Lundberg v. UNUM Life Insurance Company of America

Background

Bradley J. Lundberg sought long-term disability benefits under an employee welfare benefit plan sponsored by his former employer, Blue Cross and Blue Shield of Minnesota, and insured and administered by UNUM Life Insurance Company of America. UNUM initially approved his claim and began paying benefits in 2018. In 2021, UNUM terminated the benefits after determining that Lundberg was no longer disabled. Lundberg appealed through the plan’s administrative process, but UNUM upheld the termination.

Lundberg’s claim was based primarily on anterior ischemic optic neuropathy in his right eye and resulting symptoms. The administrative record included evidence of a persistent visual-field defect, irregular eye movements, headaches, eye strain, light sensitivity, disequilibrium, and falls. Medical providers and occupational therapists documented that Lundberg could read or use a computer only for limited periods before experiencing increased symptoms. The court also noted that Lundberg had received more than 24 months of benefits, so the plan’s definition of disability had changed from inability to perform his regular occupation to inability to perform any gainful occupation for which he was reasonably fitted by education, training, or experience.

Standard of review

The parties agreed that the court should review the benefits claim de novo, meaning independently and without deferring to UNUM’s decision. Because the parties asked for judgment based on the administrative record, the court acted as the factfinder: it resolved factual disputes, assessed credibility, and weighed the evidence. Lundberg had the burden of showing, by a preponderance of the evidence, that he was disabled and entitled to benefits under the plan.

Court’s analysis

The court concluded that the preponderance of the evidence supported Lundberg’s claim as of August 2021. It found no dispute that Lundberg had experienced anterior ischemic optic neuropathy and observed that UNUM had relied on that condition when it initially approved his benefits. The court found that the record better supported the conclusion that Lundberg continued to have functionally limiting symptoms when UNUM terminated his benefits.

The court determined that Lundberg’s symptoms were connected to the requirements of his work. His senior recovery specialist position, like the insurance-claim-examiner occupation that UNUM identified as comparable, required extensive computer work and frequent near vision. The court credited evidence that Lundberg’s irregular eye movements, visual-field loss, and related symptoms prevented him from performing sustained computer-based work.

The court found UNUM’s evidence unpersuasive. Near-normal corrected visual acuity did not address the other symptoms that interfered with computer work. Nor did Lundberg’s reported 2021 drive from Arizona to Minnesota establish that he could perform his occupation; the record did not clearly describe the trip or show that Lundberg did all the driving, and driving was not a material and substantial duty of his occupation. The court also found that UNUM’s reviewing physicians relied on an incomplete or inaccurate understanding of the record, including an apparent belief that Lundberg had returned to work for 15 months after his eye injury.

The court further concluded that UNUM had evaluated Lundberg primarily under the regular-occupation standard even though the plan required the any-gainful-occupation standard after 24 months of payments. UNUM did not address whether Lundberg could perform another gainful occupation. The court declined to limit the award to the first 24 months of benefits or to the date of UNUM’s appeal decision because UNUM had already paid benefits beyond the 24-month period and had not shown a basis for ending the award under the any-gainful-occupation standard.

Disposition

The court ordered:

- Lundberg’s motion for judgment on the administrative record was granted. - UNUM’s motion for judgment on the administrative record was denied. - UNUM must pay Lundberg benefits due from the date of termination to the present.

The parties were ordered to meet and confer about the amount of benefits, prejudgment interest, attorney’s fees and costs, and other issues requiring court action if they could not reach agreement. The court stated that UNUM remained free to reevaluate Lundberg’s claim based on whether he could perform occupations other than his own.