Anne Wittmann (“Wittmann”) was an attorney at Baker, Donelson, Bearman, Caldwell, Berkowitz PC (“Baker Donelson”). Unum Life Insurance Company of America (“Unum”) administered and underwrote the long-term disability (LTD) plan that covered Wittmann. Wittmann filed a claim for disability benefits on April 7, 2014, since she had not worked from December 31, 2013. Under the plan, disability is defined as the following:
“You are disabled when Unum determines that due to your sickness or injury: 1. You are unable to perform the material and substantial duties of your regular occupation and are not working in your regular occupation or any other occupation. You must be under the regular care of a physician in order to be considered disabled.”
Wittmann explained that her cause for her condition was “unknown – other fibromyalgia and pericarditis,” including “chest pain, SOB, muscle/joint pain, fatigue, lightheaded.” Further, she stated that she was “unable to concentrate” and her “physical endurance [wa]s limited due to pain and fatigue.” Wittmann cited her doctors as: Dr. Charles Chester, psychiatrist; Dr. Frank Cruz, Internal Medicine/Nephrology; Dr. Robert Kelly, Physician; Dr. William Davis, Rheumatologist; and Dr. Robert Lizana, Chiropractor. Unum asked Dr. Cruz about Wittmann’s potential restrictions and limitations and he stated that “As of this time she is unable to perform her usual job. I am not able to predict when she may resume usual employment.” Additionally, Baker Donelson submitted information relating to the requirements that Wittmann needed to perform her duties as an attorney. Specifically, this included:
- Ability to concentrate and pay close attention to detail for up to 100% of work time.
- Analytical skills necessary to conduct complex and detailed analysis of legal matters.
- Work requires more than 40 hours per week to perform the essential duties of the position.
- Must be able to maintain regular attendance to meet client and Firm’s needs.
As a result of the above, Unum decided that the requirements of Wittmann’s occupation were “performed at a sedentary exertional demand level and require[d] frequent concentration/attention to detail/focus and multi-tasking.” Unum conducted an initial phone interview with Wittmann related to her claim. She stated that she was diagnosed with pericarditis in November of 2012 and she experienced “horrible fatigue and muscle and joint pain.” Unum then began reviewing Wittmann’s medical records.
On July 31, 2014, Unum contacted Dr. Davis to inquire about Wittmann’s ability to meet the requirements of her job full-time. Dr. Davis said that he was “uncertain” and “she has chronic pain and fatigue that likely impair her ability to focus for 8 hours on complicated issues.” Unum then had a Family Medicine physician, Dr. Tony Smith, work to review Wittmann’s file and contact her doctors. Eventually, Dr. Smith decided that Wittmann’s existing restrictions and limitations were not supported by her medical records because the records did not show physical or cognitive deficits.
Unum had another physician review Wittmann’s file, Dr. James Bress. He determined that Dr. Davis did not provide any restrictions or limitations. Further, Dr. Bress stated that there was no evidence of cognitive impairment or tender point testing used for a diagnosis of fibromyalgia. As a result, Unum denied Wittmann’s claim for benefits. Wittmann appealed on January 26, 2015. She claimed that evidence of tender point testing had been overlooked by Unum and additionally submitted a letter from her psychiatrist. Dr. Chester said that “I do not believe she has the capacity to function in her job as a lawyer because of the fatigue, the pain, and the lack of ability to concentrate.”
Unum had an additional consultant review the appeal: Dr. Chris Bartlett. He opined that: “Regardless of the presence or absence of FMS, however, the insured’s functional capacity is what matters. FMS is not in and of itself necessarily a disabling diagnosis and any people with FMS work full-time, controlling their symptoms with exercise and medication.” Further, Dr. Bartlett believed that the restrictions of no full-time sedentary work were out of proportion because of the lack of data and testing indicating cognitive deficiency. Therefore, Unum upheld Wittmann’s denial of benefits.
On October 24, 2016, Wittmann provided her Social Security disability determination. Unum attempted to obtain the SSI file, but never received it. As a result of other medical records that it had reviewed, Unum opted to pay twenty-four months of mental health disability benefits. The record held information that supported that Wittmann was anxious and unable to concentrate. Wittmann additionally provided a report from Dr. Fowler, psychologist. He stated that “given the cognitive demands of her profession, it does seem that she would currently have some difficulty performing work related tasks, including ability to focus, read, retain, analyze, and recall information. Complaints of lowered energy, pain, and fibromyalgia may render her unable to perform even simple job tasks in a stable, reliable manner.” Wittmann claims this report must show that she has fibromyalgia. However, Unum was unable to identify the specific reason that the SSI benefits were awarded.
Wittmann’s main arguments were that Unum’s denials of her alleged benefits were not supported by any substantial evidence. However, the court disagreed with her. In fact, the court believed that Unum made its denial decisions based on the evidence provided in the record. Wittmann believed that Unum denied her benefits because she did not meet the diagnostic criteria for fibromyalgia. In actuality, Unum stated that it denied her benefits because Dr. Smith and Dr. Bress could not find any medical evidence to show that she would not be able to complete her duties as an attorney.
Unum’s reviewing physicians examined Wittmann’s treating physicians’ opinions relating to her inability to concentrate and perform work. However, Unum’s physicians were unable to obtain any medical evidence to support those opinions. Overall, the court agreed with Unum in its denial of Wittmann’s determinations. It cited that Unum was not arbitrary and capricious in its decision-making and that its decisions were based on evidence provided throughout the entire record. As such, it ruled in favor of Unum’s motion.[Note: this claim was not handled by the Ortiz Law Firm. It is merely summarized here for a better understanding of how Federal Courts are handling long term disability insurance claims.]
Here is a PDF copy of the decision: