Tobin v. Unum – Court Awards “Own Occupation” Disability Benefits for Intractable Headaches but Rejects the “Any Occupation” Claim

Mary Rose Tobin stopped working as an account executive after she woke up with what she called the “worst headache of [her] life,” a pain that never resolved. The court delivered a split decision: it found she could not perform her own demanding occupation, but it agreed with Unum Life Insurance Company of America that she had not proven she was unable to perform any gainful occupation at all.

Who Was the Claimant and What Condition Did She Have?

Mary Rose Tobin was an account executive in her early 30s at a Grand Rapids marketing agency when an intractable headache forced her to stop working on January 14, 2022. The condition produced constant pain, fatigue, and difficulty concentrating, and it never responded fully to treatment.

The onset was sudden and severe. Tobin woke on January 11, 2022 with a headache that over-the-counter remedies, prescription medications, and two emergency room visits could not relieve. Imaging — including CT, MRI, and venogram studies — was normal, and her providers diagnosed an “acute intractable headache.” Her treating team explained that headaches often take months and several medication trials to manage, and her neurology specialists consistently described her as a reliable and genuine reporter of her symptoms.

What Did Unum Decide Before the Lawsuit?

Unum first approved Tobin’s claims and then reversed course. It paid short-term disability benefits for the maximum period, approved her long-term disability claim in March 2022, and approved her life insurance premium waiver — only to discontinue both the long-term disability (LTD) and life benefits in March 2023 after a series of internal file reviews.

The parties stipulated that the court would review the denial under the de novo standard, meaning the court owed Unum no deference and decided for itself whether Tobin was disabled. Tobin then had the burden of proving disability by a preponderance of the evidence.

How Did the Two Disability Standards in These Policies Differ?

The case turned on two different definitions of “disability,” and Tobin had to satisfy each one separately. The first asks whether she can do her own job; the second asks whether she can do any suitable job at all.

Standard	Question it asks	Where it applied
Own / regular occupation	Can she perform her own job as an account executive?	LTD Policy — first 24 months
Any gainful occupation	Can she perform any job she is reasonably fitted for that pays at least 60% of her prior earnings?	Life Policy (after a 9-month wait); LTD Policy after 24 months

The LTD Policy also capped benefits “based primarily on self-reported symptoms” at 24 months, and it expressly listed headaches, pain, and fatigue as examples of symptoms that may not be verifiable by testing. That language proved important, because it showed the policy itself contemplated paying benefits for exactly the kind of condition Tobin had.

Why Did the Court Find Tobin Disabled from Her Own Occupation?

The court held that Tobin proved she could not perform the highly skilled work of an account executive, a role both sides agreed required frequent concentration and attention. Her evidence came from providers who actually examined her, and it was backed by objective testing.

Three categories of evidence carried the day:

• Her treating neurologist, Dr. Pomeroy — a board-certified headache specialist — and two neurology nurse practitioners examined her in person, found her reliable and genuine, and opined she was disabled from her own occupation.
• A pain-management psychologist evaluated her and found no sign of malingering or exaggeration.
• A neuropsychological evaluation produced objective test results showing she could not sustain attention and concentration over time, corroborating her treating providers.

Because the account executive role demanded sustained concentration, the court found that her documented attention deficits prevented her from doing that specific job, regardless of whether she could hold eye contact, attend a concert, or go for a hike.

Why Did the Court Give Little Weight to Unum’s File Reviews?

The court found Unum’s three file-reviewing doctors internally inconsistent, unsupported, and entitled to little weight. None of them examined Tobin in person, and their reasoning repeatedly clashed with both the policy language and Sixth Circuit law. The court identified several specific problems:

• They treated the lack of a known cause (etiology) and the “self-reported” nature of her symptoms as disqualifying — even though ERISA does not require a specific etiology and the policy itself contemplated self-reported headaches, pain, and fatigue.
• They faulted her “treatment intensity,” such as her three-to-six-month follow-ups and limited ER visits, while ignoring that her specialists set those intervals and that early ER visits had given her no relief.
• They never exercised Unum’s right to an independent medical examination, despite making judgments that depended on firsthand observation of her demeanor.
• They second-guessed the credibility findings of doctors who had actually examined her — something courts disfavor from reviewers who never saw the patient.
• They relied on normal mental status exams even though her neurologist said such exams would not detect her abnormalities and that deeper cognitive testing was needed.
• They made “speculative leaps,” pointing to activities like hiking and attending concerts with earplugs without explaining how those resembled the demands of an account executive.

Why Did the Court Reject the “Any Gainful Occupation” Claim?

The court denied this part of Tobin’s claim because she did not prove she was unable to work in any gainful occupation, a separate and higher burden. Her strong evidence was almost entirely about her own demanding job, not about her capacity for simpler work.

Her treating providers explained in detail why she could not work as an account executive, but addressed any other occupation only in cursory, conclusory sentences. Critically, the neuropsychologist’s own report noted that her deficits “may not necessarily interfere with her ability to work” and that her overall profile was within normal limits. The court also observed that Tobin’s briefing devoted little argument to this point, effectively leaving the higher standard unsupported.

What Did the Court Ultimately Order?

The court granted Tobin’s motion in part and denied it in part. It ruled that she was disabled under the “own occupation” standard but not under the “any gainful occupation” standard, and it directed the parties to submit a proposed judgment.

In practical terms, Tobin was entitled to the long-term disability benefits tied to her inability to perform her regular occupation, but not the longer-term benefits or the life insurance premium waiver, both of which required proof that she could not perform any gainful occupation. The outcome shows that a single condition can satisfy one disability definition while falling short of another in the same set of policies.

What Can Disability Claimants Learn from This Decision?

This case shows that the words in your policy define your case, and that the two halves of a disability definition must each be proven with targeted evidence. Winning on “own occupation” does not automatically win the “any occupation” stage that follows.

It also illustrates how much weight courts give to consistent, in-person treatment and objective functional testing, and how skeptically they can view paper file reviews that never examine the claimant or use an independent medical examination.

If your benefits have been denied or cut off — especially for a condition like migraine that does not show up on a scan — an experienced disability attorney can assess whether the record supports your claim before you appeal. Contact the Ortiz Law Firm for a free case evaluation, or call (888) 321-8131 today.

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Here is a PDF copy of the decision: Mary Rose Tobin v. Unum Life Insurance Company of America