SHANNON MCMAHON v. UNUM LIFE INSURANCE COMPANY OF AMERICA UNUM GROUP CORP (2025)

MEMORANDUM

Before the Court is Plaintiff Shannon McMahon's motion for judgment on the record. (Doc. 20.) Defendants, Unum Life Insurance Company of America and Unum Group Corporation (collectively, “Unum”), responded in opposition (Doc. 22), and Plaintiff replied (Doc. 23). The Court heard oral argument from both parties on June 18, 2025. (Doc. 25.)

I. BACKGROUND

Plaintiff brings the present action pursuant to the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. §§ 1001 et seq., to obtain judicial review of Unum's termination of her long-term disability (“LTD”) benefits and life waiver of premium (“LWOP”) benefits. (Doc. 1.)

A. The Relevant Plans and Preliminary Approval of Benefits

Plaintiff previously worked for the American Association for the Advancement of Science (“AAAS”) as an Editorial Coordinator. (Id. ¶ 12.) As an Editorial Coordinator, Plaintiff was responsible for facilitating communications between editors, authors, and peer reviewers for scienctific journals and assisting users in the day-to-day use of the clinical trial subjects database. (Doc. 16-1 at 256.) This occupation is best represented in the national economy and the Dictionary of Occupational Titles (“DOT”) as “secretary.” (Doc. 16-2 at 860, 884.)

As part of her employment, Plaintiff was covered by a long-term disability plan (the “LTD plan”) issued and administered by Unum. (Doc. 1 ¶¶ 13, 17.) The definition of disability under the LTD plan changes based on whether a participant has been paid disability benefits for less or more than twenty-four months. (See Doc. 16-1 at 279.) The plan provides in relevant part:

HOW DOES UNUM DEFINE DISABILITY FOR THE FIRST 24 MONTHS OF PAYMENTS?

You are disabled when Unum determines that due to your sickness or injury:

1. You are unable to perform the material and substantial duties of your regular occupation and are not working in your regular occupation or any other occupation

or,

2. You are unable to perform one or more of the material and substantial duties of your regular occupation, and you have a 20% or more loss in your indexed monthly earnings while working in your regular occupation or in any occupation․

HOW DOES UNUM DEFINE DISABILITY AFTER 24 MONTHS OF PAYMENTS?

You are disabled when Unum determines that due to the same sickness or injury:

You are unable to perform the duties of any gainfu1 occupation for which reasonably fitted by education, training or experience.

(Id.)

The LTD plan defines “material and substantial duties” as duties that “are normally required for the performance of your regular occupation” and “cannot be reasonably omitted or modified.” (Id. at 417.) The plan defines “regular occupation” as “the occupation you are routinely performing when your disability begins” and provides that Unum will “look at your occupation as it is normally performed in the national economy, instead of how the work tasks are performed for a specific employer or at a specific location.” (Id.)

As part of her employment, Plaintiff was also covered by a group life insurance plan (the “life plan”) issued and administered by Unum. (Doc. 1 ¶¶ 14–17.) The life plan “provides that a participant's coverage will be continued, and life insurance premiums will be waived if the participant becomes disabled while covered under the life insurance policy. Such benefits are termed Life Waiver of Premium (“LWOP”) benefits under the Life Plan.” (Id. ¶ 16.) The life plan states in relevant part: “Unum does not require premium payment for an insured employee's life coverage if he or she is under age 60 and disabled for 9 months.” (Doc. 16-5 at 14.) “Proof of disability, provided at the insured employee's expense, must be filed by the insured employee and approved by Unum.” (Id.)

The life plan defines “disabled” to mean “during the elimination period, you are not working in any occupation due to your injury and sickness” and “after the elimination period, due to the same injury or sickness, you are unable to perform the duties of any gainful occupation for which you are reasonably fitted by training, education, or experience.” (Id. at 23.) The life plan defines the elimination period as “a period of continuous disability which must be satisfied before you are eligible to have your life premium waived by Unum.” (Id. at 39.) The life plan defines “gainful occupation” to mean “an occupation that within 12 months of your return work is or can be expected to provide you with an income that is at least equal to 60% of your annual earnings in effect just prior to the date your disability began.” (Id.)

Plaintiff began her employment with AAAS in July 2012. (Doc. 16-1 at 24.) She worked in this role until October 4, 2021, (id.), when she became unable to work “due to several chronic conditions and residual symptoms caused by and related to her contraction of COVID-19.” (Doc. 21 at 5.) She applied for short-term disability benefits, which Unum approved until July 20, 2022. (Doc. 16-1 at 492.) After expiration of her short-term disability, Plaintiff's claim transitioned to one for long-term disability. (See id.) Unum initially approved Plaintiff's LTD benefits on September 21, 2022. (Id. at 529.) On September 26, 2022, Unum also initially approved Plaintiff's LWOP benefits. (Doc. 16-4 at 108.) Despite these initial approvals, Unum informed Plaintiff they would do a review of her LTD claim and requested medical records relating to Plaintiff's conditions “to determine when [Plaintiff] [would] regain the capacity to return to work” (Doc. 16-1 at 531), and would require updated information to determine whether Plaintiff “continue[d] to meet the definition of disability in the life insurance” plan (Doc. 16-4 at 108).

B. Medical Testimony and Evidence

During the relevant period, Plaintiff was treated by her primary care physician, Dr. Elizabeth Cilenti, board certified in internal medicine. According to treatment notes, Plaintiff tested positive for COVID-19 on January 5, 2022. (Doc. 16-1 at 177.) As of January 31, 2022, Plaintiff's symptoms of congestion, sore throat, cough, and post-nasal drainage had subsided, but she continued to have fatigue, brain fog, body aches, tingling of hands, arm weaknesses, itchy eyes, vivid dreams and nightmares, headaches, intermittent chest pain, and lightheadedness while standing. (Id.) Plaintiff's providers discussed the possibility of “long COVID”¹ with Plaintiff and suggested a potential COVID recovery course if symptoms continued. (Id. at 178.)

Due to her continued migraines and persistent light and sound sensitivity, Plaintiff saw Dr. Carrie O. Dougherty, MD, board certified in neurology, on February 16, 2022. (Id. at 849.) Dr. Dougherty recommended a cardiology evaluation because she was suspicious of postural orthostatic tachycardia syndrome (“POTS”).² (See id. at 182, 185.) Plaintiff saw Dr. Cilenti again on February 23, 2022. (Id. at 181–83.) She once again noted Plaintiff was experiencing fatigue, brain fog, heart palpitations, migraines, and difficulty reading anything over a few paragraphs long. (Id. at 181.) Dr. Cilenti determined Plaintiff was “unable to do the essential functions of her job at [that] time due to significant fatigue and neurocognitive sequelae and orthostatic intolerance.” (Id.)

Due to Plaintiff's symptoms, Dr. Cilenti referred Plaintiff to a cardiologist for a cardiology workup and to a doctor at a COVID recovery clinic. (Id. at 181–82.) On March 8, 2022, she saw Dr. Eric Wisotzky, MD, board certified in physical medicine and rehabilitation, at the COVID recovery clinic. (Id. at 184–86.) He noted that her “fatigue and brain fog are the biggest barriers to getting back to work.” (Id. at 184.) Due to her issues, Dr. Wisotzky referred her to neuropsychology for an evaluation and an Ear Nose and Throat doctor for her tinnitus and sinus pain. (Id. at 185.)

On April 13, 2022, Plaintiff saw Dr. Cilenti once again, who noted Plaintiff continued “to experience debilitating symptoms post-COVID 19.” (Id. at 187.) Dr. Cilenti reported that Plaintiff continued to “have persistent difficulty concentrating, fatigue, difficulty standing up without [heart rate] increasing and feeling lightheaded/dizzy” that caused her to “remain unable to perform the essential functions of her job.” (Id.) She noted that she would try to move up Plaintiff's cardiology appointment due to her severe health issues. (Id.) She also referred Plaintiff to physical therapy and a mental health therapist to help Plaintiff “manag[e] uncertainty around diagnosis and coping w[ith] chronic illness.” (Id.)

