A Massachusetts court found Unum unreasonably denied long term disability (“LTD”) benefits to a claimant with Lyme disease.
Ms. Moseley’s Disability Claim
Susan Moseley was disabled from Lyme disease. She was approved by Unum for LTD benefits, but they applied a mental health limitation and only paid her for a limited time period.
In an attempt to prove her condition is not psychological, but physically disabling, she requested an independent medical evaluation (“IME”) from Unum. Unum denied her request alleging an IME would not assess her functional capacity from a year and a half prior – the relevant time frame it claimed she needed to prove her disability.
The Court Rejected Unum’s Argument
The Massachusetts court did not buy Unum’s reasoning. The court held that Unum failed to act as a fiduciary by not approving the request for an IME. The court notes that the IME could accomplish the opposite—it could provide the evidence of disability that Unum claims was lacking.
The court determined that the only logical reason Unum denied Ms. Moseley’s request for an IME was to preclude her from supplementing the record with evidence that could prove her disability. Thus, the court found Unum’s decision was arbitrary and capricious.
This case nicely sets up an argument that the disability insurance company acted in its own best interest and not the best interest of the claimant, as required under ERISA. The court was able to recognize the wrongful behavior and order Unum to send the claimant to an IME.
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