This month’s Friday Five covers recent decisions on credibility pertaining to long COVID symptoms, weighing of disability evidence, overpayment accounting, preemption of state law claims, and a motion to compel discovery on financial incentives and other information.
- District of Vermont grants insurer’s motion for judgment on the record in long COVID case finding the plaintiff was not credible. Plaintiff was terminated from his engineering position because “his engagement ended with his client.” He submitted a claim for short-term disability (“STD”) and long-term disability (“LTD”) benefits, alleging inability to work due to symptoms of long COVID that pre-dated his termination. The District of Vermont did not reach the question of whether the de novo or arbitrary and capricious standard applied because it found the plaintiff’s claim did not survive even under the broader de novo standard, due in part to the plaintiff’s lack of credibility. The credibility determination stemmed from the plaintiff’s conflicting statements, self-described poor memory, and extensive daily marijuana use. Additionally, the treating provider’s opinions were found to lack reliability. According to the court, the nurse practitioner’s diagnosis was retroactive and “appear[ed] to accept any diagnosis Plaintiff proffered.” Ultimately the court found the plaintiff was not entitled to STD or LTD benefits. Finally, the court rejected the plaintiff’s assertion that the insurer’s structural conflict of interest – by both reviewing claims and paying LTD benefits – affected its decision. The court reasoned that the insurer made its decision on the merits rather than denying benefits on timeliness grounds, and took steps to reduce the potential for bias and to promote accuracy by hiring two independent medical examiners and offering plaintiff the opportunity to comment on the medical examiners’ opinions. Weiss v. Lincoln Nat’l Life Ins. Co., No. 2:24-CV-00591-CR, 2026 WL 483280 (D. Vt. Feb. 20, 2026).
- Western District of Michigan finds plaintiff’s evidence of disability due to intractable headache outweighed insurer’s evidence of ability to perform regular occupation. Plaintiff, a former account executive, was initially approved to receive LTD benefits after being diagnosed with an acute intractable headache. However, the insurer later discontinued the benefits in light of updated information it received regarding the plaintiff’s medical status. Reviewing the denial of benefits de novo, the Western District of Michigan found the plaintiff satisfied her burden of showing she was disabled and unable to perform her regular occupation. Plaintiff’s evidence of disability, which included disability statements by a board-certified neurologist, among others, who examined the plaintiff face-to-face, were afforded significant weight. The insurer’s evidence, on the other hand, which included file reviews by three physicians, carried “little weight.” Among the reasons the court discounted the insurer’s reviewers were that, unlike the providers for plaintiff, they did not conduct a physical examination. Moreover, the plaintiff’s treating physician was the “only board-certified neurologist and headache specialist to examine” the plaintiff. Acknowledging the plaintiff’s role as an account executive was highly skilled and required frequent concentration and attention, the court found the plaintiff’s disability precluded her from performing her regular occupation. However, as it pertained to the plaintiff’s ability to perform any gainful occupation, the court found in favor of the insurer in light of the “paucity of evidence or analysis offered” by the plaintiff’s treating physicians on that topic. Tobin v. Unum Life Ins. Co. of Am., No. 1:24-CV-1012, 2026 WL 508810 (W.D. Mich. Feb. 13, 2026).
- Western District of Wisconsin orders accounting from plaintiff relating to insurer’s counterclaim for overpayment of benefits. Plaintiff, a former crisis manager, reported persistent postural perceptual dizziness, anxiety, depression, heart issues and joint pain. His claim for LTD benefits was initially approved, but later discontinued after the insurer determined the plaintiff was not precluded from performing the duties of his regular occupation. Applying the de novo standard of review, the court disagreed, finding the plaintiff presented “overwhelming evidence” of his disability, which impacted his ability “to function cognitively at a high level under stressful conditions” as required by his regular occupation. However, the court also determined that the insurer was entitled to recover overpayment incurred after the Social Security Administration granted plaintiff Social Security Disability Insurance (“SSDI”) benefits. Plaintiff argued “creatively, if unsuccessfully” that the SSDI benefits were dissipated because plaintiff used them to pay living expenses and legal fees, and thus, the funds were not in his possession. The court reasoned that, due to its ruling that plaintiff was entitled to additional LTD benefits, the insurer could recover any overpayment from those benefits. It ordered the plaintiff to provide an accounting to the insurer to determine the amount of SSDI benefits received. Lehnen v. Unum Life Ins. Co., No. 23-CV-192-WMC, 2026 WL 444692 (W.D. Wis. Feb. 17, 2026).
- Northern District of Georgia determines negligent misrepresentation claim is preempted by ERISA. Plaintiff brought alternative ERISA claims against her spouse’s former employer and claims administrator for unpaid life insurance coverage (against the claims administrator only), or, alternatively, for breach of fiduciary duty (against both the claims administrator and former employer). Plaintiff claimed an alternative cause of action for negligent misrepresentation against the former employer only. The Northern District of Georgia granted the former employer’s motion to dismiss the third claim, finding the claim for negligent misrepresentation “relates to” the ERISA plan, and thus, was preempted. Plaintiff’s reliance on Cotton v. Massachusetts Mut. Life Ins. Co., 402 F.3d 1267, 1271 (11th Cir. 2005), the court explained, was misplaced. The court noted that Cotton was distinguishable, because although a negligent misrepresentation claim was not preempted and survived dismissal, the claim was pleaded against an insurer for its conduct in selling coverage before the policy was executed – not related to administering an ERISA plan. Atkins v. Prudential Ins. Co. of Am., No. 1:25-CV-2912-TWT, 2026 WL 280492 (N.D. Ga. Feb. 3, 2026).
- Middle District of Pennsylvania rejects boilerplate objections and compels production of financial incentives, internal procedures, and information relating to third-party medical providers. Following the alleged improper termination of disability benefits, plaintiff brought claims for breach of contract, bad faith insurance practices, improper denial of benefits, and breach of fiduciary duties under ERISA. The parties proceeded to discovery and plaintiff served interrogatories and requests for production on the insurer. The insurer objected to the discovery requests, prompting plaintiff to file a motion to compel the insurer to fully respond to the requests. As an initial matter, the Middle District of Pennsylvania deemed the insurer’s “boilerplate” general objections, which were incorporated into every answer, to be waived. Further, the court granted the plaintiff’s motion, in part, ordering the insurer to answer and produce information relating to: (1) incentives, bonuses, or other reward programs for any employees involved in any meaningful way in reviewing the plaintiff’s disability claims; (2) internal procedures for claim review and supervisory structure; and (3) information relating to a third party medical provider’s role in plaintiff’s claim denial. However, the court denied the motion to compel when it came to “batting average” information, i.e., the amount of prior claims reviewed and the ratio of decisions by medical personnel and third party medical providers, and “overbroad” requests for information relating to state and federal agency investigations within the last ten years. Finally, the court denied the plaintiff’s request to serve additional interrogatories. Schaefer v. Unum Life Ins. Co. of Am., No. 4:24-CV-00590, 2026 WL 396445 (M.D. Pa. Feb. 12, 2026).