On April 20, 2022, Plaintiff saw Dr. Kenneth M. Lee, MD, board certified in cardiology. (Id. at 190–93.) He noted her echocardiogram was normal but that her heart monitor showed short periods of symptomatic sinus tachycardia and premature cardiac contractions. (Id. at 190–91.) He prescribed her fludrocortisone and propranolol, which helps slow down heart rate. (Id. at 191.) Plaintiff followed-up with Dr. Cilenti on June 6, 2022 (id. at 143–161), and with Dr. Lee again on June 20, 2022 (id. at 119–20). Dr. Lee noted that her symptoms had improved but that she was still easily fatigued and might have been experiencing symptoms of POTS. (Id. at 119.) For this reason, he “uptitrated” Plaintiff's betablocker to a higher dose, which Dr. Cilenti would manage, and suggested an additional medication if her rapid heart rate persisted. (Id.) “Due to the expense, [Plaintiff] [was] reluctant to begin additional medication” at that time. (Id. at 119–20.)

Dr. Cilenti referred Plaintiff to another cardiologist, Dr. Monvadi Srichai-Parsia, for evaluation of a possible POTS diagnosis. (Id. at 104–09.) On July 5, 2022, Dr. Srichai-Parsia noted Plaintiff had signs and symptoms suggestive of POTS, which were “likely related to inflammation from [her] prior COVID infection[,] although she also ha[d] some history of mild hypermobility syndrome which may be [a] contributing factor.” (Id. at 106.) She asked Plaintiff to schedule a tilt-table test, which is used to evaluate whether someone has POTS or another type of dysautonomia. (Id. at 108.) On July 18, 2022, Dr. Srichai-Parsia filled out a Unum form stating Plaintiff was unable to perform the occupational demands on a full-time basis due to persistent concentration issues related to her tachycardia. (Id. at 205.) Plaintiff's POTS diagnosis was then confirmed by the tilt-table test on August 6, 2022. (Id. at 392.) Dr. Srichai-Parsia stated that this diagnosis was “not a big surprise” due to Plaintiff's symptoms. (Id. at 396.) Dr. Srichai-Parsia prescribed Plaintiff Droxidopa, a medicine for her POTS symptoms. (See Doc. 16-2 at 301.)

On September 27, 2022, Plaintiff saw Dr. Cilenti again for continued symptoms of post-acute sequelae of COVID-19, POTS, brain fog, anxiety and depression, urinary frequency, and an immunization due. (Doc. 16-1 at 911.) At the appointment, Plaintiff had regular vitals, including a regular heart rate and rhythm with no murmurs, gallops, or rubs. (Id. at 913.) Despite following up with the COVID clinic and other specialists, Dr. Cilenti found that Plaintiff “continue[d] to have significant disability resulting from prior COVID infection with symptoms including brain fog with delayed processing on neuropsych testing, fatigue, worsening of her migraine headaches, POTS, and now what sounds like neuropathic symptoms.” (Id.) Dr. Cilenti noted that Plaintiff's neuropsychology test showed “slower than expected” processing speed and that Plaintiff reported her whole body felt like it was vibrating and tingling throughout. (Id. at 912.) She described Plaintiff's post-COVID symptoms as “disabling.” (Id.) Dr. Cilenti opined Plaintiff was unable to perform the essential functions of her job. (Id. at 913.)

Unum contacted Dr. Cilenti for medical records and an opinion on Plaintiff's restrictions and limitations. (Id. at 651.) On November 14, 2022, Dr. Cilenti returned Unum's medical provider opinion form and provided restrictions and limitations for Plaintiff beyond September 27, 2022, because she remained “unable to do office work” or “screen/computer work” due to “difficulty sitting upright, brainfog/fatigue due to long COVID-19.” (Id. at 682.) Dr. Cilenti stated Plaintiff's treatment included physical therapy, referrals to specialists, and follow-up visits every two to three months. (Id.)

On December 5, 2022, Plaintiff had another telehealth medicine visit with Dr. Cilenti. (Id. at 707–10.) Dr. Cilenti noted that Plaintiff had symptoms of dizziness, palpitations, tachycardia, and orthostasis associated with POTS, as well as other symptoms like fatigue, daily headaches, brain fog, concentration difficulties and weakness, tinnitus, neck pain, and sleep disruption. (Id. at 707.) She opined that Plaintiff had very slowly improved but remained unable to do prolonged work “due to inability to sustain attention and concentration.” (Id. at 709.) Plaintiff returned to Dr. Srichai-Parsia for a follow-up appointment on December 13, 2022. (Doc. 16-2 at 202–07.) She noted that Plaintiff's POTS symptoms were not well controlled and “severely affect[ed] her quality of life.” (Id. at 205–06.) On December 21, 2022, Dr. Cilenti returned another form from Unum and provided restrictions and limitations for Plaintiff beyond September 27, 2022, because although she did show gradual improvement, she had “not yet reached maximum anticipated improvement and [was] not yet able to return to part time work.” (Doc. 16-1 at 684.)

Plaintiff saw Dr. Cilenti by telehealth once again on March 2, 2023. (Doc. 16-2 at 299–301.) Dr. Cilenti noted Plaintiff's POTS symptoms were better controlled but that she continued “to have persistent fatigue, difficulty sustaining attention, difficulty working on screens/computer, headache, sleep disruption as part of her symptom complex.” (Id. at 301.) Given Plaintiff's tingling in her hands and feet, Dr. Cilenti found another general neurological evaluation was reasonable. (Id.) She opined that Plaintiff was unable to work at that time because she continued to have “significant cognitive impairment in complex attention, memory, [and] executive function.” (Id.)

On January 30, 2023, and March 21, 2023, Dr. Cilenti returned Unum's medical provider opinion forms and provided restrictions and limitations for Plaintiff. In the January 30, 2023, form, Dr. Cilenti indicated Plaintiff's restrictions and limitations were to last until June 30, 2023, but suggested it “may be longer” due to Plaintiff's inability to concentrate, sit, stand, and walk for prolonged amount of times. (Doc. 16-1 at 712.) In the March 21, 2023, form, Dr. Cilenti once again outlined restrictions and limitations until June 30, 2023, but indicated it “may be longer” due to Plaintiff's continued inability to sustain attention, maintain pace, and do office work on a screen or computer due to long COVID-19. (Doc. 16-2 at 274.)

Plaintiff had more follow-up visits with Dr. Cilenti on May 2, 2023, May 11, 2023, and July 7, 2023. (Id. at 581–89.) In May, Dr. Cilenti noted that Plaintiff continued to experience headaches, “cognitive fatigue, difficulty concentrating and brain fogginess, which are worsened with screen exposures and prolonged exertion.” (Id. at 581.) She also noted Plaintiff could only “stand for brief periods of a few minutes, long enough to wash a dish or two, and then feels dizzy and like she will faint if she doesn't sit down.” (Id.) Dr. Cilenti reported that “[d]ue to postexertional fatigue [Plaintiff] ha[d] been unable to tolerate” physical therapy and one visit had exacerbated her symptoms for a week. (Id.) She also noted that Dr. Srichai-Parsia's increase of her POTS medication was “without much improvement” and that Plaintiff continued to have dizzy spells after standing for short amounts of time. (Id.) Because she continued to have “impairment in reading, concentrating, persisting, and thinking,” Dr. Cilenti opined she was unable to do work of any kind at that time. (Id. at 583.) In July, Dr. Cilenti reported that Plaintiff was still having headaches, heart-rate spikes, neuro-cognitive symptoms, fatigue, and autonomic manifestations from POTS that limited her ability to work. (Id. at 591–92.)

On July 18, 2023, Dr. Cilenti returned Unum's medical provider opinion form and provided restrictions and limitations for Plaintiff due to her long COVID-19 and POTS. (Id. at 634–36.) She asserts Plaintiff's medical conditions would prevent or restrict her from working on the computer or looking at a computer screen longer than an hour a day and would hinder her ability to concentrate, work at a consistent pace, follow simple instructions, complete tasks, and respond to usual work changes. (Id. at 635–36.) She predicted Plaintiff's issues would cause her to be absent fifteen or more times in a month. (Id. at 636.) On August 29, 2023, Dr. Srichai-Parsia also returned Unum's medical provider opinion form and outlined limitations for Plaintiff due to her POTS. (Id. at 631–33.) She opined Plaintiff's medical conditions would prevent or restrict her from working on the computer or looking at a computer screen longer than six hours a day and her conditions might limit her ability to concentrate, demonstrate reliability, work at a consistent pace, and timely complete tasks commonly found in work settings at times. (Id.) She predicted Plaintiff would likely be absent six times a month due to her condition. (Id. at 633.)

