Byard recognized that Dardick claimed his particular occupation required extensive travel. However, Mr. Byard opined that the position did not require extensive travel as the position is normally performed in the economy.
Based on Nurse Grover’s and Mr. Byard’s reports, Unum denied benefits.
Dardick filed another administrative appeal and included reports from his treating physicians.
Nurse Grover requested an additional review of the medical evidence, which was performed by Dr. Chris Bartlett. Dr. Bartlett opined that the medical evidence did not support a finding of disability.
Unum denied the second appeal based on Dr. Barlett’s opinion.
The Lawsuit
After exhausting all of his administrative appeals with the insurance company, Dardick filed a lawsuit in federal court.
Dardick argued that Unum’s treatment of the medical evidence demonstrated that the denial of benefits was arbitrary and capricious.
First, he argued that Unum’s initial benefits decision was based solely on surgery recovery times, rather than on his coronary artery disease. The Court found that this argument was not supported by the record.
Dardick also argued that Unum ignored the stress of his job or erroneously considered that all job stress is the same. However, Dr. Bartlett acknowledged that Dardick’s “job could indeed be stressful,” but found that the “lack of any treatment” with appropriate medication was inconsistent with a disabling intolerance of stress. The Court therefore concluded that substantial evidence supported Unum’s determination.
Finally, Dardick challenged Unum’s reliance on its medical reviewers, Ms. Grover and Dr. Bartlett, arguing that neither of them had the necessary training or experience in advanced cardiac disease or mental health conditions related to cardiac disease to offer an opinion. The Court of Appeal agreed with the lower district court that “Unum did not make a medical judgment as to whether [Mr. Dardick] suffered from coronary artery disease or other cardiac conditions identified by Dr. Trujillo but rather determined that [his] medical record failed to establish that [he] was incapable of performing his job despite these conditions.”
One other notable argument that Plaintiff raised was an allegation that Unum mischaracterized the nature of Plaintiff’s work as a vice president for Westcon, which was a procedural irregularity demonstrating arbitrariness. However, the Plan provided that an employee’s occupation would be viewed “as it is normally performed in the national economy, instead of how the work tasks are performed for a specific employer or at a specific location.” The Court, therefore, concluded that Unum’s assessment of Dardick’s occupation was not arbitrary and capricious.
Summary
A complete win for Unum.
Disclaimer: This was not a case handled by disability attorney Nick A. Ortiz. The court case is summarized here to give readers a better understanding of how Federal Courts decide long-term disability ERISA claims.
Here is a PDF copy of the decision: