Courtroom: United States District Courtroom for the Southern District of Florida, Miami Division
Insurance coverage Service: Unum Life Insurance coverage Firm of America
Claimant’s Employer: Johns Hopkins Bayview Medical Heart
Claimant’s Occupation: Scientific and Analysis Nurse
Disclaimer: Please observe that this declare was not dealt with by the Ortiz Legislation Agency. It’s summarized right here for instructional functions.
From Offering Compassionate Care to Power Ache
Yvette Eggleston devoted her profession to nursing, working for greater than a decade at Johns Hopkins Bayview Medical Heart in quite a lot of scientific and analysis roles. Her work included advanced affected person care, workers supervision, and specialty areas like oncology. However in February 2011, her skilled life got here to a halt because of a cascade of persistent medical issues, together with decrease again ache, fibromyalgia, undifferentiated connective tissue dysfunction (UCTD), and different inflammatory situations that induced persistent ache and fatigue.
Unum, the long-term incapacity insurance coverage supplier for Johns Hopkins workers, initially authorised Eggleston’s declare in 2011. For years, Unum authorised the LTD declare and paid advantages, citing persistent ache and restricted mobility as causes she couldn’t carry out even sedentary work. Unum even transferred the declare to its “core” division, which is reserved for much less intensive critiques.
In 2021, Unum reevaluated Eggleston’s declare after reviewing her social media posts. Pictures and posts promoted “Yvette’s Soul Meals Kitchen” and documented journey and occasion attendance. Unum interpreted this exercise as proof of elevated practical capability and transferred her case out of its “core” unit for a extra in-depth evaluation.
The corporate then initiated an intensive medical reevaluation. Though Eggleston’s medical doctors continued to claim that she was disabled and unable to take a seat or stand for lengthy durations of time, Unum’s inside medical consultants—none of whom had personally examined her—reviewed her medical data and decided that she may carry out full-time sedentary work. These consultants emphasised secure check outcomes, minimal goal scientific findings, and the effectiveness of her drugs in managing her signs.
Denial Upheld Regardless of In depth Help
In early 2022, Unum formally terminated Eggleston’s advantages. She appealed the choice, submitting an in depth bundle of medical data, statements from seven treating suppliers, a practical capability analysis (FCE), and ache questionnaires. The FCE concluded that she couldn’t sit, stand, or stroll lengthy sufficient to take care of any employment.
However, Unum stood by its determination. The reviewing physicians famous that her imaging and lab outcomes didn’t present impairments extreme sufficient to preclude sedentary work, and one reviewer even questioned the validity of the FCE based mostly on her lack of an elevated coronary heart fee throughout exertion testing.
The Courtroom Sided with Unum
The court docket utilized an “arbitrary and capricious” customary, deferring to Unum’s discretion below ERISA. It acknowledged conflicting medical opinions however discovered that Unum’s determination was cheap in gentle of the proof. Emphasizing that Unum was not required to favor treating medical doctors over impartial medical suppliers (even suppliers who didn’t study the claimant in particular person), the court docket concluded that there was no indication that Unum’s determination was pushed by its battle of curiosity as each claims administrator and insurer.
Because of this, the court docket granted abstract judgment in favor of Unum and closed the case.
In case your incapacity advantages have been denied based mostly on alleged social media exercise or conflicting medical opinions, the Ortiz Legislation Agency may also help. We’ve got expertise representing people with persistent ache situations reminiscent of fibromyalgia and inflammatory arthritis. Contact us to guard your rights and safe the advantages you deserve.
Here’s a PDF copy of the choice: Eggleston v. Unum