On October 9, 2023, through October 10, 2023, Plaintiff underwent a two-day cardiopulmonary exercise test (“CPET”) performed by Dr. Betsy Keller, PhD, FACSM, to help assess Plaintiff's ability to carry out normal daily activities given her cardiopulmonary abnormalities and impairments. (Id. at 543–54.) Dr. Keller concluded Plaintiff's peak oxygen consumption, which measures one's ability to produce energy and recover normally following exertion, was “equivalent to the average, inactive 88 year-old female.” (Id. at 546.) She found that this “severe” impairment was due to “an underlying pathophysiology” that caused Plaintiff “undue fatigue and symptom exacerbation that is not normally commensurate with ․ activities,” such as dressing, driving a car, or walking around the workplace. (Id. at 547.)

She opined that “efforts to perform sedentary level work will exacerbate her illness symptoms.” (Id. at 550.) “Given her low [ventilation anaerobic threshold] level of energy production which classifies her with severe impairment, even meaningful accommodations, such as frequent, long breaks with no exertional load (physical, cognitive, or emotional), the opportunity to sit/lie down, and/or not work consecutive days, would not be sufficient for Ms. McMahon to tolerate her job, full-or part-time.” (Id. at 551 (emphasis omitted).) Dr. Cilenti and Dr. Annie Amitrani, Plaintiff's physical therapist, both reviewed Dr. Keller's report and agreed with the restrictions and limitations set forth by Dr. Keller. (Id. at 556, 558.)

C. Unum's Review and Termination of Benefits

Upon obtaining these medical records, Unum reviewed Plaintiff's claim via forum discussion on February 17, 2023, and April 5, 2023. (Id. at 132–37, 326–28.) On April 17, 2023, Unum forwarded Plaintiff's claim to Vocational Rehabilitation Consultant Karin Pinske, MA, CRC, for vocational review to identify the duties of Plaintiff's occupation. (Id. at 368–70.) Ms. Pinske found that Plaintiff's occupation, in light of the national economy, was most consistent with a “Associate Web Editor” position, which “involves assisting web editors with developing, coordinating, editing and maintaining assigned content on organization or client websites.” (Id. at 368.) She classified this as sedentary work that required mostly sitting but may involve standing or walking for brief periods of time, lifting, carrying, pushing, and pulling up to ten pounds occasionally. (Id. at 369.) She determined this occupation requires concentration, memory and attention, problem solving, making evaluations, maintaining “interpersonal relationships in job situations beyond receiving work instructions,” and adhering to and achieving exact and precise levels of performance. (Id.)

Unum then forwarded Plaintiff's claim to Senior Clinical Consultant, Kay O'Reilly, RN, MSN, who concluded that Plaintiff's functional loss and ability to meet the physical and cognitive demands of her job were unclear. (Id. at 378–79.) She noted that Plaintiff's complaints were consistent but that the physical exams were mostly normal. (Id. at 379.) She also noted the neuropsychological testing showed lower bounds of functioning but did not show conclusively that those were her limits. (Id.)

The claim was then referred to Medical Consultant, Dr. Catherine Vitosh, MD, board certified in family medicine, for review. (Id. at 423–29.) On May 8, 2023, Dr. Vitosh opined that “the physical exam findings, diagnostic testing, intensity of management, reported activities, other AP's opinions, and improvement of condition reflected in the file do not support that [Plaintiff] would be precluded from performing the outlined occupational demands on a full-time basis.” (Id. at 428.) After this, Plaintiff's claim was referred to Designated Medical Officer, Zachary Gross, MD, board certified in internal medicine, for review. (Id. at 439–41.) Dr. Gross agreed with Dr. Vitosh's opinion and found that there were “no clinical findings present in the available records to support the degree of [Plaintiff's] self-reported impairment to support the restrictions and limitations opined” by Dr. Cilenti. (Id. at 441.) Specifically, he noted that there have been no abnormalities on exams, brain imaging was normal, the echocardiogram only showed mild to moderate mitral regurgitation, and Plaintiff's follow-up with neurology and cardiology had been infrequent. (Id. at 440–41.)

Based on these reviews, on May 15, 2023, Unum informed Plaintiff it was terminating her LTD benefits because her medical records did not show she could not perform the duties of her regular occupation. (Id. at 451–61.) Unum determined that although Plaintiff's treating physicians did set limitations, they were not to such a degree that would preclude Plaintiff from performing the duties of her sedentary occupation. (Id. at 456.) Unum denied Plaintiff's LWOP two days later based on the same evidence. (Doc. 16-4 at 638–42.)

D. Plaintiff's Appeal of Unum's Termination of Benefits

On November 10, 2023, Plaintiff's counsel appealed Unum's denial of both claims and submitted additional records for consideration. (Doc. 16-2 at 534–40.) These records included additional medical records; medical opinion forms; a magnetic resonance imaging (“MRI”) report; CPET report; and CPET report agreement forms. (Id. at 541–58.) On November 13, 2023, Unum acknowledged receipt of Plaintiff's appeal and confirmed the case had been assigned to Lead Appeals Specialist Libby Reed for review. (Id. at 562–63.)

On November 27, 2023, Plaintiff's counsel submitted additional records for Unum's consideration. (Id. at 674–78.) Shortly thereafter, Unum forwarded the file to Appeals Physician Neal Greenstein, MD, board certified in internal medicine. (Id. at 785–88.) He stated the following:

The insured and Dr. Cilenti opine [Plaintiff] is precluded from performing the outlined occupational demands for the functional time period under review. I disagree and no other providers are opining [restrictions and limitations]. In my opinion, the self-reported symptoms/conditions are disproportionate to the clinically unremarkable exams and diagnostics. The evidence to support my opinion is derived from the provided documentation ․

(Id. at 786.)

On November 30, 2023, Unum notified Plaintiff's counsel that that it had not reached a decision but was providing new information for review and response by counsel. (Id. at 809.) Plaintiff's counsel submitted additional records for Unum's consideration, including a CPET addendum; a vocational evaluation; and declarations made by Plaintiff. (Id. at 847–69.)

The CPET addendum was completed by Dr. Keller, who criticized Dr. Greenstein's “disregard [of] the objective evidence of Ms. McMahon's very low energy producing capacity and symptom complex.” (Id. at 854.) She opined that “[t]he 2-day CPET results indicate that Ms. McMahon, according to the valid and highly regarded objective standards measured during CPET, is severely impaired to the extent that she is unable to perform sustained work. Efforts to do so will exacerbate her illness symptoms and worsen her overall health and wellness.” (Id. (emphasis omitted).)

The vocational evaluation was completed by Ashley H. Johnson, MS, CRC, CLCP, who “disagree[d] with the classification used for Ms. McMahon's prior occupation” by Unum. (Id. at 861.) She explained that Plaintiff's material and substantial duties are consistent with clerical or secretarial work, not with the occupation of associate web editor. (Id.) Accordingly, Plaintiff was performing a skilled occupation which required her “to multi-task, meet deadlines, respond to requests, and manage databases.” (Id. at 862.) In her opinion, Plaintiff “is unable to perform either her regular occupation or any occupation as a result of her symptoms and limitations.” (Id. at 863.)

Lastly, Plaintiff included her own declarations that “shed light on [her] typical day.” (Id. at 865.) She explained that her brain fog and fatigue were “overwhelming and interfere[d] significantly with [her] ability to focus and remember things.” (Id.) Throughout the declaration she represented she struggles greatly with day-to-day functioning such as getting ready for the day, carrying items, being on her feet, sitting upright, leaving the house, looking at screens, doing household tasks, and getting ready for bed. (Id. at 865–69.) She noted having to stop and rest to recuperate. (Id. at 868.)

On January 8, 2024, Unum forwarded the file to Senior Vocational Rehabilitation Consultant, G. Shannon O'Kelly, M.Ed., CRC, who performed a vocational review and agreed with Ms. Johnson that Plaintiff's occupation required sedentary work and was closest to that of secretary. (Id. at 884.) She determined Plaintiff's material and substantial duties would require mostly sitting, standing or walking for brief periods, occasional lifting, carrying, pushing, or pulling, frequent reaching at desk level, frequent handling, frequent fingering and using keyboard, dealing with people, and making judgments and decisions. (Id.)

