{"id":7569,"date":"2020-05-04T15:43:02","date_gmt":"2020-05-04T20:43:02","guid":{"rendered":"https:\/\/www.nickortizlaw.com\/?p=7569"},"modified":"2024-01-04T17:26:30","modified_gmt":"2024-01-04T22:26:30","slug":"wittman-v-unum-ltd-denial-was-not-arbitrary-and-capricious","status":"publish","type":"post","link":"https:\/\/www.nickortizlaw.com\/wittman-v-unum-ltd-denial-was-not-arbitrary-and-capricious\/","title":{"rendered":"Wittman v. Unum – LTD Denial Was Not Arbitrary And Capricious"},"content":{"rendered":"

Anne Wittmann (\u201cWittmann\u201d) was an attorney at Baker, Donelson, Bearman, Caldwell, Berkowitz PC (\u201cBaker Donelson\u201d).\u00a0Unum Life Insurance Company of America<\/a> (\u201cUnum\u201d) administered and underwrote the long term disability (LTD) plan<\/a> 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:<\/p>\n

\u201cYou are disabled when Unum determines that due to your\u00a0sickness or injury<\/strong>: 1. You are unable to perform the\u00a0material and substantial duties\u00a0<\/strong>of your\u00a0regular occupation<\/strong>\u00a0and are not working in your regular occupation or any other occupation. You must be under the regular care<\/a> of a physician in order to be considered disabled.\u201d<\/p>\n

Wittmann explained that her cause for her condition was \u201cunknown \u2013 other\u00a0fibromyalgia<\/a>\u00a0and\u00a0pericarditis<\/a>,\u201d including \u201cchest pain, SOB, muscle\/joint pain, fatigue, lightheaded.\u201d Further, she stated that she was \u201cunable to concentrate\u201d and her \u201cphysical endurance was limited due to pain and fatigue.\u201d 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\u2019s potential restrictions and limitations and he stated that \u201cAs of this time she is unable to perform her usual job. I am not able to predict when she may resume usual employment.\u201d Additionally, Baker Donelson submitted information relating to the requirements that Wittmann needed to perform her duties as an attorney. Specifically, this included:<\/p>\n

    \n
  1. Ability to concentrate and pay close attention to detail for up to 100% of work time.<\/li>\n
  2. Analytical skills necessary to conduct complex and detailed analysis of legal matters.<\/li>\n
  3. Work requires more than 40 hours per week to perform the essential duties of the position.<\/li>\n
  4. Must be able to maintain regular attendance to meet client and Firm\u2019s needs.<\/li>\n<\/ol>\n

    As a result of the above, Unum decided that the requirements of Wittmann\u2019s occupation were \u201cperformed at a sedentary exertional demand level and require[d] frequent concentration\/attention to detail\/focus and multi-tasking.\u201d 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 \u201chorrible fatigue and muscle and joint pain.\u201d Unum then began reviewing Wittmann\u2019s medical records.<\/p>\n

    On July 31, 2014, Unum contacted Dr. Davis to inquire about Wittmann\u2019s ability to meet the requirements of her job full-time. Dr. Davis said that he was \u201cuncertain\u201d and \u201cshe has chronic pain and fatigue that likely impair her ability to focus for 8 hours on complicated issues.\u201d Unum then had a Family Medicine physician, Dr. Tony Smith, work to review Wittmann\u2019s file and contact her doctors. Eventually, Dr. Smith decided that Wittmann\u2019s existing restrictions and limitations were not supported by her medical records because the records did not show physical or cognitive deficits.<\/p>\n

    Unum had another physician review Wittmann\u2019s 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\u00a0cognitive impairment<\/a>\u00a0or tender point testing used for a diagnosis of\u00a0fibromyalgia. As a result, Unum denied Wittmann\u2019s 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 \u201cI 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.\u201d<\/p>\n

    Unum had an additional consultant review the appeal: Dr. Chris Bartlett. He opined that: \u201cRegardless of the presence or absence of\u00a0FMS (fibromyalgia), however, the insured\u2019s functional capacity is what matters.\u00a0FMS\u00a0is not in and of itself necessarily a disabling diagnosis and any people with\u00a0FMS\u00a0work full-time, controlling their symptoms with exercise and medication.\u201d 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\u2019s denial of benefits.<\/p>\n

    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<\/a> of mental health disability benefits<\/a>. 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 \u201cgiven 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\u00a0fibromyalgia\u00a0may render her unable to perform even simple job tasks in a stable, reliable manner.\u201d Wittmann claims this report must show that she has\u00a0fibromyalgia. However, Unum was unable to identify the specific reason that the SSI benefits were awarded.<\/p>\n

    Wittmann\u2019s main arguments were that Unum\u2019s 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\u00a0fibromyalgia. 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.<\/p>\n

    Unum\u2019s reviewing physicians examined Wittmann\u2019s treating physicians\u2019 opinions relating to her inability to concentrate and perform work. However, Unum\u2019s physicians were unable to obtain any medical evidence to support those opinions. Overall, the court agreed with Unum in its denial of Wittmann\u2019s 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\u2019s motion.<\/p>\n[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.]\n

    Here is a PDF copy of the decision: Wittman v. Unum<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

    Anne Wittmann (\u201cWittmann\u201d) was an attorney at Baker, Donelson, Bearman, Caldwell, Berkowitz PC (\u201cBaker Donelson\u201d).\u00a0Unum Life Insurance Company of America (\u201cUnum\u201d) 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 …<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[1],"tags":[242],"_links":{"self":[{"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/posts\/7569"}],"collection":[{"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/comments?post=7569"}],"version-history":[{"count":0,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/posts\/7569\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/media?parent=7569"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/categories?post=7569"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/tags?post=7569"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}