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Unum Loses its Bid to Have Case Dismissed and to Introduce New Evidence

In Anne Wittmann v. Unum Life Insurance Company of America (Unum), the U.S. District Court for the Eastern District of Louisiana did not make any ruling about whether or not Wittmann, an attorney suffering from fibromyalgia, was entitled to long term disability benefits. The only question presented was whether or not she had exhausted her administrative remedies before filing this ERISA lawsuit.

Wittmann argued she had exhausted her remedies, and so a medical review report submitted by Unum after she filed her lawsuit should be stricken from the administrative record. Unum argued she had not exhausted her remedies, so the case should be dismissed.

After conducting a comprehensive analysis of the relevant law, the Court sided with Wittman and held that she had exhausted her remedies, so that all “documents dated or generated” after the date the lawsuit was filed would not be considered by the Court “in determining whether Unum abused its discretion in denying Wittmann’s claim for long-term disability benefits.”

Relevant Facts

Anne Wittmann was an attorney with a large law firm when she stopped working due to fibromyalgia. In April 2014, she filed a claim for long-term disability benefits. By letter dated October 3, 2014, Unum denied her claim and she appealed. In a letter dated May 29, 2015, Unum again denied her claim and informed her that “No further review is available.” She was informed of her right to file an ERISA lawsuit.

Meanwhile, on January 24, 2017, Unum granted Wittmann mental health benefits for the 24-month period from June 30, 2014, through June 30, 2016. In that letter, Unum said it would reevaluate her claim for disability for reasons unrelated to mental illness after June 30, 2016. In response, Wittmann’s attorney provided more medical records.

In a letter dated July 31, 2017, Unum again denied Wittmann long-term disability benefits stating there was “no evidence of physical or organic medical problems that would preclude her from being able to perform her sedentary occupation as an attorney after June 30, 2016.” The letter informed plaintiff of her administrative appellate rights.

Plaintiff Exhausted Her Administrative Remedies

Plaintiff argued that Unum’s July 30, 2017, letter denying her further benefits had no bearing on her ability to file a lawsuit challenging the October 3, 2014, denial of her claim for benefits at which time she had exhausted all of her administrative remedies.

The Court agreed, stating that it could find no case law to support Unum’s claim that a plan administrator could “reset the administrative procedural clock after administrative remedies have been exhausted or require a claimant to exhaust additional rounds of administrative appeals prior to filing suit.”

Accordingly, the lawsuit would go forward. The Court found Plaintiff had exhausted her administrative remedies, and documents filed by Unum after the date upon which Plaintiff filed her lawsuit would be stricken from the record.

This case was not handled by our firm, but we believe it can be instructive to those who are dealing with exhausting their administrative remedies. If you have questions about this case, or about any aspect of your disability claim, contact our disability attorneys at Dell & Schaefer for a free consultation.