949 F.3d 297
7th Cir.2020Background
- Stephanie Dorris, former president of Beans Plus, received long‑term disability (LTD) benefits from Unum beginning in 2002 for endometriosis and later Lyme disease; SSA granted disability benefits in 2007.
- Unum periodically reviewed her claim and in 2015 terminated benefits after file reviews and consulting physicians concluded she could perform her regular‑occupation duties (company president).
- Dorris administratively appealed, submitted additional materials and treating‑physician opinions, and disputed Unum’s focus on physical duties; Unum denied the appeal and sought an IME before the regulatory deadline.
- In district court (de novo review because plan conferred no discretion), the court found Dorris could not perform her regular occupation but the administrative record lacked vocational evidence on the plan’s alternative disability prongs ("any occupation" and "20% less").
- The magistrate granted a protective order limiting depositions of Unum consultants; Dorris did not pursue further discovery or object to that order; the district court entered judgment for Unum and denied a Rule 59 motion to reopen discovery.
- The Seventh Circuit affirmed, holding Dorris (as plaintiff under de novo review) bore the burden to prove entitlement and failed to fill gaps in the record about other gainful occupations or the 20%‑less standard.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether vocational evidence was required to meet the plan's "any occupation" prong under de novo review | Dorris: treating physician and SSA decision showing inability to work suffice without vocational proof | Unum: claimant bears burden to show inability to perform any gainful occupation; vocational evidence needed | Court: vocational evidence necessary here; Dorris failed to meet burden, judgment for Unum affirmed |
| Whether SSA decision and treating‑physician opinion alone could satisfy claimant's burden | Dorris: SSA award and Dr. Harris’s opinion establish disability for any sedentary work | Unum: SSA and treating‑physician findings insufficient without occupation‑specific proof | Court: SSA/treating opinions could have carried burden but on this record court plausibly discounted SSA and found Dr. Harris’s opinion insufficient to prove inability to perform all gainful work |
| Whether Dorris preserved or adequately argued entitlement under the plan’s "20% less" prong | Dorris: her limited volunteer work and unemployment show >20% income loss and performance of at least one material duty | Unum: Dorris offered only conclusory statements and no supporting evidence | Held: Argument waived/underdeveloped before district court; appellate review denied on that ground |
| Whether district court abused discretion by limiting review to administrative record and denying reopening of discovery/Rule 59 relief | Dorris: court should have allowed supplementation or reopened discovery to cure record gaps | Unum: magistrate’s protective order proper; Dorris did not seek other discovery or object timely | Held: No abuse of discretion—protective order did not preclude relevant discovery, Dorris failed to pursue further discovery, and Rule 59 motion properly denied |
Key Cases Cited
- Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101 (1989) (establishes ERISA de novo/independent decision standard when plan gives no discretion)
- Krolnik v. Prudential Ins. Co. of Am., 570 F.3d 841 (7th Cir. 2009) (explains "de novo review" is an independent decision and extra‑record evidence may be admitted)
- Diaz v. Prudential Ins. Co. of Am., 499 F.3d 640 (7th Cir. 2007) (same principle on independent decisionmaking in de novo ERISA cases)
- Marantz v. Permanente Med. Grp., Inc. Long Term Disability Plan, 687 F.3d 320 (7th Cir. 2012) (district court may admit extra‑record evidence and permit discovery in de novo review)
- Pakovich v. Broadspire Servs., Inc., 535 F.3d 601 (7th Cir. 2008) (contrast under arbitrary‑and‑capricious review: remand to administrator where record is undeveloped)
- Tate v. Long Term Disability Plan for Salaried Emps. of Champion Int'l Corp., 545 F.3d 555 (7th Cir. 2008) (medical evidence can sometimes suffice without vocational proof)
- Cheney v. Standard Ins. Co., 831 F.3d 445 (7th Cir. 2016) (claimant bears burden of proof under de novo ERISA review)
- Black v. Long Term Disability Ins., 582 F.3d 738 (7th Cir. 2009) (SSA decision is a factor but not dispositive in ERISA determinations)
- Anderson v. City of Bessemer City, 470 U.S. 564 (1985) (standard for clear‑error review)