Whitehouse v. UNUM Life Insurance Company of America

Background

Sara F. Whitehouse, a physician employed by Fairview Health Services, was covered by UNUM’s group long-term disability policy. She became ill in March 2020 with symptoms that she suspected were caused by COVID-19, although the illness was not confirmed. She later experienced conditions and symptoms including viral cardiomyopathy, vocal cord dysfunction, chronic pain, fatigue, anxiety, depression, and post-traumatic stress disorder.

UNUM approved Whitehouse’s short-term disability claim and paid benefits through November 2, 2020. Whitehouse then sought long-term disability benefits. UNUM denied that claim, concluding that the medical records did not support restrictions preventing her from working full time during the policy’s 180-day elimination period. After Whitehouse appealed, UNUM relied primarily on reviews by Dr. Scott Norris and paid long-term disability benefits through March 15, 2021.

Whitehouse returned to work gradually in January 2021. Her treating physician limited her to two half-days per week initially, followed by a gradual increase to three full days per week. Whitehouse remained at approximately 60% capacity through the end of 2021 and returned to full-time work in January 2022. The parties agreed that the court would decide their competing requests for judgment based on the administrative record and would review the benefits decision without deference to UNUM.

Court’s analysis

The court found that Whitehouse proved by a preponderance of the evidence that she was partially disabled under UNUM’s policy from January 25, 2021, through December 31, 2021. The court found that her continuing voice and throat problems affected her ability to meet the speaking demands of her occupation, which could require speaking for up to 5.5 hours per day. It also found that her chronic pain and severe fatigue continued well into 2021.

The court considered the February 2021 diagnosis of chronic fatigue syndrome and central sensitization disorder, her treatment records, the Mayo Clinic pain rehabilitation program, her doctors’ work-hour restrictions, and her pay records. The court found that the absence of objective testing did not defeat her claim because the policy recognized that symptoms such as pain and fatigue may not be verifiable through tests or examinations. The court also found that Whitehouse consistently reported both improvements and setbacks and that the evidence supported her account of continuing limitations.

The court found Dr. Norris’s reasoning unpersuasive. It concluded that he selectively accepted Whitehouse’s reports, failed to explain the combined effect of her conditions, overlooked Dr. Barry’s continuing 60% work-hour restriction, and treated objective evidence as a threshold requirement rather than weighing its absence with the rest of the evidence.

Time Off Time Away payments

The parties disagreed about how Whitehouse’s “Time Off Time Away,” or TOTA, payments should affect the benefit calculation. Whitehouse argued that the payments were disability earnings, which would be deducted only under the policy’s earnings limit. UNUM argued that they were accumulated sick leave and should be fully deducted.

The court ruled that Whitehouse’s TOTA payments in February, March, and August through December 2021 functioned as salary continuation rather than compensation for work performed. Because Whitehouse was not working during the hours for which she redeemed the payments, the court treated the payments as accumulated sick leave and fully deducted them from her gross disability benefits. Based on the policy’s formula and Whitehouse’s pay records, the court calculated unpaid disability benefits of $71,649.90 for the rest of 2021.

Ruling and remaining matters

Judge Jerry W. Blackwell denied UNUM’s Motion for Judgment on the Administrative Record and granted Whitehouse’s Motion for Judgment on the Administrative Record. The court ordered UNUM to pay Whitehouse $71,649.90 in lost benefits plus prejudgment interest. The court directed Whitehouse to submit an updated interest calculation and a submission supporting attorney’s fees and costs. UNUM was permitted to respond to the fee request, and the court did not decide the fee issue in this order.