Latest / FLG Disability Insights / When Speaking Limits Define an ERISA Disability Dispute
Transcript
- If a person can sit at a desk, does that answer whether they can sustain a job that requires hours of speaking? Welcome to FLG Disability Insights. I’m Nick Feden of Feden Law Group. Krambeck versus Unum shows why a job label like “sedentary” may leave the most important functional question unanswered. Unum initially approved long-term disability benefits for a Costco employee whose symptoms included shortness of breath and difficulty speaking after claimed COVID infections. After nine months under an own-job definition, the policy shifted to an any-gainful-occupation definition. The medical evidence described sharply different capacities. The treating physician first limited speaking to thirty minutes per day, then reduced that estimate to only a few minutes. Unum’s reviewers concluded that the claimant could perform sedentary work with occasional speaking, meaning up to roughly two and a half hours in an eight-hour day. Those are not small differences. They describe very different abilities to sustain work. A telephone conversation between the treating physician and an insurer reviewer, the reviewer’s summary, and the physician’s later responses also raised credibility questions. The court did not resolve those factual disputes at summary judgment. The policy’s history mattered too. It selected Washington law, and a twenty twenty amendment replaced the entire policy. The court concluded that Washington’s prohibition on discretionary clauses applied, rejecting Unum’s argument based on the original policy’s twenty oh one effective date. That meant the court would review entitlement to benefits de novo. Applying controlling Eleventh Circuit decisions, the Florida federal court denied both sides’ requests for summary judgment. It did not award benefits, and it did not send the claim back to Unum. The benefits dispute remained unresolved. A bench trial was planned unless the parties jointly agreed to another procedure. The practical takeaway is to measure the function the job actually demands. A useful medical record can address how long a person can speak, what symptoms follow, how much recovery is needed, and whether that pattern can be repeated through a workday and workweek. The proposed occupation deserves the same precision. How much speaking does it require, in what intervals, and with what opportunity to recover? Krambeck is about a particular policy, amendment history, governing-law provision, and disputed record. Claimants should not assume that every policy amendment triggers the same state law, that every court applies de novo review, or that difficulty speaking automatically establishes disability. The ruling opened the way for the court to resolve the dispute later; it did not decide who was entitled to benefits. Visit FedenLawGroup dot com and try FLG Case Analyst Beta. Get a full report generated by an attorney-trained, cutting-edge AI model, then connect with our firm about your next step. This podcast provides general information only and is not legal advice. I’m Nick Feden. Thanks for listening to FLG Disability Insights.