In Pamela Fleming v. Unum Life Insurance Company of America (Unum), Plaintiff, a litigation attorney, was in a car accident in 1994 and suffered serious injuries to her spine. She never fully recovered and by July 2005, she was only able to work four hours a day and eventually had to completely stop working.
In December 2005, Unum approved Plaintiff’s claim for LTD benefits. Through the years, she periodically submitted updated medical records and continued to receive benefits until September 26, 2016, when Unum informed her by letter that her benefits were terminated. Unum stated that it believed she was no longer disabled and could return to work. After exhausting her administrative remedies, Plaintiff filed this ERISA lawsuit.
The termination of benefits came after a new administrator arranged for video surveillance of Plaintiff and ordered an independent review of her medical records. Relying on these two things, the administrator terminated Plaintiff’s benefits.
The U.S. District Court for the Central District of California, Southern Division, ruled in favor of Plaintiff. The Court held the video surveillance was consistent with Plaintiff’s report of her symptoms and that the reviewing physicians “cherry-picked” the medical records. The Court concluded that Plaintiff “has met her burden of showing she was entitled to benefits under the Policy when Unum terminated those benefits on September 23, 2016.”
Video Surveillance Unconvincing
Unum relied on 15-minutes of video surveillance that it claimed showed Plaintiff carrying a trash bag and lifting it over her head. She then got in her car and placed a small one-pound ice chest in the back seat of her car and drove to a doctor’s appointment with her mother in the passenger seat.
The Court noted that in the surveillance video, Plaintiff “can be seen for only brief periods from a distance.” Plus, the trash bag carried only empty plastic water bottles. Plaintiff could be seen walking gingerly down a flight of steps, holding on to the rail and taking the steps one-at-a-time. The Court essentially chastised Unum for relying on this video over the reams of medical evidence it received supporting Plaintiff’s disability.
If anything, the Court concluded, the entire surveillance report and footage supported Plaintiff’s claim. Over the course of two days, she left her apartment only once—to drive to the doctor’s appointment. Plaintiff had informed Unum that on occasion, she drove herself to her doctor’s appointment. The Court stated that it saw “no reason to credit Unum’s 15-minute surveillance footage from one day here, especially when it is contradicted by over ten years of medical records.”
Unum’s Paper Review Cherry-Picked the Evidence
The Court found that the paper-only review of Plaintiff’s claim “also fails to support Unum’s termination of benefits. Each reviewer’s conclusions were largely dependent on the purported ‘inconsistencies’ between the 15 minutes of surveillance footage and Unum’s file of over a decade of interview notes and medical records.” The termination of benefits decision “rested entirely on cherry-picked statements from Fleming’s physicians and a paper-only review of Fleming’s claims.”
The Court concluded that “Over a period of almost eleven years, Fleming underwent two back surgeries, nearly weekly medical appointments, and dozens of cervical facet rhizotomies and other painful injections…one day of surveillance footage and Unum’s physicians’ paper-only reviews of Fleming’s claim do not overcome the overwhelming evidence that Fleming was limited from performing the ‘material and substantial duties of [her] regular occupation.”
This case was not handled by our office, but we believe it can be helpful to those who suddenly have their disability benefits terminated after receiving them for many years. For any questions about your disability claim, contact one of our disability attorneys at Dell & Schaefer for a free consultation.