The case of Chris Bunger v. Unum Life Insurance Company of America, is an example of how hard an insurer will fight in order to avoid paying a claim for short term and long term disability benefits. This was the second district court opinion on this case out of Seattle, but it will not be the last one.

Plaintiff first became ill in early 2014 and was unable to continue in his employment as a Web Content Specialist with the Costco Wholesale Corporation. He suffered from chronic fatigue syndrome (CFS), Lyme disease, or an unspecified illness causing him to be constantly fatigued with an inability to concentrate.

For a few months, Unum granted Plaintiff short term disability benefits (STD), but on August 29, 2014, terminated those benefits and denied his claim for long term disability benefits (LTD). Unum alleged that plaintiff had not been properly diagnosed, and had not proven he was disabled from performing his own occupation.

The Court disagreed with Unum and found that, although a close case, Plaintiff had presented sufficient evidence to prove he had been disabled from performing the job requirements of his own occupation, so was entitled to STD and LTD benefits on that ground. Since there had been no analysis of whether or not he was disabled from working in “any occupation,” in order to justify further LTD benefits, the Court remanded for Unum’s determination of that claim.

Plaintiff is Disabled from Working in His Own Occupation When Treating Physicians’ Reports More Credible than those of Reviewing Physicians

Unum’s disability plan allowed for disability benefits, both STD and LTD, for a period of time when Plaintiff was unable to perform the duties of his own occupation. All of Plaintiff’s treating physicians agreed he suffered from chronic fatigue and brain fog, which prevented him from performing the duties of a Web Content Specialist, which required “excellent written and verbal communication skills” as well as concentration, attention to detail, and ability to multi-task, among other things.

Unum argued that there were no medical tests supporting the diagnosis of CFS or fibromyalgia, and no positive results for Lyme disease. Therefore, Plaintiff had not proven he was unable to perform the duties of his own occupation.

Relying on precedent, the Court concluded that Unum could not require positive tests for conditions for which no diagnostic tests exist. Also, the Court chose to give more weight to all medical professionals who examined Plaintiff and found him disabled, than to the contrary opinions of Unum’s paid professionals who conducted only a paper review of medical records.

Ultimately, the Court concluded: “The evidence weighs in Mr. Bunger’s favor and he meets his burden of establishing his entitlement to disability benefits through July 5, 2015.” This was the date the definition of disability changed from unable to perform in his own occupation, to inability to perform in any occupation.

Remand for Determination of Whether Plaintiff is Disabled from Working in Any Gainful Occupation

This issue had never been considered by Unum, so the Court remanded with instructions to Unum to use different reviewing physicians for that analysis and also to assign the case to a new claims manager.

This case was not handled by our law firm, but we believe it can be helpful to anyone who is doing battle with their insurer concerning their claim for short term or long term disability. For more information, or to discuss any aspect of your disability claim, contact one of our attorneys at Dell & Schaefer. We offer a free case evaluation.