In Western v. Unum Life Insurance Company of America, 798 F.App'x 154, 2020 U.S. App. LEXIS 8362 (9th Cir. March 17, 2020), the Ninth Circuit affirmed Unum Life's determination that an aerospace engineer diagnosed with chronic fatigue syndrome was not disabled under the terms of a group long-term disability policy.
Disclaimer: Hinshaw represented Unum Life in all phases of the ERISA litigation.
Plaintiff Lonny Western ("Western"), an engineer for The Aerospace Company, was a participant in his employer's LTD plan, which was funded by a group insurance policy issued by Unum Life. Western stopped working in 2010 and subsequently submitted a claim for LTD benefits based on a diagnosis of chronic fatigue syndrome ("CFS").
After initially approving Western's LTD claim based on his subjective reports of impairment, Unum Life investigated and evaluated Western's claim. Despite the diagnosis of CFS reported by his doctor, Western did not mention fatigue when Unum Life asked him why he could not return to work throughout the course of his claim. Instead, Western repeatedly reported he was unable to return to work because of purported cognitive deficits, which he attributed to recurring fevers and CFS. Accordingly, Unum Life focused its evaluation on Western's functional capacity, rather than the validity of his CFS diagnosis, and concluded that the available medical information established that Western was not cognitively impaired. During the claim review process, two separate neuropsychological evaluations (one arranged by Western, one arranged by Unum Life) each confirmed that Western was not cognitively impaired, despite his assertions to the contrary. Unum Life also arranged for several of its medical consultants (including an infectious disease specialist, an internal medicine physician and a neuropsychologist) to review Western's medical information. Based on the findings and opinions of those medical consultants and the neuropsychologists who evaluated Western, Unum Life determined that Western was not entitled to benefits under the LTD Plan.
Western filed suit against Unum Life seeking not only to recover the LTD benefits in dispute, but also seeking equitable relief pursuant to 29 U.S.C. § 1132(a)(3). The district court reviewed Unum Life's claim decision de novo and affirmed the decision. Following a bench trial, the court concluded that Western "failed to demonstrate that he is disabled as that term is defined in the LTD Policy." The court also found that Western's breach of fiduciary duty claim was "barred because it is redundant of his claim for benefits."
Western appealed to the Ninth Circuit. He argued, inter alia, that the district court applied a "de facto" deferential review favoring Unum Life's evidence, and should have focused its review on the validity of his CFS diagnosis and the "evidence relevant to the time period of the termination of benefits and afterwards."
A panel of three Ninth Circuit judges affirmed the district court's decision. The Ninth Circuit held that the court correctly applied a de novo standard of review and did not err in finding that Western was no longer disabled as of March 12, 2015. The panel noted that the court "appropriately focused its analysis on whether Western was disabled by cognitive deficits," and concluded that "the record supported its finding that he was not." The Ninth circuit also held that the court did not err by dismissing Western's claim for breach of fiduciary duty.