Unum then forwarded the file to Dr. Greenstein once again and he submitted an addendum to his prior review. (Id. at 886–87.) Dr. Greenstein again concluded that no restrictions and limitations were supported that would prevent Plaintiff from performing sedentary work. (Id.) Specifically, Dr. Greenstein found the CPET performed by Dr. Keller did not reflect her functional capacity during the period under review because it was performed five months after the period and that the new information and records did not alter his prior opinion. (Id. at 887.)

On January 12, 2024, Unum notified Plaintiff's counsel that that it had not reached a decision but was providing new information for review and response by counsel. (Id. at 899.) On February 12, 2024, Plaintiff's counsel submitted additional records for Unum's consideration, including a CPET statement by Dr. Cilenti confirming the CPET report was consistent with Plaintiff's functionality during the review period and a new declaration by Plaintiff representing there had been no significant changes in her conditions during the review period. (Id. at 926–28.) In addition to this, Plaintiff attached three of Dr. Greenstein's reports in other ERISA cases to argue Unum should not rely on his opinion here. (Id. at 930–44.) Plaintiff suggested “Dr. Greenstein's reports are replete with instances of bias and laziness” and are “mostly comprised of the same boilerplate or formulaic text that superficially support the denial of each claim being review.” (Id. at 921.)

Despite this new evidence, on February 22, 2024, Unum notified Plaintiff that it was upholding its denial of benefits. (Id. at 951–59.) Unum stated the following findings in support of its decision.

• “The medical records do not support [Plaintiff's] self-reported symptoms/conditions of fatigue, insomnia, and cognitive deficits, or [that] her reported behavioral health symptoms precluded her from performing her regular occupational demands ․”

• “There was no documentation of abnormal speech, language, insight, judgment, mood, affect, irritability, decreased concentration/memory, inattentiveness, lethargy, and no somnolence, sedation, psychomotor retardation, abnormal behaviors or functional deficits.”

• If Plaintiff had “been precluded from her occupational demands, it would be expected records would document a clinically abnormal September 2022 sleep study, repeat cognitive testing (given August 2022 results), and clear documentation of cognitive impairment.”

• “The CPET provided on appeal was performed approximately five months after benefits ended.” (AR 1542-54).

• “The records do not support [Plaintiff's] self-reported general and associated symptoms/conditions of migraines and headaches precluded her from performing her occupational demands as of May 16, 2023.”

• As to Plaintiff's POTS diagnosis, “[i]t would be expected that records would document abnormal exams ․ “[c]linically remarkable diagnostics, additional therapeutics and closer cardiology follow-up ․”

• “Records do not support [Plaintiff] was precluded from performing her occupational demands as of May 16, 2023, due to tinnitus, dysphonia, and sinus pressure.”

• Plaintiff's medical records did not support reports of chronic neck pain, cervical disc disease, and paresthesia because they did “not include abnormal exams or diagnostics” or therapeutics (physical therapy, injections, recent refills of NSAIDs, muscle relaxers, narcotics) or specialty evaluation/management.”

(Doc. 22 at 15–16.)

On August 19, 2024, Plaintiff filed this action, seeking judicial review of Unum's denial of her LTD and LWOP benefits under ERISA. (Doc. 1.) Plaintiff now moves for judgment on the ERISA administrative record (Doc. 20), and her motion is ripe for the Court's review.³

II. STANDARD OF REVIEW

ERISA allows a participant in an employee benefit scheme to bring a civil action to recover benefits due under the terms of a plan. 29 U.S.C. § 1132(a)(1)(B). “Denials of benefits challenged under 29 U.S.C. § 1132(a)(1)(B) are reviewed de novo ‘unless the benefit plan gives the administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe the terms of the plan.’ ” McClain v Eaton Corp. Disability Plan, 740 F.3d 1059, 1063 (6th Cir. 2014) (quoting Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989)). The parties agree the appropriate standard of review is de novo because the plan does not grant discretion to the plan administrator. (Doc. 21 at 15; Doc. 22 at 16.)

Under a de novo standard of review, the plan administrator's decision is afforded no deference or presumption of correctness. Hoover v. Provident Life & Accident Ins., 290 F.3d 801, 808–09 (6th Cir. 2002). Instead, the role of the court “is to determine whether the administrator ․ made a correct decision” to deny benefits. Id. at 809 (quotation omitted). In making this determination, courts only consider the evidence available to the plan administrator at the time the final decision was rendered. McClain, 740 F.3d at 1064. Courts apply general principles of contract law and must read the plan provisions “according to their plain meaning in an ordinary and popular sense.” O'Neill v. Unum Life Ins. Co. of Am., No. 18-1382, 2018 WL 7959523, at *3 (6th Cir. Nov. 19, 2018) (quoting Williams v. Int'l Paper Co., 227 F.3d 706, 711 (6th Cir. 2000)). Although there is no deference given to the plan administrator's decision, the insured bears the burden of proof by a preponderance of the evidence. O'Neill, 2018 WL 7959523, at *3. To succeed in her claim for disability benefits under ERISA, Plaintiff must prove by a preponderance of the evidence that she was ‘disabled,’ as that term is defined in the Plan.” See Messing v. Provident Life & Accident Ins. Co., 48 F.4th 670, 678 (6th Cir. 2022) (quoting Javery v. Lucent Techs., Inc. Long Term Disability Plan for Mgmt. or LBA Emps., 741 F.3d 686, 700 (6th Cir. 2014)).

III. DISCUSSION

Plaintiff has moved for judgment on the ERISA record, arguing that Unum incorrectly terminated her LTD and LWOP benefits. (Doc. 21 at 3, 27.) The Court will address Plaintiff's entitlement to the two types of benefits in turn.

A. LTD Benefits

Plaintiff suggests her treatment notes “are replete with the consistent findings of her providers that she continued to experience debilitating fatigue, brain fog, and other issues despite her pursuit of reasonable treatments.” (Id. at 18.) There is no question Plaintiff has a well-documented history of medical conditions that have caused her to have symptoms including headaches, brain fog, fatigue, concentration difficulties, tinnitus, neck pain, and sleep disruption. The Court has little doubt Plaintiff's conditions have contributed to significant decreases in her functional capacity. See Huffaker v. Metro. Life Ins. Co., 271 Fed. App'x. 493, 502 (6th Cir. 2008). The relevant inquiry, though, is whether these conditions made Plaintiff unable to perform her regular occupation. See Saunders v. Procter & Gamble Health & Long-Term Disability Benefit Plan, No. 1:15-CV-154, 2015 WL 13037566, at *9 (S.D. Ohio Dec. 28, 2015), aff'd, 659 F. App'x 272 (6th Cir. 2016) (citing Huffaker, 271 Fed. App'x. at 502 (“The critical question ․ is not whether [the plaintiff] does or does not have fibromyalgia ․ but whether she is disabled under the plan.”)).

To be eligible for LTD benefits under the policy, a participant must be “unable to perform the material and substantial duties of [their] regular occupation and are not working in [their] regular occupation or any other occupation” or “unable to perform one or more of the material and substantial duties of [their] regular occupation, and [they] have a 20% or more loss in [their] indexed monthly earnings while working in [their] regular occupation or in any occupation.” (Doc. 16-1 at 279.) The plan defines “material and substantial duties” as duties that “are normally required for the performance of your regular occupation” and “cannot be reasonably omitted or modified.” (Id. at 417.) The plan defines “regular occupation” as “the occupation you are routinely performing when your disability begins.” (Id.)

To determine whether Plaintiff was capable of performing “the material and substantial duties” of her “regular occupation” under the LTD plan, the Court must first define the nature of the work required for Plaintiff's regular job. See Bruton v. Am. United Life Ins. Corp., 798 F. App'x 894, 905 (6th Cir. 2020) (quoting Javery, 741 F.3d at 702). According to the job description, as an Editorial Coordinator, Plaintiff was responsible for facilitating communications between editors, authors, and peer reviewers for scientific journals and assisting users in the day-to-day use of the clinical trial subjects database. (Doc. 16-1 at 256.) Although there was some debate initially, (see Doc. 16-2 at 368), Plaintiff and Unum now seem to agree this occupation is best represented in the national economy and the Dictionary of Occupational Titles (“DOT”) as “secretary.” (Id. at 860, 884.) Plaintiff's material and substantial duties would require mostly sitting, standing or walking for brief periods, occasional lifting, carrying, pushing, or pulling, frequent reaching at desk level, frequent handling, frequent fingering and using keyboard, dealing with people, and making judgments and decisions. (Id. at 884.) The Court now must determine whether Plaintiff was disabled and unable to perform these job duties.

