Halloran v. Unum Life Insurance Company of America

Background

Andrew Halloran sought long-term disability benefits under an employee welfare benefit plan sponsored by Tennant Company and insured and administered by Unum Life Insurance Company of America. Unum approved his claim and began paying benefits in 2020. After 24 months of payments, Unum changed the standard used to evaluate his disability and terminated his benefits effective April 13, 2022. Halloran appealed within the plan’s procedures, but Unum affirmed the termination.

The plan first defined disability by reference to Halloran’s regular occupation. After 24 months, however, the plan defined disability as being unable, because of the same sickness or injury, to perform the duties of any gainful occupation for which he was reasonably fitted by education, training, or experience. The plan defined a gainful occupation as one expected to provide income above a specified percentage of indexed monthly earnings.

Halloran’s claim arose from a 2019 left-shoulder injury and surgery. The medical record showed that he could not perform the medium work required by his former sheet-metal-fabrication job. But beginning in 2020, his treating orthopedic physician, Dr. Michael Freehill, repeatedly issued restrictions allowing sedentary work, including mostly seated work and occasional lifting, carrying, pushing, or pulling within stated weight limits.

The parties’ positions and review standard

Halloran and Unum each moved for judgment on the administrative record. The parties agreed that the court should review the benefit determination independently rather than defer to Unum. Under this de novo review, the court made its own decision based on the record, and Halloran had the burden to prove by a preponderance of the evidence that he was disabled under the plan on April 13, 2022.

Unum relied on Dr. Freehill’s prior sedentary-work restrictions, its medical reviews, and a vocational assessment identifying three sedentary occupations: production clerk, rental dispatcher, and routing clerk. An initial vocational review mistakenly referred to the labor market in Otsego, Michigan, but Unum corrected the mistake during the appeal and used the Otsego, Minnesota labor market.

Halloran relied in part on later restrictions from Dr. Freehill, a 2023 functional-capacity evaluation, later treatment records, and evidence concerning his shoulder pain, weakness, and other conditions. He also argued that Unum failed to follow its claims manual, failed to give proper consideration to his treating physicians, and initially used the wrong labor market.

Court’s analysis

The court found substantial evidence that Halloran remained unable to perform his former regular occupation. That fact did not establish disability under the post-24-month standard, however, because the relevant question was whether he could perform any gainful occupation.

The court found that Dr. Freehill’s sedentary restrictions were in place when Unum evaluated Halloran’s claim under the any-gainful-occupation standard. No medical provider had stated that Halloran was unable to perform sedentary work as of April 13, 2022. The court also found that Halloran’s later restrictions stating that he could not work at all did not explain why those restrictions should apply on April 13, 2022, and conflicted with the earlier contemporaneous restrictions. The court viewed the 2023 functional-capacity evaluation and related medical opinions as addressing Halloran’s condition at later dates rather than the critical date.

The court considered Halloran’s knee and mental-health records but found that he had not claimed those conditions prevented him from performing any gainful occupation, and no restrictions for those conditions were in place on April 13, 2022. The court likewise found that his right-shoulder condition did not prevent sedentary work. That condition predated the left-shoulder injury, and the record showed that Halloran had performed his former medium-duty job despite it.

The court rejected Halloran’s arguments about Unum’s claims manual and treating-physician consideration. It also found that Unum’s initial labor-market mistake did not affect the result because Unum corrected it during the appeal. The court did not consider an additional argument Unum raised during litigation concerning the plan’s part-time-work language because Unum had not evaluated the claim under that standard when it made its decision and appeared to have abandoned the argument.

Disposition

The court concluded that Halloran had not shown by a preponderance of the evidence that he was disabled under the plan’s any-gainful-occupation standard on April 13, 2022. The court denied Halloran’s motion for judgment on the administrative record, granted Unum’s motion for judgment on the administrative record, and ordered judgment entered for Unum.