Chicco v. First UNUM Life Insurance Company

Background

Michelle Chicco sued First Unum Life Insurance Co. over the denial of benefits under a long-term disability insurance plan provided through her employment. The parties agreed to try the case on a stipulated record, meaning the court decided the dispute from an agreed written record rather than through a conventional trial.

The plan defined disability to include being unable to perform the material and substantial duties of the insured person’s regular occupation. Chicco worked as a tax accountant and later as a manager. Her work included tax calculations, research, meetings, and extensive keyboard use, generally for about 40 hours per week and longer during tax season.

Chicco began experiencing back pain, fatigue, and weakness in her limbs in 2013. She stopped working in May 2018 and submitted a disability claim. First Unum initially approved payments for several months. Chicco later returned to work part-time and then full-time, but her symptoms worsened. She reduced her workload in January 2019 and stopped working again on April 26, 2019.

First Unum reviewed the claim and obtained opinions from medical reviewers who concluded that Chicco could perform her job. First Unum notified her on May 9, 2019, that it no longer considered her disabled and that she could return to full-time work. First Unum upheld that decision after Chicco’s administrative appeal on August 31, 2020.

Legal standard

Chicco brought her claim under Section 502 of the Employee Retirement Income Security Act, a federal law commonly called ERISA, which allows a plan participant to seek benefits owed under the plan. Because the plan did not give First Unum discretion to decide eligibility or interpret the plan, Judge Cote reviewed the benefit determination independently rather than deferring to First Unum’s decision.

Chicco had to prove by a preponderance of the evidence—meaning that her position was more likely true than not—that she was disabled under the plan. The court explained that it did not have to automatically accept complaints of pain, but that a claimant’s reports of pain, together with medical evidence, could establish disability.

Court’s analysis

The court found that Chicco met her burden. Every medical professional who personally examined her found that she could not sit or stand for extended periods without serious pain. The court also found that her pain interfered with cognition, caused fatigue, and made concentration difficult. Those limitations were inconsistent with a skilled job requiring constant keyboard use for most or all of the workday.

The court relied on Chicco’s treatment records, which showed that her pain increased when she worked at her desk and improved when she stopped working. It also relied on a functional-capacity evaluation finding that she had serious pain when remaining in one position, along with weakness and fatigue. Radiological and electrodiagnostic evidence provided support for spinal nerve-root problems that could have caused her pain.

Judge Cote rejected First Unum’s arguments that later examinations were not relevant, that pregnancy affected the evidence, and that Chicco’s treatment and activity level were inconsistent with disabling pain. The court found that Chicco’s condition was progressive, that the physical therapist found pregnancy made little difference, and that her escalating treatment—including medication, physical therapy, and spinal injections—was consistent with her reported symptoms. The court also found that her limited household activity was consistent with severe pain.

The court noted that First Unum’s reviewing physicians had not personally examined Chicco, while every medical professional who had examined her concluded that she could not perform her job duties. The court explained that treating physicians are not automatically entitled to special weight, but that examining physicians’ opinions may receive significant weight when the record supports doing so.

The court further concluded that Chicco did not need to establish one precise diagnosis. Whether her pain was primarily related to radiculopathy or myofascial pain, the relevant question under the plan was whether her condition caused enough pain to prevent her from performing her regular job duties. The court found that she made that showing.

Disposition

The court concluded that Chicco had been disabled under the plan since December 17, 2018. It granted judgment to Chicco and held that First Unum was liable on the claims presented. The opinion does not state a specific dollar amount of benefits.