1. The Parties' Arguments

Plaintiff argues she has met her burden of showing Unum improperly denied her benefits because her conditions, “including her chronic fatigue, POTS, and dysautonomia, prevent her from performing the essential duties of her regulation occupation with AAAS or any other gainful occupation on a full or part-time basis.” (Doc. 21 at 16.) She contends that the record, which supports that she is disabled, “is replete with strong, consistent, and reliable evidence” including “medical records, opinion forms from her providers, and objective testing.” (Id. at 18.)

Unum disagrees and argues that the “assessments conducted by Plaintiff's healthcare providers do not objectively support that she is precluded from performing her sedentary work.” (Doc. 22 at 18.) It argues:

Indeed, the evidence shows that Plaintiff's conditions improved, and the majority of Plaintiff's healthcare providers did not opine any [restrictions and limitations]. Initially, the only physician that asserted [restrictions and limitations] was Plaintiff's primary care physician, Dr. Cilenti․ Then, on appeal, Dr. Srichai-Parsia changed her opinion via a counsel-provided form to opine limited [restrictions and limitations].4

(Id.) Unum argues the Court should give its three reviewing physicians, who all found that the totality of evidence did not support Plaintiff's inability to work, more weight than Plaintiff's treating physicians.

As alluded to above, the administrative record contains conflicting medical evidence regarding whether Plaintiff could perform her usual occupation. Dr. Cilenti and Dr. Srichai-Parsia—Plaintiff's treating physicians—opined she would require significant restrictions and limitations to perform her regular occupation. (Doc. 16-2 at 631–36.) Dr. Vitosh, Dr. Gross, and Dr. Greenstein—Unum's reviewing physicians—opined Plaintiff's medical records did not support the conclusion that she could not perform sedentary work. (Id. at 425–29, 439–41, 785–88.) Both sides attempt to discredit the other's medical evidence. In determining whether the plan administrator made the correct decision to deny Plaintiff's benefits, the Court must evaluate the medical evidence and weigh the credibility of the various physicians' opinions.

In situations where the opinions of treating physicians contradict the opinions of non-treating physicians, the Court of Appeals for the Sixth Circuit has explained, “courts may not conclude that the opinion of treating physicians is entitled to more weight than that of non-treating physicians.” Bruton, 798 F. App'x at 904 (citing Black & Decker Disability Plan v. Nord, 538 U.S. 822, 830 (2003)). At the same time, “when a plan administrator's explanation is based on the work of a doctor in its employ, we must view the explanation with some skepticism.” Moon v. Unum Provident Corp., 405 F.3d 373, 381–82 (6th Cir. 2005). “On de novo review ․ , the court is to take into account all of the medical evidence, giving each doctor's opinion weight in accordance with the supporting medical tests and objective findings that underlie the opinion.” Crider v. Highmark Life Ins. Co., 458 F. Supp. 2d 487, 505 (W.D. Mich. 2006).

Because Plaintiff has the burden to demonstrate she was disabled and unable to work, the Court will start with Unum's critiques of Plaintiff's medical evidence. Unum tries to discredit Plaintiff's medical evidence in three major ways: (1) Unum argues Plaintiff's medical evidence should be afforded little weight because it is based on “Plaintiff's subjective reports of symptoms” and not objective findings; (2) Unum argues Plaintiff's treating physicians' opinions should be afforded little weight because they are biased and trying to help Plaintiff receive benefits; and (3) Unum argues the “conclusory forms” completed by Plaintiff's treating physicians should be disregarded as unsupported. (Doc. 22 at 19–22.)

First, contrary to Unum's suggestion that the Court should give Plaintiff's subjective evidence little weight, the Plan here “does not require the claimant to produce only objective evidence, nor does it foreclose the consideration of subjective evidence.” See Laake v. Benefits Comm., W. & S. Fin. Grp. Co. Flexible Benefits Plan, 68 F.4th 984, 996 (6th Cir. 2023) (quoting James v. Liberty Life Assurance Co. of Bos., 582 F. App'x 581, 589 (6th Cir. 2014)). The fact that Plaintiff's complaints of pain are self-reported or subjective do not render them irrelevant as to whether she was disabled. See id. at 997. This is especially true because Plaintiff “has been consistent in reporting” that her subjective symptoms are debilitating and increasing. See Bruton, 798 F. App'x at 904 (finding it appropriate to give a plaintiff's self-reported level of pain considerable weight where it is “well-documented”).

Thus, the Court will consider Plaintiff's well-documented self-reported symptoms scattered throughout her treatment records, as well as Plaintiff's declaration representing that her brain fog and fatigue are “overwhelming and interfere[ ] significantly with [her] ability to focus and remember things,” and that she struggles greatly with day-to-day functioning such as getting ready for the day, carrying items, being on her feet, sitting upright, leaving the house, looking at screens, doing household tasks, and getting ready for bed. (Doc. 16-2 at 865–69.)

But, the record includes more than just her subjective reports. Plaintiff offers objective proof that she suffers from POTS in the form of the tilt-table test and Dr. Srichai-Parsia's official diagnosis. In addition, the record contains numerous medical notes and opinions throughout 2022 and 2023 where Plaintiff's providers evaluated her subjective symptoms in terms of her functional capabilities. (See, e.g., Doc. 16-1 at 205, 581–89, 664.) As the Sixth Circuit has explained, “a treating physician's notes detailing the functional capabilities of a patient are objective evidence.” Zuke v. Am. Airlines, Inc., 644 F. App'x 649, 654 (6th Cir. 2016). Further, Plaintiff submitted the “objectively valid results of Dr. Keller's two-day CPET,” which corroborate her doctors' reports of her functional limitations. (Doc. 21 at 18.) The CPET “is a valid and reliable indicator of functional capacity (peak oxygen consumption or VO2 peak).” (Doc. 16-2 at 545.)

Based on the objective evidence available in the record, the Court does not find Unum's argument persuasive. In fact, “[w]hen a defendant in a denial-of-benefits case ‘categorically states that there is no objective evidence when in fact there is such evidence,’ that weighs against the defendant.” Jahnke v. Unum Life Ins. Co. of Am., No. 24-10274, 2025 WL 2603390, at *16 (E.D. Mich. Sept. 9, 2025) (quoting Zuke, 644 F. App'x at 654).

Second, Unum argues Plaintiff's treating physicians are biased. Unum contends “the conclusory advocacy statements made by [a] certain of Plaintiff's treating physicians” were based “on the uncritical acceptance of Plaintiff's reported symptoms, all given in the context of her disability claim.” (Doc. 22 at 19–20.) Moreover, Unum says that “because treating physicians ‘will often bend over backwards to assist a patient in obtaining benefits,’ Hofslien v. Barnhart, 439 F.3d 375, 377 (7th Cir. 2006), the Court is under no obligation to accept their opinions.” (Doc. 22 at 19.) It suggests the Court must “balance the treating provider's tendency to ‘accept at face value what patients tell them about their subjective symptoms.’ ” (Id. at 20 (quoting Swanson v. Unum Life Ins. Co., No. 13-CV-4107, 2015 WL 339313, at *9 (D. Kan. Jan. 26, 2015)).) In reply, Plaintiff says this argument “is both offensive and untrue.” (Doc. 23 at 7.)

The Court agrees with Plaintiff and finds Unum's argument unavailing. There is no indication Plaintiff's providers accepted Plaintiff's symptoms at face value or bent over backwards to assist her in obtaining benefits. While the Court cannot automatically afford treating physicians more weight than file reviewers, the Court “is under no obligation to ignore the fact that a treating physician's greater experience with a plaintiff may, depending on the context of the case, provide that physician with a superior basis for making certain determinations.” Boersma v. Unum Life Ins. Co. of Am., 546 F. Supp. 3d 703, 714 (M.D. Tenn. 2021). This is especially true here because “evaluating and interpreting the patient's own account” of her autonomic manifestations is “so important” in assessing her POTS and long COVID conditions. See id. After considering the potential bias that Plaintiff's treating physicians might have based on their relationships with her, the Court ultimately finds the treating physicians' assessments to be credible. See id.

