Today we review Arenson v. First Unum Life Insurance Company that was decided by the United States District Court for the Northern District of Illinois.
Gregg Arenson was a futures and options trade broker. He sued his former employer’s benefits administrator, First Unum Life Insurance Company (hereinafter “Unum”) under ERISA.
He challenged Unum’s denial of his long term disability insurance claim and waiver of life insurance premium claim. We will focus on the LTD claim.
Arenson argued that Unum discounted the effect of his cognitive disabilities after he suffered a stroke at work. Unum’s long-term disability plan affords it discretion in benefits determinations, and the Court may not overturn those determinations unless Unum’s decision was so unreasonable as to be arbitrary and capricious.
The Court found that Arenson’s medical records did not reveal severe cognitive difficulties. The Court did, however, find that Unum’s qualified physicians adequately explained why – in their opinions – isolated mild cognitive inefficiencies did not preclude Arenson from returning to work. As such, the Court concluded, “The Court cannot find, based on that evidence, that Unum’s decision was irrational.” The Court therefore denied Arenson’s motion for partial summary judgment and granted Unum’s motion for summary judgment.
Under the Unum Long Term Disability Plan, an employee is considered “disabled” if the individual is “limited from performing the material and substantial duties of [the individual’s] regular occupation due to . . . sickness or injury” and has a resulting loss in income of 20 percent or more. Further, a “regular occupation” is one that the employee “is routinely performing when [the] disability begins.”
It is important to note that to determine an employee’s regular occupation, Unum examines the occupation “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.”
Unum sent letters to one of the claimant’s treating physicians, asking whether Arenson could perform the listed job requirements in the vocational analysis. How own treating physician replied that Arenson could perform those occupational demands and return to work!
Unum then obtained reviews of Arenson’s medical records from two in-house internal medicine physicians, Dr. Renee Chervenak and Dr. Sharon Hogan. Both doctors reported that Arenson could perform the material duties of his former job, citing the lack of “focal, neurological, cognitive or functional deficits” reflected in the records.
Relying on Dr. Chervenak and Dr. Hogan’s findings, Unum denied Arenson’s Long Term Disability claim in a letter.
Arenson appealed Unum’s decision. In support of his appeal, Arenson submitted the results of tests performed by Steven Rothke, a board-certified clinical neuropsychologist. As part of his medical evaluation, Dr. Rothke interviewed Arenson, spoke with Arenson’s former colleagues, and performed dozens of tests intended to measure Arenson’s cognitive abilities. Dr. Rothke concluded that Arenson displayed “a few isolated cognitive impairments/inefficiencies . . . (although this still may represent a decline from his pre-stroke level of functioning).” However, Arenson exhibited average or above average levels of functioning in almost all areas of testing.
Arenson also submitted a vocational report prepared by a vocational expert (“VE”). The VE determined that Arenson’s job responsibilities, which required managerial skills and quick thinking, encompassed more than those of a broker or securities trader. Both the VE and Dr. Rothke concluded that Arenson would not be able to manage his so-called job responsibilities in light of his cognitive difficulties.
Unum had more physicians review the claim. In short, Unum’s physicians opined that Arenson could return to work while Arenson’s physician opined he could not return to work.
After a final administrative denial, Arenson filed a lawsuit against Unum under ERISA.
Arenson argued that he fit the definition of disability because his strokes caused a mild neurocognitive disorder that rendered him unable to complete problem solving tasks inherent to his former position. Unum denied the claim, concluding that medical records reflected a recovery from his stroke and that “subsequent testing did not reflect cognitive or psychiatric impairment.”
The Court reviewed the evidence and found that Unum reasonably relied on the opinions of multiple physicians to reach its determination to deny benefits.
It is important to note that Unum granted Arenson’s request to hire a neuropsychologist, Dr. Nowell, to review his neuropsychological testing. The court noted, “[T]he mere fact that [Unum] sought an independent review at all tends to suggest that [its] decision was not arbitrary and capricious.” (internal citation omitted).
Arenson made much of the fact that the reviewing neuropsychologist apparently did not obtain the raw data from his neuropsychological evaluation despite Brown’s recommendation to do so. However, the Court found that the reviewing physician’s decision not to request the data did not render Unum’s decision to deny Arenson’s benefits arbitrary.
The Court emphasized that:
“the issue in this case is not “whether [the Court] would have terminated [Arenson]’s benefits, but whether Unum’s decision to do so finds rational support in the record.”
The Court stated:
“At least five medical professionals, including one of Arenson’s treating physicians, determined that he did not suffer from any cognitive impairment. Those determinations found support in medical evidence that included neuropsychological testing and evaluation.”
Again, the Court clarifies, “That’s not to say the evidence compelled [Unum]’s decision, just that it permitted it.”
Given that standard of review, the Court finally concluded: “The deferential standard of review afforded to Unum resolves Arenson’s Long Term Disability claim.”