You received short-term disability (STD) benefits, a clear acknowledgment from the insurance company that your medical condition prevents you from working. But when the time came to transition to long-term disability (LTD), you received a denial letter stating you were not disabled during the LTD elimination period. This frustrating and seemingly contradictory scenario is a common tactic used by insurers, but a recent federal court decision confirms it can be an abuse of discretion. Unfortunately, as a recent federal court decision against Unum Life Insurance Company of America highlights, securing these benefits can be a complex and frustrating process, especially when transitioning from short-term disability (STD) to long-term disability (LTD).
At The Garner Firm, our attorneys regularly represent individuals in claims governed by the Employee Retirement Income Security Act of 1974 (ERISA), the federal law that oversees most employer-sponsored disability plans. We have seen firsthand how insurance companies can create seemingly illogical roadblocks for deserving claimants. A key area of contention often involves the “elimination period,” a concept that can be confusing and is frequently used by insurers to deny otherwise valid LTD claims.
A recent case, Rogers v. Unum Life Insurance Company of America, __ F. Supp. 3d __, No. 22-cv-11399-AK (D. Mass. Sept. 11, 2025), provides a powerful example of this very issue and offers important lessons for anyone navigating the disability claims process.
Understanding the “Elimination Period” in Unum Long-Term Disability Claims
Before diving into the specifics of the Rogers case, it’s crucial to understand what an LTD elimination period is. The elimination period, also known as a waiting or qualifying period, is a specific length of time that you must be continuously disabled before your long-term disability benefits can begin.
Typically, the elimination period for an LTD plan is designed to align with the maximum benefit period of an accompanying short-term disability plan. For example, if your STD plan provides benefits for 26 weeks, your LTD plan might have a 180-day (approximately 26-week) elimination period. The intent is to create a seamless transition: your STD benefits cover the initial months of your disability, and once they are exhausted, your LTD benefits kick in, assuming you remain disabled.
To satisfy the elimination period, you must prove to the insurance company that you were disabled, as defined by the policy, for the entire duration of that waiting period. This is where many claimants run into trouble.
The Rogers v. Unum Decision: An Abuse of Discretion
Dr. Rogers, a Senior Scientist, was forced to stop working due to a combination of debilitating conditions. He applied for and was granted short-term disability benefits from Unum. In fact, Unum approved his STD benefits on three separate occasions, awarding him the maximum 26 weeks of benefits available under the policy. During this same period, the Social Security Administration and Unum’s own FMLA division also determined that Dr. Rogers was disabled.
However, when Dr. Rogers applied for long-term disability benefits, Unum denied his claim. The insurer’s rationale was that despite having paid STD benefits for the entire 26-week period, it did not believe the medical evidence was sufficient to prove he was disabled during that same timeframe—the LTD elimination period.
Dr. Rogers challenged this denial in federal court. Initially, the court found Unum’s review so arbitrary and flawed that it remanded the case, giving the insurer a second chance to correct its denial letter. Even after this second opportunity, Unum issued another denial that suffered from the same core deficiencies. On this final review, the court, applying a deferential “arbitrary and capricious” standard of review, found Unum’s decision to be unreasonable and unsupported by the evidence. The judge pointed to a glaring inconsistency: Unum had approved and paid Dr. Rogers’s STD benefits based on the opinions of his treating physicians, yet it chose to disregard those same medical opinions when evaluating his LTD claim.
The court found this to be a critical flaw. It was an abuse of discretion for Unum to approve Dr. Rogers for short-term disability benefits and then contend that he had not satisfied the LTD elimination period that ran concurrently with the STD benefit period. Unum could not provide a persuasive explanation for how Dr. Rogers could be deemed unable to work for STD purposes but simultaneously capable of working for LTD purposes during the exact same period.
Key Takeaways from the Ruling for ERISA Claimants
The Rogers decision underscores several critical points that are vital for individuals pursuing ERISA long-term disability claims:
- Consistency is Key: An insurer cannot arbitrarily treat the same period of time differently. If you have been approved for STD benefits, this serves as strong evidence that you have satisfied the elimination period for your LTD benefits, provided the definition of disability is similar under both plans.
- The Importance of Treating Physician Opinions: ERISA plans, particularly those administered by large insurers like Unum that are subject to the Unum Regulatory Settlement Agreement, are often required to give significant weight to the opinions of a claimant’s treating physicians. In Rogers, the court criticized Unum for summarily dismissing the consistent, cross-specialty opinions of four of Dr. Rogers’s treating doctors without a detailed, evidence-based reason for doing so.
- Subjective Symptoms Matter: Many disabling conditions, such as chronic pain, fatigue, and cognitive dysfunction, do not always show up on “objective” tests like MRIs or X-rays. The court noted that an insurer’s reliance on the absence of objective findings, while ignoring clinically significant subjective symptoms, can be a basis for overturning a denial. Your real-world functional limitations are what matter, and these must be properly documented.
- Don’t Give Up After a Denial: The initial denial of an LTD claim is not the end of the road. ERISA provides a process for appealing the insurer’s decision and, if necessary, filing a lawsuit in federal court. As the Rogers case demonstrates, courts will hold insurance companies accountable for unreasonable and poorly reasoned denials.
How The Garner Firm Can Help
Navigating the complexities of an ERISA disability claim can be overwhelming, especially when you are focused on your health. The legal and procedural hurdles are significant, and insurance companies have teams of lawyers and claims analysts dedicated to protecting their financial interests.
The attorneys at The Garner Firm have extensive experience handling ERISA disability claims at all stages of the process, from the initial application and administrative appeal to federal court litigation. We understand the tactics that insurers use to deny valid claims, and we know how to build a strong record to counter them.
If, like Dr. Rogers, you have been approved for short-term disability benefits only to be denied long-term disability benefits, you may have been subjected to an arbitrary and capricious decision. If your insurer is dismissing the opinions of your trusted medical providers or is unfairly demanding “objective evidence” for your disabling symptoms, we may be able to help.
We are committed to ensuring our clients receive the benefits they are entitled to. We will thoroughly review your policy and your medical records, work with your doctors to obtain the evidence needed to support your claim, and advocate tirelessly on your behalf.
If you are struggling to secure your long-term disability benefits, contact The Garner Firm today for a confidential consultation. Let our experience guide you through this challenging process and fight for the financial security you deserve.