Moreover, none of Plaintiff's providers have ever even hinted that they thought Plaintiff was malingering. Instead, her doctors continued to treat her symptoms by implementing new treatment options, ordering tests, and providing various referrals. The only medical providers who questioned the severity of Plaintiff's symptoms are Unum's reviewers who never saw her in person. (See, e.g., Doc. 16-2 at 425–28, 439–41, 785–88.) While “there is nothing inherently improper with relying on a file review, even one that disagrees with the conclusions of a treating physician,” Shaw v. AT &T Umbrella Benefit Plan No. 1, 795 F.3d 538, 550 (6th Cir. 2015) (quoting Calvert v. Firstar Fin. Inc., 409 F.3d 286, 297 n.6 (6th Cir. 2005)), the Sixth Circuit has “found fault with file-only reviews” when file reviewers make credibility determinations about claimants they have never examined. Judge v. Metro. Life Ins. Co., 710 F.3d 651, 663 (6th Cir. 2013) (citing Bennett v. Kemper Nat'l Servs., Inc., 514 F.3d 547, 555 (6th Cir. 2008)); see Jahnke, 2025 WL 2603390, at *14 (“That rule makes good sense, given that physicians who do not physically examine a patient are in no position to assess their credibility.”).

Unum also emphasizes that “the majority of Plaintiff's healthcare providers did not opine any [restrictions and limitations].” (Doc. 22 at 18.) The fact that some of Plaintiff's providers did not provide opinions as to her restrictions and limitations, however, is not evidence that she is not disabled. There is no evidence in the record as to why these doctors did not give opinions. The lack of response could be due to various reasons, including the fact physicians have busy schedules with many different responsibilities and obligations. It could also be because they are less familiar with her overall functional capabilities.

Third, Unum suggests the Court should afford the “conclusory forms” completed by Plaintiff's medical providers little, if any, weight. (Id. at 22 (citing Creech v. Unum Life Ins. Co., 162 F. App'x 445, 453 (6th Cir. 2006) (noting that treater's failure to support his opinion with data or useful analysis was sufficient to discount opinion)).) It argues “the ‘check box’ CPET agreement forms Plaintiff's counsel provided on appeal to Dr. Cilenti and physical therapist, Annie Amitrani, PT, DPT, who then marked they ‘agree[d] with the restrictions and limitations as set forth in the CPET report by Dr. Keller’ without any explanation as to the reason for their agreement, should not be considered.” (Id.) In reply, Plaintiff contends “[t]his argument fails because it overlooks that Dr. Cilenti provided multiple forms and statements to [Unum] during the administration of Plaintiff's claim that outlined restrictions consistent with the CPET findings and set forth the basis for her opinions.” (Doc. 23 at 8.)

Because there is no explanation as to how Dr. Amitrani reached her agreement with the findings of the CPET report, the Court will give little weight to her opinion. But the Court does not find the same flaws apparent in Dr. Cilenti's agreement with the findings of Dr. Keller's CPET report. As noted above, Dr. Cilenti, either within treatment notes or through forms with accompanying notes, consistently documented Plaintiff's symptoms and opined restrictions and limitations for Plaintiff throughout 2022 and 2023. (See, e.g., Doc. 16-1 at 181, 187, 196, 682, 709, 712, 913; Doc. 16-2 at 274, 301, 583 591, 634.) As required by the CPET-agreement form, Dr. Cilenti was in a position to reflect on her “own evaluation, examination, and treatment” of Plaintiff to determine whether she agreed with the conclusions contained in the CPET report. (See Doc. 16-2 at 556.) In light of Dr. Cilenti's history with Plaintiff, and that Dr. Cilenti later confirmed the CPET report was consistent with Plaintiff's functionality during the review period (id. at 926–28), Dr. Cilenti's opinion about the CPET report is not conclusory.

Unum further argues Dr. Srichai-Parsia's August 29, 2023, restriction-and-limitation form should be “disregarded for the same reason.” (Doc. 22 at 22.) It also argues Dr. Srichai-Parsia “changed her opinion via a counsel-provided form” on appeal, even though “nothing changed in Dr. Srichai-Parsia's assessment of Plaintiff leading up to the completion of the form” and Plaintiff reported a slight improvement in her condition in December 2022. (Id. at 18, 22.)

First, there is no case law or independent reasoning to support that “a counsel-provided form” is inherently suspect. Second, contrary to Unum's suggestion that Dr. Srichai-Parsia's form opining restrictions and limitations was conclusory and without support, Dr. Srichai-Parsia noted Plaintiff's POTS diagnosis and directed the parties to see her treatment notes for more explanation. (Doc. 16-2 at 631.) Third, the form is consistent with Dr. Srichai-Parsia's treatment notes and her restriction-and-limitation form completed on July 18, 2022. (See Doc. 16-1 at 205.)

Unum tries to discredit Dr. Sriachai-Parsia's opinion by focusing on the fact Plaintiff reported a slight improvement in her condition during her appointment in December 2022. Although she did note that Plaintiff's “heart rate ha[d] been better controlled” on her dose of medicine, she also noted that Plaintiff still experienced spikes in heart rate when going upstairs and doing activities, migraines, fatigue, and brain fog. (Doc. 16-2 at 204.) During this appointment, Dr. Sriachai-Parsia prescribed a new medication to Plaintiff's regimen “to see if [it] improves [her] symptoms including cognition.” (Id. at 205.) Rather than inconsistent, the form appears to be in line with her prior assessments of Plaintiff, where she noted that Plaintiff's POTS symptoms were not well controlled and “severely affected her quality of life.” (Id. at 205–06.) Thus, there is nothing in the record to suggest Dr. Srichai-Parsia changed her opinion for purposes of an appeal. See, e.g., Boersma, 546 F. Supp. 3d at 714.

The Court will now address Plaintiff's critiques of Unum's review. Plaintiff argues Unum's file reviewer, Dr. Greenstein, should be discredited. Plaintiff contends Unum “acted unreasonably by relying on the opinions of Dr. Neal Greenstein to deny [Plaintiff's] claims” because he “conducted a selective review of the record” and improperly rejected the objective CPET report. (Doc. 21 at 19–20.) Critiques about the plan administrator's reasonableness are “all beside the point because ‘it is irrelevant on de novo review whether a plan administrator's decision was principled or reasoned.’ Rather, ‘[t]o succeed in [her] claim for disability benefits under ERISA, Plaintiff must prove by a preponderance of evidence that [s]he was ‘disabled,’ as that term is defined in the Plan.’ ” Bustetter v. Standard Ins. Co., 529 F. Supp. 3d 693, 707 (E.D. Ky. 2021), aff'd, No. 21-5441, 2021 WL 5873159 (6th Cir. Dec. 13, 2021) (quoting Javery, 741 F.3d at 699–700). Nevertheless, the Court will consider the other critiques of Dr. Greenstein's opinions to determine how much weight to give them.

Plaintiff first argues Dr. Greenstein's opinion should be disregarded because “he is not qualified to evaluate [Plaintiff's] dysautonomia and POTS or to properly consider [Plaintiff's] CPET results.” (Doc. 21 at 23.) The Court does not find this critique persuasive. As a board-certified physician in internal medicine, Dr. Greenstein is “a health care professional who has appropriate training and experience in the field of medicine involved in the medical judgment.” See Castor v. AT & T Umbrella Benefit Plan No. 3, 728 F. App'x 457, 461 (6th Cir. 2018) (quoting 29 C.F.R. § 2560.503-1(h)(3)(iii)). To disregard Dr. Greenstein's opinions based on this reason would require the Court to also disregard Dr. Cilenti's opinions, because she too is only board certified in internal medicine.

Plaintiff next argues “Unum's decision should be overturned because [Dr. Greenstein] authored a boilerplate report and conducted a selective review of the record.” (Doc. 21 at 19 (emphasis removed).) Plaintiff contends that she:

notified Unum that [Dr.] Greenstein was regularly providing Unum with nearly identical reports in multiple different claims, including hers, that superficially supported the denial of benefits․ Specifically, Plaintiff informed Unum that “[e]ach report follow[ed] a similar pattern, with huge portions copies [sic] from report to report with effectively no changes. Beyond containing large swaths of identical language, Dr. Greenstein's ‘substantive’ opinions follow a similar and predictable pattern as well.”

