Dardick v. Unum – Court Upholds Cardiac LTD Claim Denial

A claimant with cardiac impairments lost his long-term disability (LTD) case against Unum at both the district court level and on appeal to the Tenth Circuit. The courts found that while Dardick’s cardiac conditions were not in dispute, the medical record failed to establish that those conditions actually prevented him from performing his sedentary occupation.

The Plaintiff’s Medical History and Claim History

Richard Dardick worked as a Vice President of Cloud Services for Westcon Group, Inc. until chronic coronary artery disease forced him to stop working in August 2015. He filed for disability benefits under a Unum group plan, supported by opinions from his internist and cardiologist that his heart disease, angina, stress, depression, and anxiety prevented him from performing his job.

Unum approved short-term disability benefits through December 2015 to cover his surgical recovery periods, but denied his long-term disability claim, concluding that the medical records did not support restrictions that would prevent him from performing his primarily sedentary role.

RELATED VIDEO: Cardiac Impairments in LTD Claims

The Administrative Appeal

On appeal, Dardick submitted an additional opinion from Dr. Fanestil, his internist. 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.
• Dardick also 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.

A complete win for Unum. Here is a PDF copy of the decision: Dardick v. Unum