Holcomb v. Unum

http://leagle.com/decision/In%20FCO%2020090811056.xml/HOLCOMB%20v.%20UNUM%
20LIFE%20INS.%20CO.%20OF%20AMERICA

Unum began paying long-term disability benefits to Ms. Holcomb on May 23, 2003. Unum advised her that its payments were “under reservation of rights,” meaning Unum did not concede present or future liability. In August 2003, one of Unum’s on-site physicians reviewed Ms. Holcomb’s medical file and filed a report that concluded that her complaints of pain were not supported by “physical exam, testing or radiological findings.” The report noted, however, that her medical records were insufficient “to allow for an independent assessment of the claimant’s functional capacity.”

In July 2005, Dr. Robert Anfield, another Unum physician, evaluated both the OSP’s review of Ms. Holcomb’s medical records and several assessments by Dr. Carson and his staff. Dr. Anfield agreed with the OSP’s analysis, concluding that Ms. Holcomb was capable of engaging in “work activities.” In addition, Dr. Anfield stated that “Ms. Holcomb’s self-reported incapacitating symptoms are primarily the feature of [fibromyalgia] … [and] the label `fibromyalgia’ provides no pathophysiologic foundation upon which to base a set of restrictions and limitations.”

In August 2005, Dr. Carson sent Unum a letter to “clarify a few matters.”  Dr. Carson wrote, “[y]our antagonistic letters and disclaimers suggest a remarkable lack of understanding for systemic lupus erythematosus and its ability to cause functional limitations in patients who are so unfortunately affected.” He wrote that Unum was “try[ing] to make a case that [Ms. Holcomb’s] problems are all subjective and thus mental.” He summarized “the abnormal [laboratory] studies that have been a consistent feature of [Ms. Holcomb’s] disease,” and he urged:  “What I wish you to understand is that the mental aspect of her illness is only a minor aspect. Far greater are the problems of widespread systemic inflammation in the connective tissues. This is most marked by a pronounced arthritis and [her] episcleritis,3 not by her mental problems…. My recommendations for medical retirement based on total and permanent disability [are] based solely on functional limitations apart from any mental disorder. She can no longer engage in any work related activities such as sitting, standing, walking, lifting, carrying or handling objects using her hands.”

Unum’s Vocational Rehabilitation Consultant (“VRC”) then conducted an occupational analysis to determine whether Ms. Holcomb’s stated restrictions and limitations would preclude her from her occupation…

By letter dated September 27, 2005, Unum notified Ms. Holcomb that it would no longer pay disability benefits to her. The letter explained that Unum had concluded she “would be able to perform the material and substantial duties of [her] regular occupation” and could perform at least five other “gainful occupations,” based on her restrictions, limitations, education, training, and experience. Unum also stated that it would not require her to repay the benefits it had disbursed to her after May 22, 2005, even though pursuant to the Policy she was not entitled to long-term benefits beyond that date…

Unum then requested that Ms. Holcomb undergo an independent neuropsychological examination from Dr. James Scott at the University of Oklahoma Health Sciences Center. Dr. Scott found that her response pattern on self-reported measures suggested “a considerable psychological overlay to her reported physical condition.” He determined that Ms. Holcomb “demonstrated average global intellectual functioning,” and that her “[p]erformance on measures of attention/concentration, processing speed, language, immediate verbal and nonverbal memory, and abstraction/problem solving ability all fell within the expected functional range.” Although Dr. Scott determined that Ms. Holcomb was experiencing a mild and intermittent memory problem, he concluded that “[d]ue to her intact general intellectual and problem solving ability, the utilization of compensatory strategies (e.g., memory notebook) would likely ameliorate this situation.”

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