(Id. at 19–20 (quoting Doc. 16-2 at 919).) In response, Unum argues “Dr. Greenstein's use of consistent phrasing in certain aspects of his reports does not negate their accuracy and he identified at length his analysis and rationale in support of the conclusion that Plaintiff was not precluded from performing her regulation occupation.” (Doc. 22 at 24.) The Court finds that Dr. Greenstein's “boilerplate” reports are not credibility shattering because there is at least some variation between claimants.

Third, Plaintiff argues Dr. Greenstein's opinion should be given less weight because he wrongly “discredit[ed] the severity of [Plaintiff's] documented fatigue and brain fog” by honing in on “irrelevant portions of Plaintiff's medical records.” (Doc 21 at 22.) As an example, Plaintiff cites Dr. Greenstein's report stating:

In my opinion, if the insured self-reported symptoms/conditions of fatigue, insomnia, BH, and cognitive deficits precluded her from performing the outlined occupation demands as of 05/16/2023, I would not have expected exams that described her as alert, oriented x3, well developed and nourished, and in NAD.

(Id. (citing Doc. 16-2 at 787).) Plaintiff suggests, “[a]t no point did [Plaintiff] or her providers claim that her fatigue and brain fog were so severe that [she] was incapacitated or unable to remember her own name.” (Id.) Plaintiff's point is well-taken, as she need not be incapacitated to be unable to perform the material and substantial duties of her regular occupation. (See Doc. 16-1 at 279.)

The Court further notes that despite Unum's emphasis on the lack of abnormal clinical findings in the tests such as the MRI and echocardiogram, her conditions such as migraines and POTS can exist even though certain physical examinations appear normal. See, e.g., Waldron v. Unum Life Ins. Co. of Am., 773 F. Supp. 3d 1169, 1188 (W.D. Wash. 2025) (“[T]he existence of certain conditions cannot be ascertained by a simple test․ And while objective tests—like an echocardiogram—can rule out other diseases, they fail to establish the presence or absence of a different chronic condition.”). Given the subjective nature of these conditions, the Court finds that Plaintiff's treating physicians' judgments are especially important in this case. “While Unum was not required to examine [Plaintiff], this lack of examination renders Unum's claim reviewers' criticism of h[er] symptoms and testing less persuasive.” Akans v. Unum Life Ins. Co. of Am., No. 3:23-CV-79, 2024 WL 1200301, at *10 (E.D. Tenn. Mar. 20, 2024), appeal dismissed, No. 24-5387, 2024 WL 3496351 (6th Cir. May 22, 2024) (citing Bruton, 798 F. App'x at 904).

Finally, Plaintiff argues Dr. Greenstein improperly rejected Dr. Keller's CPET report, which Unum then relied on as a primary basis for denying her benefits. (Doc. 21 at 25–26.) In response, Unum argues Dr. Greenstein properly considered and rejected the CPET because (1) the test was conducted more than five months after Unum determined Plaintiff was no longer entitled to benefits; and (2) the test discredited some of Plaintiff's limitations because she had the ability to sit and did not need aids, and because the test was “a better measure of the minimum level of activity [Plaintiff could] do, not the maximum.” (Doc. 22 at 24–25 (citing Doc. 16-2 at 787) (emphasis removed).)

In support of its first argument that the CPET results should be rejected as not time-relevant, Unum cites Ovist v. Unum Life Insurance Company of America, 14 F.4th 106 (1st Cir. 2021). In that case, Unum considered the results of a CPET that was conducted seven months after the termination of the plaintiff's benefits. Id. at 121. Unum's medical consultant reviewed the CPET results and concluded they were not time-relevant and did not reflect the plaintiff's maximal effort. Id. The Court of Appeals for the First Circuit ultimately upheld Unum's decision. Id. at 122.

The Ovist case, however, differs from the case at hand. In Ovist, the First Circuit was required to apply the arbitrary and capricious standard, meaning it was evaluating the reasonableness of Unum's decision. Id. at 117. In doing so, the First Circuit “did not simply approve of [the medical consultant's] rejection of the CPET as ‘not time-relevant.’ ” Mundrati v. Unum Life Ins. Co. of Am., 772 F. Supp. 3d 567, 589 (W.D. Pa. 2025) (analyzing the Ovist case). Instead, the First Circuit upheld Unum's decision due to the “the considerable absence in the record of objective evidence of [the plaintiff's] functional loss.” Ovist, 14 F.4th at 122.

Unlike in Ovist, the record here contains physical examinations and medical opinions between the start of the elimination period and the testing in which her physicians found that she continued to have functional limitations. (See, e.g., Doc. 16-2 at 591–92, 631–36.) Further, in a sworn declaration, Plaintiff stated the CPET was reflective of her condition five months earlier as there had been no significant changes in her conditions during the review period. (Id. at 928.) Dr. Cilenti also submitted a CPET statement confirming the CPET report was consistent with Plaintiff's functionality during the review period. (Id. at 926.) These representations are consistent with the issues documented throughout Plaintiff's medical records before and after Unum's claim denial.

Thus, there is:

no evidence that the condition documented in the [CPET] was meaningfully different from [Plaintiff's] condition at the time she applied for benefits. While it would be ideal to have [the CPET] performed right at the moment that an individual stopped work, one that is performed in a reasonably close period of time may still be relevant, at least in the absence of some reason to conclude that there was an intervening change in the beneficiary's health.

See Boersma, 546 F. Supp. at 712 n.5 (citing Holden v. Unum Life Ins. Co. of Am., No. 1:19-CV-28, 2020 WL 6136223, at *4, *6 n.3 (E.D. Tenn. Oct. 19, 2020)). Accordingly, the Court will not disregard the CPET results just because it was performed five months outside the initial period of review considered by Unum.

The Court will now address Unum's other arguments for discrediting the CPET. Although Dr. Greenstein emphasizes that the CPET showed Plaintiff could sit, (Doc. 22 at 24), this finding is not inconsistent with Plaintiff's opined restrictions and limitations. Next, Unum suggests the CPET is a better measure of Plaintiff's minimum capabilities because “it could ‘be stopped for any reason’ and was, in fact, stopped by Plaintiff.” (Id. at 25.) Dr. Greenstein suggests Plaintiff only performed her minimum capacity because she stopped the test when she “hit the threshold for [Respiratory Exchange Ratio (“RER”)].”⁵ (Doc. 16-2 at 787).

In reply, however, Plaintiff suggests this is untrue. (Doc. 23 at 5–6.) Plaintiff points to Dr. Keller's addendum which clarified that:

contrary to Dr. Greenstein's assertion, we did not stop the test once Ms. McMahon reached the RER criteria (which is 1.10). In fact, Ms. McMahon attained RER's of 1.15 (test 1) and 1.23 (test 2) at the end of each test, having reached 1.10 a full minute or more before her tests ended. In fact, we ended both tests when Ms. McMahon was no longer able to maintain the prescribed pedal cadence at the prescribed workload. That is, Ms. McMahon performed two valid maximum effort tests that quantified her maximum ability to produce energy to do work.

(Id. (quoting Doc. 16-2 at 854 (emphasis in original)).) Plaintiff also notes that Dr. Greenstein ignored other indicators that characterized Plaintiff's effort as “maximum exertion.” (Id. at 6 (quoting Doc. 16-2 at 546).) The Court finds it appropriate to give more weight to the professional who conducted the test and saw Plaintiff's effort for herself. Since Unum's arguments are unpersuasive, the Court will accept the CPET as objective evidence of Plaintiff's ability to work.

2. Plaintiff is Disabled Under the Terms of the LTD Plan

Having determined what weight to give the evidence in its de novo review, the Court now turns to assess whether Plaintiff has met her burden to show by a preponderance that she was disabled and unable to perform “the material and substantial duties” of her “regular occupation” under the LTD plan. (See Doc. 16-1 at 279.) Based on the objective medical evidence, objective evidence of her ability to work, the opinions of physicians, and subjective evidence, Plaintiff has shown that she remained disabled under the LTD plan.

The opinions of Plaintiff's physicians are consistent regarding Plaintiff's symptoms of fatigue, brain fog, difficulty concentrating, migraines, and tachycardia. Throughout 2022 and 2023, Plaintiff's providers repeatedly noted or opined that these symptoms affected her functional capacity, and the “doctors who knew [her] best concluded, unequivocally, that [s]he was unable to work at the relevant time.” Javery, 741 F.3d at 702.

