Christoff v. Unum Life Insurance Company of America

Background

Michael J. Christoff received long-term disability benefits under an employee benefit plan governed by the Employee Retirement Income Security Act (ERISA). He participated in the plan through Spencer Stuart, and Unum insured the plan. Christoff became disabled in November 2001 because of severe fibromyalgia and received benefits for more than fifteen years. Unum terminated those benefits effective November 22, 2016, concluding that Christoff could perform the duties of his regular occupation. Unum upheld that decision on appeal on June 15, 2017.

Christoff brought two ERISA claims. Under his first claim, he sought unpaid long-term disability benefits and clarification of his rights under the plan. Under his second claim, he alleged a breach of fiduciary duty and sought equitable monetary relief for attorney fees, substitute health-care coverage, and replacement insurance costs. Christoff argued that Unum manipulated the review process, misstated his occupational duties, failed to provide reviewers with relevant medical and vocational information, disregarded his treating physicians, and reached a conclusion inconsistent with its own earlier reviews. Unum argued that it followed the plan and denied improper conduct.

The plan gave Unum discretionary authority to determine benefit eligibility and interpret the plan. The court therefore reviewed Unum’s decision under the abuse-of-discretion standard, asking whether the decision was supported by substantial evidence and was not arbitrary and capricious.

Merits of the Benefits Claim

The court held that Unum reasonably interpreted the plan’s definition of “regular occupation” as the occupation normally performed in the national economy, rather than the job as performed for a particular employer. But the court found that Unum abused its discretion by arbitrarily changing the occupation’s physical-demand level without substantial evidence or a meaningful explanation.

The court also found that Unum abused its discretion in relying heavily on independent reviewers and an in-house physician while disregarding extensive and consistent evidence from Christoff’s treating physicians. Those doctors had specialized experience treating fibromyalgia and had repeatedly concluded that Christoff could not perform any job on a full-time, regular basis. The court stated that Unum’s review selectively presented the evidence, ignored information unfavorable to termination, and misstated the record. The court also found that the timing of Unum’s additional review—shortly after a prior review—was a serious procedural irregularity, particularly because the parties could not identify new information that prompted the review.

The court did not need to decide Christoff’s additional arguments concerning Unum’s structural conflict of interest or alleged history of abuse of discretion. It stated that it would have reached the same conclusion whether or not a conflict existed.

Relief and Disposition

The court concluded that the record did not require further proceedings. It awarded Christoff damages equal to his unpaid long-term disability benefits from the termination date, with interest calculated under 28 U.S.C. § 1961, and ordered Unum to continue paying benefits for as long as Christoff qualified under the plan.

Regarding the second claim, the court held that Christoff could not obtain duplicative relief for losses arising from the termination of benefits. The court found that his claimed inability to pay for other insurance or realize possible financial gains was speculative and was not a separate injury requiring additional relief beyond the benefits awarded under the first claim. The opinion does not separately state a formal grant or denial of summary judgment on each part of the second claim.

The court determined that Christoff was entitled to attorney fees and costs because an award could deter Unum from making benefits decisions without a thorough review of the claimant’s file. The amount was left for later determination after Christoff’s attorney submitted an affidavit and Unum and Christoff had opportunities to respond.

The order granted Christoff’s motion for summary judgment in part, denied Unum’s motion for summary judgment, and directed that judgment be entered. The order’s first paragraph refers to “Matthew Christoff,” although the caption and the rest of the opinion identify the plaintiff as Michael J. Christoff.