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Unum wins appeal cutting off worker’s long-term disability benefits
A federal appeals court upheld Unum Life Insurance Company of America’s finding that the worker was still able to do sedentary, gainful work under the plan’s stricter test after April 13, 2022.
A federal appeals court has affirmed Unum Life Insurance Company of America’s decision to end a worker’s long-term disability benefits, ruling the employee was still capable of sedentary work after a plan switch tightened the eligibility standard.
According to Insurance Business, the worker hurt his left shoulder in October 2019, received surgery in November 2019, and began receiving short-term disability benefits before long-term benefits started in April 2020.
The plan defined “disabled” one way for the first 24 months, but after that it required the worker to be unable to perform the duties of any gainful occupation he was reasonably fitted for by education, training, or experience.
Insurance Business reports that treating surgeon notes supported the ability to do “mostly seated work” with light lifting through the plan’s change period, and a Unum vocational consultant identified jobs the worker could perform; Unum ended benefits as of April 13, 2022, when the “any gainful occupation” standard took effect, and the appeals court found no clear error in the lower court’s review.