Court: United States District Court for the Southern District of Florida, Miami Division
Insurance Carrier: Unum Life Insurance Company of America
Claimant’s Employer: Johns Hopkins Bayview Medical Center
Claimant’s Occupation: Clinical and Research Nurse
Disclaimer: Please note that this claim was not handled by the Ortiz Law Firm. It is summarized here for educational purposes.
From Providing Compassionate Care to Chronic Pain
Yvette Eggleston dedicated her career to nursing, working for more than a decade at Johns Hopkins Bayview Medical Center in a variety of clinical and research roles. Her work included complex patient care, staff supervision, and specialty areas like oncology. But in February 2011, her professional life came to a halt due to a cascade of chronic medical problems, including lower back pain, fibromyalgia, undifferentiated connective tissue disorder (UCTD), and other inflammatory conditions that caused persistent pain and fatigue.
Unum, the long-term disability insurance provider for Johns Hopkins employees, initially approved Eggleston’s claim in 2011. For years, Unum approved the LTD claim and paid benefits, citing chronic pain and limited mobility as reasons she could not perform even sedentary work. Unum even transferred the claim to its “core” department, which is reserved for less intensive reviews.
Changing Course: Social Media and Reevaluation
In 2021, Unum reevaluated Eggleston’s claim after reviewing her social media posts. Photos and posts promoted “Yvette’s Soul Food Kitchen” and documented travel and event attendance. Unum interpreted this activity as evidence of increased functional capacity and transferred her case out of its “core” unit for a more in-depth review.
The company then initiated a thorough medical reevaluation. Although Eggleston’s doctors continued to assert that she was disabled and unable to sit or stand for long periods of time, Unum’s internal medical consultants—none of whom had personally examined her—reviewed her medical records and determined that she could perform full-time sedentary work. These consultants emphasized stable test results, minimal objective clinical findings, and the effectiveness of her medications in managing her symptoms.
Denial Upheld Despite Extensive Support
In early 2022, Unum formally terminated Eggleston’s benefits. She appealed the decision, submitting an extensive package of medical records, statements from seven treating providers, a functional capacity evaluation (FCE), and pain questionnaires. The FCE concluded that she could not sit, stand, or walk long enough to maintain any employment.
Nevertheless, Unum stood by its decision. The reviewing physicians noted that her imaging and lab results did not show impairments severe enough to preclude sedentary work, and one reviewer even questioned the validity of the FCE based on her lack of an elevated heart rate during exertion testing.
The Court Sided with Unum
The court applied an “arbitrary and capricious” standard, deferring to Unum’s discretion under ERISA. It acknowledged conflicting medical opinions but found that Unum’s decision was reasonable in light of the evidence. Emphasizing that Unum was not required to favor treating doctors over independent medical providers (even providers who did not examine the claimant in person), the court concluded that there was no indication that Unum’s decision was driven by its conflict of interest as both claims administrator and insurer.
As a result, the court granted summary judgment in favor of Unum and closed the case.
If your disability benefits have been denied based on alleged social media activity or conflicting medical opinions, the Ortiz Law Firm can help. We have experience representing individuals with chronic pain conditions such as fibromyalgia and inflammatory arthritis. Contact us to protect your rights and secure the benefits you deserve.
Here is a PDF copy of the decision: Eggleston v. Unum
