A disabled New York attorney was awarded disability insurance benefits from Provident Life due to chronic back and neck pain.
Edward Chung was a specialized mergers and acquisitions attorney for over 26 years. However, he began to experience pain in his neck and back that limited his ability to sit, keep his neck stable and type on a computer for long hours. Mr. Chung reduced his work to 4 hours a day, then 2 hours a day, and eventually retired due to the increasing pain.
Prior to retiring, Mr. Chung submitted a claim for long-term disability benefits to Provident Life and Casualty Insurance Company (“Provident Life”). He was covered under a standard Group Plan and a Supplemental Plan for long-term disability, both subject to ERISA and administered by Unum Group subsidiaries.
Chung applied for disability benefits under both the Group Plan and the Supplemental Plan in mid-2018, initially citing the onset of his condition as January 1, 2017. Provident Life commenced payment of benefits under the Group Plan from July 2018 but denied additional benefits under the Supplemental Plan in September 2020, arguing that Chung could still work part-time and that residual benefits were no longer payable since he had retired.
Chung appealed Provident Life's decision, but the company upheld its initial denial in October 2021. During the process, Chung's condition was extensively documented through diagnostic tests, clinical findings, and evaluations by various medical professionals, including his treating physician Dr. Levinson and neurologist Dr. Stiler. These evaluations consistently indicated Chung's inability to perform his occupational duties due to his medical condition.
However, Provident Life's review, including an independent medical examination by Dr. Rosenberg, suggested that Chung did not have restrictions that would preclude him from working, a conclusion that was contested due to the brevity of the examination and alleged inconsistencies with other medical findings.
Vocational evaluations by Dr. Wolstein for Chung and Andrea L. Coraccio and Mary Cloutier for Provident Life provided contrasting views on Chung's ability to work. Dr. Wolstein’s evaluation supported Chung’s inability to work even at a sedentary level, while Provident Life's consultants argued that part-time opportunities existed for Chung in the national economy.
The case was reviewed by the court under a de novo standard of review. This is when the court does not defer to the insurer’s interpretation but rather interprets the terms of the plan independently. The judgment was entered in favor of Chung, indicating that the court found sufficient evidence to support his claim for disability benefits under ERISA.
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