Weitzenkamp v. Unum Life Ins. Co. of America, 661 F.3d 323

Background

Weitzenkamp, insured under Unum's long-term disability plan governed by ERISA, was diagnosed with fibromyalgia, chronic pain, anxiety, and depression and received disability benefits for 24 months.
Unum terminated benefits after 24 months, applying the plan's self-reported symptoms limitation, and asserted an overpayment recovery for retroactive Social Security benefits.
She was awarded Social Security Disability benefits retroactive to December 13, 2005, which reduced the plan payments and created an overpayment balance of $9,089.
Unum initially approved benefits with a reservation of rights but later invoked the self-reported symptoms and mental illness limitations to stop benefits on August 22, 2008.
Treating and evaluating physicians (including Dr. Partain) and Unum's medical reviewers disputed whether fibromyalgia was primarily evidenced by self-reported symptoms or by objective findings, leading to the termination.
The district court held Unum erred in some respects but upheld the self-reported symptoms limitation; the Seventh Circuit reversed parts of that ruling and remanded for reinstatement of benefits.

Issues

Issue	Plaintiff's Argument	Defendant's Argument	Held
Does self-reported symptoms limitation apply to fibromyalgia claims?	Weitzenkamp argues fibromyalgia is objectively verifiable and not primarily based on self-reported symptoms.	Unum contends the limitation applies to disabilities primarily based on self-reported symptoms, including pain.	Self-reported symptoms limitation does not apply; fibromyalgia can be objectively evidenced.
Is the fibromyalgia diagnosis primarily based on self-reported symptoms or objective evidence?	Diagnosis is supported by trigger point testing and objective findings, not solely self-reported pain.	Pain and subjective symptoms are central to fibromyalgia and can support limitation.	Fibromyalgia diagnosis can be based on objective evidence, so the limitation does not apply.
Whether Unum may recover overpayments from retroactive Social Security benefits under § 207(a) of the Social Security Act	§ 207(a) precludes attachment or garnishment of Social Security benefits, potentially barring recovery.	Equitable lien on funds not sourced from Social Security is allowed; recovery does not attach to Social Security payments.	Recovery is permissible; § 207(a) does not bar the equitable lien on overpayments.
Whether Unum's cross-appeal was procedurally proper	The cross-appeal should be considered as an improper attempt to reargue grounds for affirmance.	The cross-appeal preserved alternate grounds for affirmance of the district court's decision.	The cross-appeal was procedurally improper and forfeited the disability-issues argument.
Appropriate remedy for ERISA denial of benefits	Remand or reinstatement should consider the record and ensure full remedy for defective procedures.	Remand or reinstatement should align with the court's interpretation of the plan and evidence.	Reinstatement of benefits retroactive to August 22, 2008 is appropriate; remand guidance limited.

Key Cases Cited

Hawkins v. First Union Corp. Long-Term Disability Plan, 326 F.3d 914 (7th Cir. 2003) (objective feasibility of trigger test in fibromyalgia)
Chronister v. Baptist Health, 442 F.3d 648 (8th Cir. 2006) (trigger test can qualify as clinical examination)
Marrs v. Motorola, Inc., 577 F.3d 783 (7th Cir. 2009) (deferential arbitrary-and-capricious review; conflict factors)
Ross v. Indiana State Teacher's Ass'n Ins. Trust, 159 F.3d 1001 (7th Cir. 1998) (standard of review and plan interpretation principles)
Sereboff v. Mid Atl. Med. Servs., 547 U.S. 356 (U.S. Supreme Court 2006) (recovery pursuant to plan provisions; equitable interests)
Gutta v. Standard Select Trust Ins. Plans, 530 F.3d 614 (7th Cir. 2008) (overpayment recovery under reimbursement provisions)
Hall v. Liberty Life Assurance Co. of Boston, 595 F.3d 270 (6th Cir. 2010) (equitable lien versus Social Security program protections)
Cusson v. Liberty Life Assurance Co. of Boston, 592 F.3d 215 (1st Cir. 2010) (interpretation of self-reported symptoms in disability claims)
Schneider v. Sentry Grp. Long Term Disability Plan, 422 F.3d 621 (7th Cir. 2005) (remedial considerations in ERISA remedies)
Holmstrom v. Met. Life Ins. Co., 615 F.3d 758 (7th Cir. 2010) (factors guiding awards of benefits on evidence merits)
Tarkowski v. United States, 248 F.3d 596 (7th Cir. 2001) (cross-appeals and procedural posture in appeals)
Wellpoint, Inc. v. C.I.R., 599 F.3d 641 (7th Cir. 2010) (alternate grounds for affirmance and record arguments)