Gill v. UNUM Life Insurance Company of America
- Edward Chen
- 3:19-cv-04066
- U.S. District Court · Northern District of California
- 20
In Gill v. UNUM, Judge Chen denied Gill’s motion, granted UNUM’s motion, and entered judgment for UNUM in the ERISA benefits dispute.
Terrance Gill, who sought additional long-term disability benefits, and UNUM Life Insurance Company of America, which obtained judgment in its favor.
What happened
In Gill v. UNUM Life Insurance Company of America, Terrance Gill sought additional long-term disability benefits under an employee-benefits policy governed by federal law. UNUM had stopped paying after 24 months because it determined that Gill’s disability resulted from mental illness. Gill argued that his cognitive impairment was mild cognitive impairment, a separate physical condition not covered by the policy’s 24-month limit.
The court reviewed the evidence without deferring to UNUM’s decision. It found that Gill had not shown, by the greater weight of the evidence, that his cognitive impairment came from a physical condition rather than bipolar disorder or related mental illness. The court also ruled that the policy’s mental-illness limitation was clear and that UNUM had conducted a full and fair review of Gill’s appeal.
Judge Edward M. Chen granted UNUM’s motion for judgment, denied Gill’s motion, and directed the clerk to enter judgment for UNUM. The ruling meant Gill was entitled to no more than the 24 months of benefits he had already received under the policy.
The detailed version
- Gill v. UNUM Life Insurance Company of America · No. 3:19-cv-04066
- Edward Chen
- Nov. 23, 2020
Background
Terrance Gill sued UNUM Life Insurance Company of America under the Employee Retirement Income Security Act (ERISA) to recover additional long-term disability benefits. UNUM’s policy limited benefits for disabilities caused by a mental illness to 24 months. The policy defined mental illness as a psychiatric or psychological condition, including bipolar illness.
Gill had a long history of bipolar disorder. He claimed that his inability to work resulted instead from mild cognitive impairment, or MCI, which he characterized as a separate physical, non-psychiatric condition. UNUM initially approved benefits for two periods of disability but later discontinued them after applying the 24-month mental-illness limitation.
The medical evidence was conflicting. Gill’s treating psychiatrist, Dr. Bruce Milin, documented cognitive problems but also treated Gill for bipolar disorder and sometimes recorded normal cognitive functioning. Milin later suggested that Gill might have a neurocognitive disorder and recommended additional brain imaging, but Gill did not obtain the recommended fMRI or SPECT scan. Neurologist Dr. Howard J. Rosen concluded that Gill’s cognitive symptoms were most likely related to mania and continuing depression, while recommending further evaluation. Dr. Steven McIntire later diagnosed MCI, but he did not review Gill’s medical records or contact his treating physicians. UNUM’s reviewing physicians concluded that the evidence did not establish a separate physical cause for Gill’s cognitive impairment.
Court’s Analysis
The parties filed cross motions for judgment under Federal Rule of Civil Procedure 52(a), which permits a court deciding a case on the record to make factual findings and legal conclusions. The parties agreed that the court should review UNUM’s decision de novo, meaning the court would independently decide whether Gill proved entitlement to benefits under the policy. Gill bore the burden of proving that entitlement by a preponderance of the evidence, or showing that his position was more likely true than not.
The court held that Gill did not meet that burden. It found that Milin’s opinions about a physical cause were tentative and based on inconsistent observations, a book, and proposed testing that was never completed. The court viewed Rosen’s opinion that depression and mania were the most likely cause as favoring UNUM’s position, particularly because the later brain MRI was normal and Gill did not obtain further follow-up with Rosen. The court also found McIntire’s MCI opinion poorly supported because he did not review the records, did not consult Gill’s treating physicians, and relied significantly on a cognitive screening test that UNUM’s reviewing physician said could not, by itself, establish an MCI diagnosis or related work impairment.
The court concluded that the weight of the evidence showed Gill’s cognitive impairment was a manifestation of his mental illness, not a separate physical, non-psychiatric, or non-psychological condition. It therefore ruled that the policy’s 24-month limitation applied.
The court separately held that the policy language was not ambiguous. It specifically defined mental illness as a psychiatric or psychological condition regardless of cause and expressly included bipolar illness. The court said the policy clearly applied its 24-month limit to disabilities caused by those conditions while leaving separate physical conditions outside the limitation.
Finally, the court rejected Gill’s argument that UNUM failed to conduct a full and fair review. The court found that UNUM identified the basis for ending benefits, provided access to relevant records upon request, and did not have a duty to ensure that every proposed test or follow-up evaluation occurred before making its decision.
Disposition
UNUM’s motion for judgment was GRANTED. Gill’s motion was DENIED. The court directed the clerk to enter judgment for UNUM under Federal Rule of Civil Procedure 58 and stated that the order disposed of Docket Nos. 32 and 33.
Read the full 20-page opinion on CourtListener, the free public archive maintained by the Free Law Project.