It is well-established that disability insurance companies do not like to pay claims. One powerful
way for an insurer to issue a facially plausible denial where a disability claimant has otherwise
established a disability is to assert that the disability claimant can still perform sedentary work.
Abrams v. Unum Life Ins. Co. of Am., 2022 WL 17960616 (W.D. Wash. Dec. 27, 2022) is an
excellent example of a disability insurance company employing this stratagem to thwart a
legitimate disability claim.

In Abrams, the plan participant/insured, William Abrams, was a high-powered trial and appellate
lawyer earning a base salary of $525,000 per year and was an active marathon runner who
planned to run in three major international marathons during 2020. Unfortunately, Mr. Abrams’
life completely changed in April 2020 when he began to suffer from frequent, near-daily fevers,
along with severe fatigue and mental fogginess. Mr. Abrams attempted to treat his sudden
illness while continuing to work, but it was clear to him and his colleagues that he was not the
same highly-functioning individual they had dealt with previously – his communications were
confused and he did not seem to understand information conveyed in meetings well enough to
participate.

After his symptoms failed to improve over the next several months, Mr. Abrams filed for long-term disability (“LTD”) benefits with Unum in July 2020. The subject LTD policy covered
Abrams if he could not perform his “regular occupation” because of “disability.” In relevant
part, “disability” was defined as “you are limited from performing the material and substantial
duties of your regular occupation due to your sickness or injury.” Unum denied Abrams’ LTD
claim based on the opinions of four paper reviewers, concluding that impairment was not
supported for the 90-day elimination period and that Plaintiff’s treatment plan could be provided
“while performing the noted sedentary demand level of [his] occupation.”

Abrams appealed the denial, bolstering his claim with opinions from seven different doctors –
four of whom diagnosed him with Long COVID and three of whom diagnosed him with Chronic
Fatigue Syndrome. Unum denied the appeal in July 2021, stating that neuropsychological tests
“demonstrated essentially normal cognitive functioning,” and that “Mr. Abrams did not meet the
criteria” for Chronic Fatigue Syndrome (“CFS”) because “his medical records have not
supported significant cognitive impairment… as required for the diagnosis of CFS.” By this
time, Abrams had exhausted his savings account, sold his home, and was drawing on retirement
savings to afford daily life.

Abrams filed suit in federal district court to recover the LTD benefits owed to him. The
applicable legal standard is well-established: A disability claimant must demonstrate disability
under the terms of the plan by a preponderance of the evidence. Armani v. Nw. Mut. Life Ins.

Co., 840 F.3d 1159, 116263 (9th Cir. 2016) (citing Muniz v. Amec Constr. Mgmt., Inc., 623 F.3d
1290, 1294 (9th Cir. 2010)). This requires a “meaningful dialogue between ERISA plan
administrators and their beneficiaries.” See Booton v. Lockheed Med. Ben. Plan, 110 F.3d 1461,
1463 (9th Cir. 1997). The court began its analysis by noting that a trial lawyer’s regular
occupation is determined by examining how it is performed in the national economy. The court
found that trial work requires a high level of cognitive work, making court appearances, working
15-hour days, and traveling extensively, which is mentally and physically grueling. Unum failed
to account for these non-physical demands of the job, focusing its analysis solely on the minimal
physical demands. The court also noted that while Abrams’ doctors did not agree on a unifying
diagnosis, all seven of them agreed he was sick, which was sufficient to grant Abrams’ claim,
awarding him past due LTD benefits, with continuing benefits through July 20, 2023. The court
was also persuaded by sheer common sense, especially given Abrams’ highly successful legal
career prior to his illness: “If Plaintiff were able to work, then he would have done so prior to
selling his home and exhausting his savings. Instead, Plaintiff remains housebound and
unemployed.”

Notably, the court credited Abrams’ near-obsessive daily video recordings taking his own
temperature, to show that he was, in fact, experiencing daily fevers. The court also rejected
Unum’s contention that because there was no correct definitive diagnosis, he did not qualify for
disability:

Unum may be correct that [the plaintiff] has not been correctly diagnosed. But that does
not mean he is not sick. If [the plaintiff’s] complaints, and [the doctor’s] assessments, are
to be believed, [the plaintiff] cannot focus for more than a few minutes at a time, making
it impossible for [the plaintiff] to perform the varied and complex tasks his job requires.

Lastly, the court denied Abrams’ bad faith claim, finding that while Plaintiff had met his burden,
“the evidence of disability is not overwhelming.”

This case presents some practice pointers, one of which is – if you have recurrent objective
symptoms that can be documented to support your claim, you should be doing so. It is important
for individuals confronted with improper denials of disability coverage to seek highly competent
and experienced disability insurance attorneys to review and assess the facts and policy terms
and, if appropriate, sue to receive the benefits to which they are entitled. This is especially true
with respect to insurer denials based on the groundless assertion that they can perform sedentary
work with virtually any medical condition