Hinchey v. First UNUM Life Insurance Company, 7:17-cv-08034

Background

Joseph J. Hinchey, Manhattanville College Director of Campus Security, underwent aortic valve replacement in Aug. 2010 and applied for long‑term disability (LTD) benefits under Manhattanville’s Plan issued by First Unum; the Plan grants Unum discretionary authority to determine benefits.
First Unum approved Hinchey’s LTD benefits in Feb. 2011 but later initiated a settlement/pre‑existing‑condition review beginning in 2015 that prompted updated medical collection and renewed evaluation.
New/updated records (notably an Oct. 2014 exercise stress test showing peak 12.5 METs and a Jan. 2016 Holter) plus treating‑physician notes were reviewed by multiple clinicians and vocational specialists retained by First Unum.
First Unum’s reviewers (clinical consultants, a cardiology Designated Medical Officer, and vocational experts) concluded the record showed improvement and that Hinchey could perform his regular occupation as performed in the national economy (classified as Security Director, light work).
First Unum terminated benefits on April 25, 2016; Hinchey appealed, administrative denial was affirmed, and Hinchey sued under ERISA § 502(a)(1)(B).
District court applied the arbitrary‑and‑capricious standard, concluded First Unum’s decision was supported by substantial evidence, and granted defendants’ summary judgment.

Issues

Issue	Plaintiff's Argument	Defendant's Argument	Held
Standard of review / DOL procedural compliance	Hinchey argued Unum violated 29 C.F.R. §2560.503‑1 (failed to consider/act on Dr. Tartaglia’s July 2016 letter), warranting de novo review	Unum said it had discretionary authority (Plan language) and did consider the letter in the administrative record; no showing of procedural rule violation by Hinchey	Court applied arbitrary‑and‑capricious review: Hinchey failed to show DOL‑rule violation or prejudice, so deferential review applies
Substantial‑evidence support for termination	Hinchey: administrative record overwhelmingly shows he remained totally/permanently disabled; Unum cherry‑picked favorable snippets	Unum: multiple medical reviews, objective tests (2014 stress test, 2016 Holter), treating‑notes and vocational analysis supported improvement and ability to perform light‑work duties	Held: reviewers’ conclusions were supported by substantial evidence; termination not arbitrary and capricious
Whether Unum was required to order an independent physical/IME	Hinchey: failure to order IME made denial unreliable, especially given subjective symptoms	Unum: IME is discretionary; reviewers had sufficient, objective updated records to render a reasoned decision	Held: no arbitrary‑and‑capricious error in declining IME where record contained objective data and multiple reviews
Occupational classification / employer‑specific duties	Hinchey: Unum misclassified his job and ignored Manhattanville‑specific, physically demanding duties (EMT, crowd control, patrolling)	Unum: Plan defines “regular occupation” as how job is performed in the national economy; vocational review using DOT/eDOT found Security Director (light work) was the proper comparison	Held: Unum’s vocational methodology followed the Plan’s definition; classification was reasonable and not arbitrary
Conflict of interest / Unum’s history of bias	Hinchey: Unum’s structural conflict (insurer‑payor) and criticized history with biased claim handling warrant reduced deference	Unum: multiple independent reviewers, treating‑physician contacts, and steps to mitigate bias; no case‑specific evidence showing taint	Held: conflict considered but carried minimal weight here; no evidence that structural conflict or history altered outcome

Key Cases Cited

Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101 (1989) (administrator’s discretionary authority triggers deferential review)
Metro. Life Ins. Co. v. Glenn, 554 U.S. 105 (2008) (insurer‑as‑payor conflict of interest is a factor in abuse‑of‑discretion review)
Halo v. Yale Health Plan, Dir. of Benefits & Records Yale Univ., 819 F.3d 42 (2d Cir. 2016) (failure to follow DOL claims‑procedure regs can convert review to de novo unless error is harmless)
McCauley v. First Unum Life Ins. Co., 551 F.3d 126 (2d Cir. 2008) (discusses Unum’s criticized claims practices and conflict implications)
Black & Decker Disability Plan v. Nord, 538 U.S. 822 (2003) (no automatic special weight to treating physician; administrators may credit other reliable evidence)
Durakovic v. Bldg. Serv. 32 BJ Pension Fund, 609 F.3d 133 (2d Cir. 2010) (definition of substantial evidence in ERISA benefit review)
Kinstler v. First Reliance Standard Life Ins. Co., 181 F.3d 243 (2d Cir. 1999) (definition of regular occupation when plan is silent)