Facts

Amy Olis was covered under a long-term disability plan through her employment with Enterprise Holdings, Inc. Unum Life Insurance Company of America issued the group policy that funded the LTD benefits payable under that plan. After Plaintiff submitted a claim for LTD benefits, Unum Life determined that she was not disabled under the terms of the policy and denied her claim.

PLAINTIFF'S CONTENTIONS: Plaintiff claimed to be disabled from performing her occupational duties as an account specialist due to vision problems and related headaches. Plaintiff contended that Unum Life's claim determination was incorrect and further contended she was entitled to benefits because she was disabled from performing her "own occupation" under the policy.

DEFENDANT'S CONTENTIONS: Defendant contended that its claim determination was correct because the medical evidence did not demonstrate any clinical support for plaintiff's claimed work impairment and plaintiff was able to work despite her reported symptoms for many months before submitting her claim.

Result

The court reversed Unum Life's claim determination and awarded "own occupation" LTD benefits to plaintiff in the amount of $40,562. The court also remanded plaintiff's claim to Unum Life to determine whether plaintiff was entitled to benefits under the policy's "any gainful occupation" provision.