Kantor & Kantor, LLP recently achieved a victory in Olis-v.-Unum-Life-Insurance-Company-of-America No. 8:19-cv-01347-JVS-DFM, __ WL __ (C.D. Cal. July 27, 2020), a lawsuit seeking payment of an ERISA-governed disability claim based on debilitating migraines. Disability cases involving subjective reports of pain may be the most difficult benefit cases courts have to consider. This case provides a good example of what makes for a convincing claim, and what courts are looking for in deciding whether to award benefits. Our client was represented by Kantor & Kantor attorneys, Brent Dorian Brehm, Sarah Demers, and myself, Peter Sessions.
The plaintiff in this case was a 36-year-old woman who was employed by Enterprise, the rental car company, as an account specialist, which involved significant computer use. She had suffered from headaches for much of her life, but in 2016 those headaches intensified into recurrent migraines, which were accompanied by vertigo and visual disturbances. She took a medical leave of absence to address her problems and then tried to return to work, but she only lasted another month before she had to stop working entirely. During this time, Plaintiff visited numerous doctors in a number of specialties, tried several medications, and attended countless physical therapy sessions.
Plaintiff submitted a claim for LTD benefits to Unum Life Insurance Company of America, which Unum denied on the ground that she had not presented sufficient evidence to prove that she could not return to work. Plaintiff unsuccessfully appealed, and then filed suit against Unum under ERISA. The parties filed cross-motions for judgment under Fed.R.Civ.P. 52.
The district court granted Plaintiff’s motion and denied Unum’s, reviewing Unum’s decision de novo pursuant to the parties’ stipulation. The court characterized the “central dispute” as “whether [plaintiff’s] medical records sufficiently indicate that she was precluded from performing the duties of her occupation with both sides providing contradictory opinions from physicians.”
The court ultimately identified two reasons to overturn Unum’s denial decision. First, the court recognized that migraine symptoms cannot be established with objective evidence, but did not discount objective evidence entirely, finding that “inconsistent objective data is certainly relevant to determining the credibility of a physician’s opinion.” Plaintiff had in fact provided objective evidence in the form of laboratory and vision testing. The court gave these limited weight— considering them “not robust”—but noted that it was still evidence in Plaintiff’s favor, and that her physicians uniformly supported her disability claim and had relied on this testing.
Second, the court found that Plaintiff was “credible in relating her symptoms to a variety of providers over an extended period.” Plaintiff “consistently sought medical treatment, including multiple opinions, visited additional medical providers referred by her physicians, undergone significant diagnostic testing, taken a series of different prescription medications for migraines and other symptoms, and attended over 100 therapy sessions for which she paid out of pocket.” The court found that Unum erred by ignoring these facts and solely demanding objective evidence. Unum “looked only at test results while giving little weight to plaintiff’s reported symptoms and continued efforts to find a cure.”
Based on these two factors, the court concluded that Plaintiff’s physicians’ opinions were “more convincing than that of Unum’s medical reviewers because of the extent of [their] history treating [plaintiff], their specializations in the relevant practices and the amount of detail provided in their notes and letters.”
This case shows that even when the disabling symptoms at issue cannot be objectively verified, medical evidence is still very important. Paradoxically, such cases probably require more documentation because of the lack of easily identifiable medical markers for determining impairment. Furthermore, credibility is paramount. When symptoms are subjective, a court must be convinced that the plaintiff is being honest. Extensive records and support letters from physicians, as well as a history of industriousness and consistent treatment effort, are persuasive factors.
If your condition requires you to provide subjective reports of your pain and symptoms, please contact the attorneys at Kantor & Kantor, LLP for a free consultation at 800-446-7529 or use our online contact form. We have helped thousands of insureds secure benefits from private insurance companies