Haag v. UNUM Life Insurance Company of America

Background

Rebecca Haag sought long-term disability benefits under a group policy issued by Unum Life Insurance Company of America. The policy was governed by the Employee Retirement Income Security Act of 1974, a federal law regulating employee-benefit plans. Haag brought the claim under 29 U.S.C. § 1132(a)(1)(B), which allows a participant to sue to recover benefits allegedly due under an ERISA plan.

The policy defined disability during the relevant period as being limited by sickness or injury from performing the material and substantial duties of the claimant’s regular occupation, together with at least a 20 percent loss in indexed monthly earnings from the same condition. The policy also stated that a person is disabled from her usual occupation when she cannot perform, with reasonable continuity, the substantial and material acts needed to pursue that occupation in the usual and customary way.

Haag worked as a Clinical Lab Scientist. Her job required frequent sitting, standing, and walking; frequent twisting of her body and neck; and occasional lifting of more than 10 pounds. She experienced worsening lower-back pain and right-side symptoms, underwent physical therapy and injections, and had lumbar surgery in January 2020. She continued to report pain and functional limitations afterward. A later functional-capacity examination found limits on sitting, standing, walking, lifting, twisting, and bending. Haag was later diagnosed with a right-hip labral tear and had surgery in September 2021.

Unum determined that Haag was disabled from August 6, 2019 through April 28, 2020, and that benefits were payable after the policy’s 180-day elimination period. Unum later concluded that Haag could perform light work as of April 27, 2020 and denied continuing benefits. Haag and Unum each moved for judgment under Federal Rule of Civil Procedure 52(a), which permits a court deciding a case on the record without a jury to make factual findings and legal conclusions.

Standard of Review and Policy Terms

The parties agreed that the court should independently review the benefit determination rather than defer to Unum. The court explained that, under this de novo review, Haag had to prove by a preponderance of the evidence—meaning that her position was more likely than not—that she was disabled under the policy.

Court’s Analysis

The court found that Haag met that burden for the period after April 27, 2020 through December 7, 2021. It credited her consistent reports of serious pain and symptoms to multiple medical providers. The court also considered treatment records showing limited movement, tenderness, muscle spasms, guarding, gait-related pain, and other findings. It gave some weight to the opinions of Dr. Ben Pradhan and Dr. Marina Manvelyan, who had treated Haag and supported extending her disability, while considering the opinions of Unum’s file-review consultants less persuasive in several respects.

The court rejected Unum’s arguments that Haag’s symptoms were not sufficiently supported by objective evidence, that mental stress rather than back pain explained her work absence, and that her later work history showed she could have worked during the disputed period. The court found that the functional-capacity examination corroborated Haag’s earlier reports and Dr. Manvelyan’s restrictions, even though the examination occurred later. The court also found that the job description from Haag’s actual position was more demanding than Unum’s light-duty characterization.

The court separately found that the record did not establish disability after December 7, 2021. It relied on evidence that Haag’s hip surgery had been followed by improvement, that Dr. Timothy Jackson reported on December 7 that she was doing really well and had only mild pain, and that Haag later returned to full-time work in August 2022.

Disposition

Judge Hixson granted in part and denied in part Unum’s motion and granted in part and denied in part Haag’s motion. The court found that, for the period April 27, 2020 through December 7, 2021, the preponderance of the evidence showed Haag was disabled under the policy. The court found that the administrative record did not establish that Haag was disabled after December 7, 2021. The parties were ordered to meet and confer and submit a stipulated proposed judgment within 14 days of the order.