For example, on September 27, 2022, Dr. Cilenti described Plaintiff's symptoms as “disabling” and recommended that Plaintiff continue to remain off work because she continued “to be unable to perform the essential functions of her job.” (Doc. 16-1 at 912–13.) On December 13, 2022, Dr. Srichai-Parsia confirmed Plaintiff continued to have spikes in her heart rate and significant fatigue and brain fog from her POTS that “severely affected her quality of life.” (Doc. 16-2 at 206.) In May 2023, Dr. Cilenti noted Plaintiff was unable to do work of any kind at that time because she he continued to have “impairment in reading, concentrating, persisting, and thinking,” and could only “stand for brief periods of a few minutes” before feeling dizzy and like she would faint. (Id. at 581–89.) On July 7, 2023, Dr. Cilenti reported that Plaintiff was still having headaches, heart-rate spikes, neuro-cognitive symptoms, fatigues, and autonomic manifestations from POTS that limited her ability to work. (Id. at 589–92.) In July and August 2023, respectively, Dr. Cilenti and Dr. Srichai-Parsia returned Unum's medical provider opinion form and provided for limitations for Plaintiff due to her POTS. (Id. at 631–36.) Despite Unum's assertion that Plaintiff's condition had improved some, the worsening of her condition is shown by her continued symptoms and increase of treatment and medication prescribed. (See, e.g., id. at 301, 583, 591–92.)

In addition to medical records, Plaintiff provided objective evidence of her ability to work through the CPET report and a vocational review. The CPET report confirmed that Plaintiff's “ability to carry out normal daily activities is limited and renders her unable to perform work on a sustained basis.” (Id. at 551.) It states, “[g]iven her low [ventilation anaerobic threshold] level of energy production which classifies her with severe impairment, even meaningful accommodations, such as frequent, long breaks with no exertional load (physical, cognitive, or emotional), the opportunity to sit/lie down, and/or not work consecutive days, would not be sufficient for [Plaintiff] to tolerate her job, full-or part-time.” (Id. (emphasis omitted).) Plaintiff also provided a vocational review conducted by Ms. Johnson who determined that based on the CPET report and the medical record as a whole, Plaintiff is unable to maintain competitive employment because she “cannot perform the material duties of sedentary work and because she cannot meet basic standards regarding attendance and concentration.” (Id. at 863.) These limitations were supported by the recommendations of her own doctors, who are the only ones that examined her in person. SeeJudge, 710 F.3d at 663; Barnes v. Unum Life Ins. Co. of Am., No. 1:19-CV-138, 2020 WL 10221073, at *11 (E.D. Tenn. Nov. 24, 2020).

Because Plaintiff has shown she remained unable to perform the tasks required of her as an Editorial Coordinator, as understood as “secretary” in the national market, the Court finds she met her burden of showing she was disabled under the terms of the LTD plan. See Javery, 741 F.3d at 699–700. Therefore, the Court will ENTER judgment in her favor as to the LTD benefits and ORDER that Plaintiff's LTD benefits be reinstated retroactive to May 15, 2023, through the date of the Judgment Order.

B. LWOP Benefits

In its decision denying LWOP benefits, Unum relied on its termination of LTD benefits and stated that since Plaintiff was not precluded from performing her own occupational demands, she did not meet the definition of disability for LWOP benefits. (Doc. 16-4 at 639.) Plaintiff argues she is entitled to LWOP benefits because the “[s]ubstantial evidence in the ERISA [r]ecord confirms [she] is disabled from any gainful occupation, including her own.” (Doc. 21 at 16 (emphasis removed).) In response, Unum states it “has made no determination whether Plaintiff can meet the more rigorous ‘any gainful occupation’ standard.” (Doc. 22 at 4.)

The life plan “provides that a participant's coverage will be continued, and life insurance premiums will be waived if the participant becomes disabled while covered under the life insurance policy. Such benefits are termed Life Waiver of Premium (“LWOP”) benefits under the Life Plan.” (Doc. 1 ¶ 16.) The life plan states in relevant part: “Unum does not require premium payment for an insured employee's life coverage if he or she is under age 60 and disabled for 9 months. (Doc. 16-5 at 14.) The plan defines “disabled” to mean “during the elimination period, you are not working in any occupation due to your injury and sickness” and “after the elimination period, due to the same injury or sickness, you are unable to perform the duties of any gainful occupation for which you are reasonably fitted by training, education, or experience.” (Id. at 23.) The plan defines “gainful occupation” to mean “an occupation that within 12 months of your return work is or can be expected to provide you with an income that is at least equal to 60% of your annual earnings in effect just prior to the date your disability began.” (Id. at 39.)

Although the Court has reversed Unum's termination of LTD benefits, the record simply does not contain enough facts speaking to whether Plaintiff was unable to perform the duties of any gainful occupation for which she was suited. See Smith v. Reliance Standard Ins. Co., No. 4:21-CV-128, 2024 WL 647395, at *10 (W.D. Ky. Feb. 15, 2024). Because Unum declined to address whether Plaintiff met the “any gainful occupation” standard in its decision and its briefing, the Court will REMAND the determination as to LWOP benefits to the plan administrator. See id. Such a remedy will allow for proper determination of whether Plaintiff is entitled to LWOP benefits. See Elliott v. Metro. Life Ins. Co., 473 F.3d 613, 622–23 (6th Cir. 2006) (“We are not medical specialists and that judgment is not ours to make.”).

IV. CONCLUSION

Upon a de novo review of the record, the Court will GRANT IN PART and DENY IN PART Plaintiff's motion for judgment on the pleadings and ERISA record (Doc. 20).

The Court finds Plaintiff has properly shown she was disabled under the LTD plan and that Unum incorrectly terminated her LTD benefits. Therefore, the Court will GRANT IN PART Plaintiff's motion for judgment on the pleadings (Doc. 20) and ENTER judgment in her favor as to the LTD benefits. It will be ORDERED that Plaintiff's LTD benefits be reinstated retroactive to May 15, 2023, through the date of the Judgment Order.

Because the Court is unable to properly determine whether Plaintiff is entitled to LWOP benefits based on the record, the Court will DENY IN PART Plaintiff's motion for judgment on the pleadings (Doc. 20) as to her claim for LWOP benefits. This Court will REMAND the case to the plan administrator to determine whether Plaintiff is entitled to LWOP benefits. The Clerk of Court will be DIRECTED to CLOSE the case, but the Court will retain jurisdiction pending the administrator's review.

AN APPROPRIATE ORDER WILL ENTER.

FOOTNOTES

1.   Long COVID is defined as a chronic condition that occurs after a COVID-19 infection and is present for at least three months. See, e.g., Long COVID Basics, U.S. Centers for Disease Control and Prevention (July 24, 2025), https://www.cdc.gov/long-covid/about/index.html.

2.   POTS is defined as a chronic disorder characterized by orthostatic intolerance which often causes spikes in heart rate during upright posture, leading to various symptoms such as lightheadedness, palpitations, fatigue, headaches, and difficulty concentrating. Postural Tachycardia Syndrome (POTS), National Institute of Neurological Disorders and Stroke, https://www.ninds.nih.gov/health-information/disorders/postural-tachycardia-syndrome-pots (last visited Oct. 23, 2025).

3.   As set forth in the Court's Scheduling Order, Unum is also “deemed to have moved for judgment in [its] favor based upon the administrative record.” (Doc. 12 ¶ 4.)

4.   Although Unum asserts Dr. Srichai-Parsia only opined restrictions and limitations for Plaintiff on appeal, she also opined restrictions and limitations for Plaintiff before appeal, on July 18, 2022. (Doc. 16-1 at 205.) In a Unum-provided form, Dr. Srichai-Parsia opined Plaintiff was unable to perform the occupation demands of her job on a full-time basis because she continued to experience “persistent concentration issues” related to her POTS. (Id.)

5.   RER is “a physiological indicator of effort during exercise” and a RER result of at least 1.10 indicates a maximum effort given during an exercise test. (Doc. 23 at 5 (quoting Doc. 16-2 at 546).)

CURTIS L. COLLIER UNITED STATES DISTRICT JUDGE